[Correspondence] On progress in Africa, by African experts
The Lancet Neurology's Feature “Training non-physicians as neurosurgeons in sub-Saharan Africa”1 argued that, even though most people in high income countries “would be flabbergasted by the idea”, we should consider it since sub-Saharan nations will not soon “produce (neurosurgeons) in large numbers”. We would like to balance this proposition with our own views as African neurosurgeons. (Source: Lancet Neurology)
Source: Lancet Neurology - January 18, 2018 Category: Neurology Authors: Anthony Figaji, Allan Taylor, Muhammad Raji Mahmud, Shehu Bello, Emmanuel Wegoye, Peter Ssenyonga, Edwin Mogere, Ncedile Mankahla, Graham Fieggen, Mahmood Qureshi Tags: Correspondence Source Type: research

[Comment] The SeLECT score is inappropriate to predict post-stroke epilepsy
Causes of post-stroke epilepsy are manifold and not just restricted to the stroke itself (primary post-stroke epilepsy). These causes range from premorbid conditions already present before the stroke, to morbidity that develops after the stroke, either as a complication of, or independent of, the stroke. Seizures associated with a pre-existing disposition (eg, meningitis, head trauma, or encephalopathy caused by, for example, diabetes or hypertension) can be triggered by stroke or by co-pathologies developing after a stroke (secondary post-stroke epilepsy). (Source: Lancet Neurology)
Source: Lancet Neurology - January 18, 2018 Category: Neurology Authors: Josef Finsterer Tags: Comment Source Type: research

[Comment] Long-term forgetting in preclinical Alzheimer's disease
Alzheimer's disease is characterised by progressive pathophysiological changes that correspond roughly to preclinical (ie, cognitively unimpaired), mild cognitive impairment, and dementia stages.1 Biomarkers continue to be developed, tested, and used to detect and track the pathophysiological manifestations of this disease. Although neuropsychological tests, clinical ratings, and composite cognitive test scores have shown initial promise,2 –5 the field would benefit from additional ways to detect and track cognitive, behavioural, and functional manifestations of Alzheimer's disease with optimal power, ease, and availabil...
Source: Lancet Neurology - January 18, 2018 Category: Neurology Authors: Eric M Reiman Tags: Comment Source Type: research

[Editorial] Air pollution and brain health: an emerging issue
Environmental risk factors, particularly air pollution, have been associated with increased risk of neurological disorders. In 2017, The Lancet Commission on pollution and health reported that all types of pollution (ie, air, water, soil, chemical, and occupational pollutants) is the world's largest environmental cause for poor health, responsible for about 9 million deaths in 2015 —16% of all deaths globally. Exploring, understanding, and preventing the effects of sustained exposure to air pollutants on the brain, and possible links to diseases of the nervous system, will be one of the future challenges for global healt...
Source: Lancet Neurology - January 18, 2018 Category: Neurology Authors: The Lancet Neurology Tags: Editorial Source Type: research

[Articles] The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study
The CT and APOE genotype prediction model for CAA-associated lobar intracerebral haemorrhage shows excellent discrimination in this cohort, but requires external validation. The Edinburgh rule-in and rule-out diagnostic criteria might inform prognostic and therapeutic decisions that depend on identification of CAA-associated lobar intracerebral haemorrhage. (Source: Lancet Neurology)
Source: Lancet Neurology - January 10, 2018 Category: Neurology Authors: Mark A Rodrigues, Neshika Samarasekera, Christine Lerpiniere, Catherine Humphreys, Mark O McCarron, Philip M White, James A R Nicoll, Cathie L M Sudlow, Charlotte Cordonnier, Joanna M Wardlaw, Colin Smith, Rustam Al-Shahi Salman Tags: Articles Source Type: research

[Comment] CT scanning to diagnose CAA: back to the future?
Most intracerebral haemorrhages are due to cerebral small vessel diseases hypertensive arteriopathy (arteriolosclerosis), which affects deep perforating vessels, and cerebral amyloid angiopathy (CAA), which affects superficial cortical and leptomeningeal vessels. Diagnosis of CAA is important because it has a high recurrence risk (7 ·4% per year in a pooled analysis of cohort studies)1 and might require specific prevention strategies (eg, modifying the use of antithrombotic drugs) or, in the future, disease-modifying treatments targeting vascular β-amyloid. (Source: Lancet Neurology)
Source: Lancet Neurology - January 10, 2018 Category: Neurology Authors: David J Werring Tags: Comment Source Type: research

[In Context] What do our brains really want?
Animal behaviour is complex, and the understanding of human behaviour is no exception. An individual's previous experiences can influence everyday routine decision making processes, which in turn can affect habits and behaviours. But what happens when individuals are presented with new scenarios and choices? In these situations, the brain has to anticipate the right action to reach the desired outcome. (Source: Lancet Neurology)
Source: Lancet Neurology - January 9, 2018 Category: Neurology Authors: Paul Kiet Tang Tags: In Context Source Type: research

[Position Paper] Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explan...
Source: Lancet Neurology - December 21, 2017 Category: Neurology Authors: Alan J Thompson, Brenda L Banwell, Frederik Barkhof, William M Carroll, Timothy Coetzee, Giancarlo Comi, Jorge Correale, Franz Fazekas, Massimo Filippi, Mark S Freedman, Kazuo Fujihara, Steven L Galetta, Hans Peter Hartung, Ludwig Kappos, Fred D Lublin, R Tags: Position Paper Source Type: research

[Articles] Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald criteria: a retrospective study
The 2016 MAGNIMS criteria showed similar accuracy to the 2010 McDonald criteria in predicting the development of clinically definite multiple sclerosis. Inclusion of symptomatic lesions is expected to simplify the clinical use of MRI criteria without reducing accuracy, and our findings suggest that needing three lesions to define periventricular involvement might slightly increase specificity, suggesting that these two factors could be considered during further revisions of multiple sclerosis diagnostic criteria. (Source: Lancet Neurology)
Source: Lancet Neurology - December 21, 2017 Category: Neurology Authors: Massimo Filippi, Paolo Preziosa, Alessandro Meani, Olga Ciccarelli, Sarlota Mesaros, Alex Rovira, Jette Frederiksen, Christian Enzinger, Frederik Barkhof, Claudio Gasperini, Wallace Brownlee, Jelena Drulovic, Xavier Montalban, Stig P Cramer, Alexander Pic Tags: Articles Source Type: research

[Comment] Diagnosing multiple sclerosis: art and science
When asked by a trainee how he knew that an acutely ill patient had multiple sclerosis, Harvard neurologist Raymond D Adams quipped: “How does a farmer know his sheep?” The parallel between a farmer's intuition and a clinician's judgment was apt. This anecdote is from the mid-1970s, when no therapies for multiple sclerosis existed, and clinical diagnosis relied on recognition of the phenotype and exclusion of mimics. Direct t issue examination, usually at autopsy, was the true gold standard for diagnosis. (Source: Lancet Neurology)
Source: Lancet Neurology - December 21, 2017 Category: Neurology Authors: Riley M Bove, Stephen L Hauser Tags: Comment Source Type: research

[Comment] Refining the use of MRI to predict multiple sclerosis
The field of multiple sclerosis has undergone astounding changes over the past three decades. Many developments are the result of MRI, which has improved multiple sclerosis diagnosis and enhanced clinical trial outcome measures. The term clinically isolated syndrome describes a first symptomatic episode of CNS demyelination that might later develop into multiple sclerosis. Improving the imaging criteria to predict conversion to clinically definite multiple sclerosis has been a major, collaborative research effort. (Source: Lancet Neurology)
Source: Lancet Neurology - December 21, 2017 Category: Neurology Authors: Anne H Cross, Robert T Naismith Tags: Comment Source Type: research

[In Context] Multiple sclerosis: what's it got to do with your guts?
Might the gut microbiota of people with multiple sclerosis differ from that of healthy people? Do some bacteria aggravate symptoms? Are other species protective? Could we treat patients by manipulating their intestinal microbes? Work is underway to find out. Adrian Burton investigates. (Source: Lancet Neurology)
Source: Lancet Neurology - December 20, 2017 Category: Neurology Authors: Adrian Burton Tags: In Context Source Type: research

[In Context] Living well with dementia
According to Alzheimer's Disease International (ADI), close to 50 million people were living with dementia worldwide in 2017, which is projected to double every 20 years. Working closely with WHO, ADI focus on global solutions, but importantly recognise the value of local knowledge in creating safer, supportive, inclusive communities for people living with dementia. In the UK, the Alzheimer's Society estimate that 850  000 people are living with dementia, with numbers set to rise to over 1 million by 2025. (Source: Lancet Neurology)
Source: Lancet Neurology - December 19, 2017 Category: Neurology Authors: Jules Morgan Tags: In Context Source Type: research

[Review] Mechanisms of action for the medium-chain triglyceride ketogenic diet in neurological and metabolic disorders
High-fat, low-carbohydrate diets, known as ketogenic diets, have been used as a non-pharmacological treatment for refractory epilepsy. A key mechanism of this treatment is thought to be the generation of ketones, which provide brain cells (neurons and astrocytes) with an energy source that is more efficient than glucose, resulting in beneficial downstream metabolic changes, such as increasing adenosine levels, which might have effects on seizure control. However, some studies have challenged the central role of ketones because medium-chain fatty acids, which are part of a commonly used variation of the diet (the medium-cha...
Source: Lancet Neurology - December 16, 2017 Category: Neurology Authors: Katrin Augustin, Aziza Khabbush, Sophie Williams, Simon Eaton, Michael Orford, J Helen Cross, Simon J R Heales, Matthew C Walker, Robin S B Williams Tags: Review Source Type: research

[Articles] Investigating the genetic architecture of dementia with Lewy bodies: a two-stage genome-wide association study
Despite the small sample size for a genome-wide association study, and acknowledging the potential biases from ascertaining samples from multiple locations, we present the most comprehensive and well powered genetic study in dementia with Lewy bodies so far. These data show that common genetic variability has a role in the disease. (Source: Lancet Neurology)
Source: Lancet Neurology - December 16, 2017 Category: Neurology Authors: Rita Guerreiro, Owen A Ross, Celia Kun-Rodrigues, Dena G Hernandez, Tatiana Orme, John D Eicher, Claire E Shepherd, Laura Parkkinen, Lee Darwent, Michael G Heckman, Sonja W Scholz, Juan C Troncoso, Olga Pletnikova, Olaf Ansorge, Jordi Clarimon, Alberto Ll Tags: Articles Source Type: research