Dietary treatments for epilepsy: management guidelines for the general practitioner

As ketogenic diets become more frequently used as a standard treatment for epilepsy in children and adults, hospital and community neurologists, pediatricians, intensivists, general practitioners, and house officers will readily encounter patients who are receiving these dietary treatments. A growing body of evidence demonstrates that dietary therapies for epilepsy (classic ketogenic diet, medium-chain triglyceride diet, modified Atkins diet, and low-glycemic-index treatment) are highly effective, with approximately 30-60% of children overall having at least a 50% reduction in seizures after 6 months of treatment. However, as would be true of any other medical anticonvulsant therapy, these treatments have known side effects and complications requiring recognition and timely action. In addition, the ketogenic diet is a significant intervention requiring rigorous daily adherence; not every family is willing or able to make the necessary commitment to this therapy. We provide herein a survey of the most common situations faced in both the inpatient and outpatient settings, including a discussion of triage and management based on our center's experience as well as the recent 2009 International Consensus Guideline.     

Grading of gliomas: the road from eminence to evidence

The development of concise grading schemes for diffuse gliomas with proven relevance to tumor behavior and susceptibility to therapy is important for clinical decision making. At present, there is unacceptably large interobserver discrepancy in the application of the current World Health Organization (WHO) criteria for accrual of patients in trials for patients with gliomas. Because of a lack of relevant studies, the WHO guidelines for grading are not yet as clear as would be desirable. The development of well-defined grading schemes consisting of features with low interobserver scoring variability and prognostic or predictive relevance is needed. Although interobserver concordance can be tested in retrospective studies, the prognostic or predictive qualities of histological parameters can only be tested in prospective studies. Only evidence-based histopathology will retain its critical role in the diagnosis and treatment of diffuse gliomas.     

On the road to new treatments for multiple sclerosis: targeting dendritic cell migration into the central nervous system

<正>Distinct migratory pathways and trafficking of dendritic cells to the central nervous system (CNs):The immune system is a host defense mechanism protecting against invaders, such as bacteria and viruses,while maintaining tolerance to self. Nonetheless, a few sites throughout the body are believed to be immunologically inert, such as the testes,the eye and the brain. Indeed, experiments in the mid-20~(th) century gave     

Structural neuroimaging in schizophrenia: from methods to insights to treatments

Historically, Kraepelin speculated that dementia praecox resulted from damage to the cerebral cortex, most notably the frontal and temporal cortices. It is only recently, however, that tools have been available to test this hypothesis. Now, more than a century later, we know that schizophrenia is a brain disorder. This knowledge comes from critical advances in imaging technology--including computerized axial tomography, magnetic resonance imaging, and diffusion imaging--all of which provide an unprecedented view of neuroanatomical structures, in vivo. Here, we review evidence for structural neuroimaging abnormalities, beginning with evidence for focal brain abnormalities, primarily in gray matter, and proceeding to the quest to identify abnormalities in brain systems and circuits by focusing on damage to white matter connections in the brain. We then review future prospects that need to be explored and pursued in order to translate our current knowledge into an understanding of the neurobiology of schizophrenia, which can then be translated into novel treatments.     

Genetics of anxiety disorders: the complex road from DSM to DNA

Anxiety disorders are among the most common psychiatric disorders, affecting one in four individuals over a lifetime. Although our understanding of the etiology of these disorders is incomplete, familial and genetic factors are established risk factors. However, identifying the specific casual genes has been difficult. Within the past several years, advances in molecular and statistical genetic methods have made the genetic dissection of complex disorders a feasible project. Here we provide an overview of these developments, with a focus on their implications for genetic studies of anxiety disorders. Although the genetic and phenotypic complexity of the anxiety disorders present formidable challenges, advances in neuroimaging and experimental animal models of anxiety and fear offer important opportunities for discovery. Real progress in identifying the genetic basis of anxiety disorders will require integrative approaches that make use of these biologic tools as well as larger‐scale genomic studies. If successful, such efforts may yield novel and more effective approaches for the prevention and treatment of these common and costly disorders. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Neural synchrony in schizophrenia: from networks to new treatments

Evidence is accumulating that brain regions communicate with each other in the temporal domain, relying on coincidence of neural activity to detect phasic relationships among neurons and neural assemblies. This coordination between neural populations has been described as "self-organizing," an "emergent property" of neural networks arising from the temporal synchrony between synaptic transmission and firing of distinct neuronal populations. Evidence is also accumulating that communication and coordination failures between different brain regions may account for a wide range of problems in schizophrenia, from psychosis to cognitive dysfunction. We review the knowledge about the functional neuroanatomy and neurochemistry of neural oscillations and oscillation abnormalities in schizophrenia. Based on this, we argue that we can begin to use oscillations, across frequencies, to do translational studies to understand the neural basis of schizophrenia.     

The road less travelled: moving from distribution to determinants in the study of gambling epidemiology.

This article reviews the current status of gambling epidemiology studies and suggests that it is time to move from general population-prevalence research toward the investigation of risk and protective factors that influence the onset of gambling disorders. The study of incidence among vulnerable and resilient populations is a road yet to be taken. In this review, we briefly introduce the history of the field and thoroughly review the epidemiologic research on disordered gambling before providing a critical assessment of the current diagnostic tools. Overall, the extant research shows that disordered gambling is a relatively stable phenomenon throughout the world. Given that certain segments of the population (for example, adolescents and substance users) have elevated prevalence rates, we suggest focusing future prevalence studies on groups with apparently increased vulnerability. Moreover, we suggest that, for the field of gambling studies to progress, researchers need to take the road less travelled and examine more carefully the onset and determinants of disordered gambling. That said, given the problems with the current diagnostic screens, investigators need to refine their theoretical concepts and the epidemiologic tools used to examine them before the field can travel down this new road.