Volume 8 Issue 3, March 2012

Predicting response to therapy in individual patients with epilepsy is not straightforward. An exploration of long-term surgical outcomes in an epilepsy cohort has identified seven patterns of remission and relapse, and the probability of each outcome has been calculated. The study provides new predictors of postoperative outcomes in epilepsy.

Intensive glucose management, if begun early, diminishes the long-term complications of diabetes. Whether the cognitive domain also benefits from such therapy is not clear, and has remained subject to investigation. Do the new results from the ACCORD-MIND study settle the issue?

Subarachnoid hemorrhage is a rare but potentially fatal cause of headache. According to results from a recent study, CT scans enable clinicians to identify patients with subarachnoid hemorrhage, with a high sensitivity. Does CT imaging rule out the need for lumbar puncture in patients who present with headache?

The geometry of carotid arteries, both normal and narrowed, produces flow characteristics that predict the location of atherosclerosis and the site of plaque rupture. A recent study has shown that the upstream carotid plaque undergoes profound biochemical and apoptotic changes that are closely linked to the development of stroke symptoms.

Genetically determined epilepsy with encephalopathy can develop early in life, often with prenatal onset, which makes diagnosis difficult. New molecular screening studies have identified causative mutations in patients with early-onset epilepsy with encephalopathy. What can we learn from the results of genetic screening in patients with this disorder?

Predicting the molecular pathology that underlies neurodegeneration in patients with frontotemporal lobar degeneration (FTLD) is crucial to determine how to treat each individual. Whitwell and Josephs show how patterns of atrophy assessed on MRI can be used to identify signatures of pathology for each specific diagnosis within this broad spectrum of diseases. The authors discuss how these patterns of atrophy could be used as biomarkers of FTLD.

Vaccination represents a mainstay in preventing infection but, in patients with multiple sclerosis (MS), this therapeutic approach can carry the risk of triggering a relapse. Hartung and colleagues review the safety of vaccines against various infections in patients with MS, and discuss the issue of vaccine efficacy in the context of disease-modifying MS drugs.

Self-projection allows an individual to remember the past, simulate the future and imagine the viewpoints of others, and seems to be mediated by key frontal and temporal lobe regions of the so-called default network of the brain. Irish and colleagues discuss pathological changes to the default network and self-projective functions in patients with frontotemporal dementia (FTD), focusing on behavioral variant FTD and semantic dementia.

Chronic migraine is a severely disabling condition that is poorly recognized and undertreated by clinicians. Much debate has existed over the nomenclature and diagnostic criteria for this condition and, until 2007, there had been a paucity of clinical trial data for preventive therapies. In this Review, Diener and colleagues discuss the evolution of terminology and definitions used for chronic migraine, as well as the epidemiology, pathophysiology and treatment of this condition.

The first-in-human phase I trial of stem cell transplantation for amyotrophic lateral sclerosis was approved by the FDA in 2009 and is ongoing. In their Perspectives article, Eva Feldman and colleagues, who are conducting the trial, discuss the preclinical research supporting this therapeutic approach, key aspects of the trial design to overcome translational issues, and ongoing challenges to address in future studies.