Lancet neurology
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Progressive multifocal leukoencephalopathy (PML) is a rare, devastating demyelinating disease of the CNS caused by the JC virus (JCV) that occurs in patients with compromised immune systems. Detection of PML in systemically immunocompetent patients with multiple sclerosis treated with natalizumab points to a role for this drug in the pathophysiology of PML. ⋯ Frequent MRI, stratified along a clinical and virus-specific immune risk profile, can be used to detect presymptomatic PML. Improved approaches to PML risk stratification are needed to guide treatment choices and surveillance of patients with multiple sclerosis.
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Neuropathic pain-pain caused by a lesion or disease of the somatosensory nervous system-is underdiagnosed and difficult to treat. However, development of easy-to-use questionnaires based mainly on self-reports of symptoms has improved diagnosis and management. Two types of questionnaires (screening and assessment) have been validated, and rapidly translated and revalidated in several languages, probably because of their simplicity. ⋯ Assessment questionnaires measure neuropathic symptoms and have been used to create phenotypic profiles of patients in various neuropathic conditions. These profiles can predict treatment outcomes, and thus enable a personalised therapeutic approach. The dissemination of these questionnaires in different countries should further improve diagnosis and management worldwide and advance knowledge on the mechanisms of neuropathic pain.
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Biography Historical Article
Frederik Barkhof: building bridges between disciplines.