Volume 7 Issue 4, April 2011

Vigabatrin is an efficacious new-generation antiepileptic drug, but visual field loss (VFL) has strongly limited its use. A systematic review has established that vigabatrin increases the risk of VFL fourfold, with age and exposure as predicting factors. For infantile spasms, the benefits of vigabatrin seem to outweigh the VFL risk.

Patients with transient ischemic attack (TIA) at high short-term risk of stroke can be identified. Evidence-based treatments can decrease this risk; however, organization of care of TIA patients is suboptimal. The National Stroke Association provides recommendations for improving TIA-related care delivery, but symptom recognition and treatment response remain a challenge.

One of the main challenges associated with late-onset genetic neurodegenerative diseases is predicting when the condition begins and how it progresses over time. In a new study, Tabrizi et al. have used a range of imaging, clinical and neuropsychiatric measures to assess the progression of Huntington disease.

Statin use in patients with cerebral hemorrhage may not be without risk. A recent article analyzing existing statin data in a mathematical model suggests that statins might need to be avoided after intracerebral hemorrhage, particularly in patients with a lobar hemorrhage.

Quality of care for patients with epilepsy can be variable. The American Academy of Neurology has recently published measures to guide physicians during treatment of epilepsy patients. Are these considerations enough to provide optimal care?

Quality improvement in medicine has largely focused on conditions managed in primary care rather than specialist care. The American Academy of Neurology has introduced process-focused quality metrics for neurologists managing patients with Parkinson disease with the goal of informing evaluation of clinical performance. These metrics might eventually inform pay-for-performance decisions.

Stroke is an important cause of long-term disability in children. In this Review, Jordan and Hillis examine the etiology of and risk factors associated with pediatric stroke, before exploring the notable diagnostic challenges associated with this condition. The authors also examine the management of stroke in children, highlighting the need for further clinical trials of potential stroke therapies in this patient group.

Psychogenic nonepileptic seizures (PNES) and epileptic seizures share many similar features, as a result PNES are often misdiagnosed and mistreated as epilepsy. In this article, Devinsky et al. provide an overview of the latest findings relating to risk factors and pathogenesis of PNES, and highlight the clinical features that can help clinicians differentiate between this condition and epileptic seizures.

Many patients with multiple sclerosis relapse or experience continued disease progression despite disease-modifying therapies, such as interferon β. This Review explores responses to interferon β treatment in patients with multiple sclerosis, discusses early identification of nonresponders, and describes a practical approach for incorporating clinical data, biological markers and MRI measures of disease activity into the management of these patients.

Age-associated white matter lesions are commonly observed in patients with idiopathic Parkinson disease, and are expected to contribute to the clinical symptoms in this condition. Bohnen and Albin review the literature addressing the occurrence and effects of white matter lesions in Parkinson disease, as well as describing existing and emerging methods for studying white matter pathology.

Labate et al. argue that benign mesial temporal lobe epilepsy (bMTLE)—defined as at least 24 months of seizure freedom with or without antiepileptic medication—has been under-recognized because of a bias in the literature towards refractory forms of epilepsy. Here, the authors discuss emerging concepts on bMTLE, some of which were formulated during an international workshop held in Italy.