Articles in 2012

Three recent phase III trials have shown that adjunctive treatment with perampanel—a first-in-class, noncompetitive AMPA antagonist—decreases seizure frequency in patients with refractory focal epilepsy. Although the introduction of perampanel offers more treatment choice for epilepsy, whether it brings urgently needed clinical benefit over existing drugs remains to be addressed.

Nearly 40% of ischaemic strokes remain cryptogenic when no clear aetiology is identified after a thorough initial investigation. Two recent articles in Stroke described extended arrhythmia monitoring modalities to reveal paroxysmal atrial fibrillation in patients with ischaemic stroke, with implications for decisions regarding anticoagulation.

Owing to recent advances in brain–machine interfaces and electrical stimulation of the spinal cord, restoration motor function in patients with spinal cord injury (SCI) has become a reality. Jackson and Zimmerman review the mechanisms underlying closed-loop interfaces—in which electrical stimulation is driven by neural output—as prostheses, and propose that such devices enhance neural plasticity, thereby providing long-term therapeutic benefits to patients with SCI.

New EFNS–ENS guidelines provide a broad and comprehensive overview of the literature and key recommendations regarding treatment and diagnosis across a vast range of conditions associated with dementia, with the exception of Alzheimer disease, which was deliberately excluded. Although excellent, the breadth and brevity of the guidelines lead to some important omissions.

In a recent trial investigating the effectiveness of speech and language therapy versus a control intervention in poststroke aphasia, patient outcome improved equally in both groups. However, flaws in the study relating to design of the control intervention, inadequate therapy 'dose', and the interpretation of null results should be highlighted.

The neurovascular unit is a key concept in stroke medicine that for many years has been defined as the endothelial cells, neurons and glia surrounding cerebral capillaries. In this Perspectives article, the authors expand this concept to encompass more-distant circulation, smooth muscle cells and perivascular innervation. This 'neural vascular network' in turn points to new strategies for stroke therapy.

Strong evidence supports the importance of genetic factors in the development of multiple sclerosis (MS), but environmental factors also have a major role. Ascherio et al. review the evidence for such factors, with a focus on three main aspects: infection with Epstein–Barr virus, vitamin D nutrition, and cigarette smoking. They discuss how these processes might influence the initiation of MS, the potential for therapeutic approaches that target these risk factors, and how lifestyle modification could aid in MS prevention.