Volume 8 Issue 1, January 2012

Neurological markers are used to predict outcomes in patients resuscitated after cardiac arrest, and are crucial in informing treatment decisions in comatose patients. A multicenter study reports that therapeutic hypothermia in cardiac arrest alters the reliability of several recommended prognostic parameters, and the authors highlight challenges to optimization of prognostic paradigms.

Now that antipsychotic medication is all but proscribed for the treatment of distress and disturbed behavior in people with dementia in care homes, the drive to identify effective alternative approaches is pressing. A study from Norway suggests that paracetamol may be effective in many cases, but some caution is required.

In the past two decades, there has been concern that levodopa—the gold-standard therapy for Parkinson disease (PD)—may be toxic to dopaminergic neurons. However, findings from a recent study suggest that chronic use of levodopa does not enhance progression of PD pathology. Can we make sense of this controversy?

Spinal angiography has historically been associated with a high risk of complications, but up-to-date safety reports are lacking. A recent retrospective review found a low complication rate of catheter angiography of the spine, and suggests that MRI performs poorly as an alternative approach to the diagnosis of spinal vascular disorders.

A new cross-sectional study proposes three subtypes of Alzheimer disease: hippocampal-sparing, typical and limbic-predominant, associated with average lifespans of 72, 79 and 86 years, respectively. A longitudinal view suggests that age might be a major neuropathological determinant, with typical cases having younger onset and limbic-predominant cases having older onset.

Lesion activity detected on MRI scans has become an accepted surrogate for disease activity in relapsing–remitting multiple sclerosis (MS). Barkhof and colleagues provide key recommendations for efficient use of MRI in clinical trials for relapse-onset MS, including practical issues related to acquisition, analysis and reporting of MRI data, approaches to optimization of trial design, and safety considerations.

Cases of postural tachycardia syndrome (PoTS) have been described dating back to the 19^thcentury; however, the condition remains poorly understood, and the diagnosis is not readily made. Mathias and colleagues provide a comprehensive Review detailing the characteristics and possible pathophysiological mechanisms of PoTS, as well as investigation and treatment.

Depression is a common symptom in patients with Parkinson disease (PD), and is found at higher rates in these individuals than in healthy populations or patients with other neurodegenerative disorders. Aarsland et al. discuss both the course of depression and the mechanisms that may contribute to the enhanced susceptibility to depression in patients with PD. Management strategies to control depression in these individuals are also highlighted.

Multifocal motor neuropathy (MMN) is a rare inflammatory disorder that features slowly progressive, asymmetric distal limb weakness. Leonard van den Berg and colleagues describe the diagnostic criteria for MMN, which are important for distinguishing this disease from mimic disorders such as amyotrophic lateral sclerosis. The authors also discuss the pathophysiology of MMN, emphasizing the role of GM1-specific autoantibodies, and outline current treatment options and possible new therapeutic strategies.