Volume 8 Issue 7, July 2012

Depressive symptoms frequently accompany Parkinson disease. Screening instruments to detect depression in this patient group exist, but the relative performance of these tools had not been assessed. A recent study has compared the clinimetric properties of nine frequently used depression rating scales in an attempt to identify the best instrument.

Two recent studies have carefully characterized amyloid-related brain insulin resistance in animal models of, and patients with, Alzheimer disease (AD). The researchers show that exendin-4, a glucagon-like peptide 1 receptor agonist, ameliorates pathology and symptoms in a mouse model of AD, suggesting a novel therapeutic approach to this disease.

A new concept in stroke emergency care is to bring specialized units and neuroimaging facilities to the patient in order to reduce time to treatment. But does this strategy have an effect on stroke outcome, and is the cost of these units worth the time saved?

The past two decades have witnessed the emergence of minimally invasive techniques in most surgical specialties, but their role in spinal surgery remains controversial. A recent study has compared outcomes in minimally invasive versus open spinal fusion surgery. Does the size of the surgical approach really matter?

A recent study to investigate the safety and efficacy of serotonin reuptake inhibitors suggests that these drugs are beneficial for the treatment of depressive disorders in Parkinson disease. Whether these treatments will offer such benefits in the long term compared with other pharmacological and nonpharmacological approaches remains to be determined.

Carotid endarterectomy reduces the risk of stroke in patients with symptomatic carotid artery stenosis, but the optimum time to perform surgery has been uncertain. A large study has shown that surgery within 2 days of stroke or transient ischaemic attack has an unacceptable complication rate, but is safe thereafter.

As many causes can underlie small-fibre neuropathy (SFN)—a condition characterized by neuropathic pain symptoms and autonomic complaints—making a clinical diagnosis of this disorder is difficult. Hoeijmakers et al. review recent advances in the understanding of the pathophysiology of SFN, highlighting new diagnostic methods for this disorder and discussing how these advances will contribute to better patient management.

Autoantibodies that target neuronal proteins are becoming increasingly recognised. Lancaster and Delmau provide an overview of antibodies with intracellular neuronal targets, together with more-recently characterized antibodies against cell-surface and synaptic antigens, such as neurotransmitter receptors. The authors describe the pathogenic mechanisms of these antibodies and the associated disorders, and provide guidelines for rigorous antibody testing in patients with suspected neuronal autoantibodies.

Deep brain stimulation (DBS) is currently used as an effective treatment to reduce symptoms in chronic pain and movement disorders. An inadvertent and positive side effect of this therapy is the autonomic response to DBS in terms of changes to respiratory indices, lung function, and urinary and bladder function. This Review discusses the circuitry of the autonomic nervous system and its higher control centres, and the potential for DBS as a therapy for patients with dysautonomias.

The immune response is increasingly recognised as a complex modulator of outcome after acute stroke. Chamorro and colleagues review key players of the innate and adaptive immune systems that are activated following brain ischaemia, and discuss stroke-induced immunodepression and the associated increased risk of infection in patients with stroke.