It is my pleasure to introduce the Winter edition of US Neurology, which brings you a diverse selection of papers covering cutting-edge clinical and research advances, authored by some of the world’s leading figures in their fields.
The impact of walking impairments is a serious concern for those individuals with multiple sclerosis (MS). The assessment of these disturbances has required complex and difficult to use technologies. In Francois Bethoux’s timely editorial, Bethoux asks, “Should we routinely monitor walking in patients with MS?” With the advances in newer and simpler to use technology, previously time-consuming methods may become assigned more to research protocols while the easier techniques become more widely used.
Physicians treating patients with epilepsy face a plethora of factors to address when selecting the appropriate treatment for an individual. In the review by Selim Benbadis et al., a critical comparison of antiepileptic drugs is provided, followed by four real-life case reports. These treatments must presume an accurate diagnosis and take into account the many comorbidities that exist in this constellation of disorders. New developments in magnetic resonance imaging (MRI) for individuals with epilepsy are the subject of Heath Pardoe and Ruben Kuzniecky’s excellent review of this rapidly changing field. In Parkinson’s disease (PD), MRI and nuclear imaging of the brain can assist in making timely diagnosis and treatment decisions. However, as Meir Kestenbaum and Cheryl Waters highlight, these tests should not be used routinely, but rather only in patients where the diagnosis of PD is unclear.
Lambert-Eaton myasthenic syndrome (LEMS), which involves impaired neuromuscular transmission and subsequent serious muscle weakness, is a rare neuromuscular disorder. Shin J Oh and Jörn Peter Sieb provide an expert update on the drug amifampridine. Based on the clinical trial data, amifampridine phosphate was recently assigned Breakthrough Therapy designation by the FDA, which may enable fast-track new drug application (NDA) approval.
Around one-third of patients with migraine experience episodes with aura. The phenomenology of migraine with aura is succinctly summarized by Michele Viana and Peter Goadsby. There is an update by Richard Wurtman, the discoverer of melatonin and a close friend, on the use of low dose melatonin to promote sleep onset and sleep maintenance in older people, which updates his previous review. The management of unruptured brain arteriovenous malformations is discussed by Andrew Ducruet and Robert Friedlander. They consider the clinically confusing information regarding studies of treatment options (surgical versus conservative), the need for more class 1 level information and the possibility of a prospective registry. The first comprehensive guidelines published for neurostimulation therapy are described in a special report by Jason E Pope et al. which will have a profound effect on the approaches that we take to patients with chronic moderate to severe pain.
US Neurology would like to take this opportunity to thank all participants on this edition, from organizations to individuals. A special thanks goes to our editorial board for their continuing support and invaluable guidance, while the biggest thanks is reserved for the expert authors who spared precious time and effort to produce a perceptive selection of articles. This expert discussion and the wide variety of topics covered ensure there is much of interest for every reader and we hope you find this edition as useful and insightful as those before it.