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Stroke One of the most important developments in the last ten years has been the introduction of new methods to treat an ischaemic stroke (a stroke caused by blockage of an artery supplying part of the brain). It is now possible to open the blocked artery and restore normal blood flow by a technique called “endovascular clot retrieval” (ECR). If this is done before irreversible damage to the brain occurs, there is an excellent chance of a complete or near complete recovery. For every two or three patients treated with ECR, one more patient makes a significant improvement compared with patients who receive usual treatment for a stroke. For every five people treated with ECR, one more can go home and live independently. The chance of this treatment working is better if there is a short time interval between the onset of the symptoms and successful clot retrieval. New Zealand has been at the forefront of acute stroke management and ECR is now routinely used at Auckland Hospital and, in some cases, at Christchurch and Wellington Hospitals. While ECR is very successful, there are many challenges ahead. The first problem is that ECR can only be performed in large hospitals that are properly equipped and staffed to perform the procedure. We need to work out how ECR can be made available to all patients who have an acute stroke, including those living outside a centre where ECR is performed and how to transport these patients to a clot retrieval centre. Another problem is the identification of patients who may benefit from ECR, even when there has been a longer interval between the onset of their symptoms and the start of treatment. New methods of imaging the brain should help with this. In the future it may be possible to administer a neuroprotective treatment on the way to the hospital to reduce the damage to the brain before the clot can be removed. The advances made in the treatment of other common neurological conditions have been less spectacular, but still important. Epilepsy There has not been a major breakthrough in the treatment of epilepsy in the last 10 years. Studies have shown that cannabidiol is beneficial in two rare forms of childhood epilepsy, but there is no reliable evidence that it is useful in people with other types of epilepsy. It has been known for a long time that surgical treatment can be very effective in some patients with epilepsy whose symptoms cannot be controlled with anti-epileptic medication. Stereo-EEG (recording the EEG from electrodes that have been surgically implanted in to the brain) helps to more precisely identify the epileptogenic zone and permits a Latest treatments update BY DR NEIL ANDERSON From the perspectives of patients, their families and caregivers, and the clinicians who care for them, the pace of medical research and the introduction of new treatments for neurological disorders is often frustratingly slow. In recent years, however, significant advances in treating neurological conditions have been made. Dr Neil Anderson has been a consultant neurologist at Auckland City Hospital since 1987. After completing his neurology training, Neil became the first ever recipient of the Neurological Foundation Chapman Fellowship and was a Fellow in the Neurology Department at the Memorial Sloan-Kettering Cancer Center in New York. Neil joined the Neurological Foundation as Chief Medical Advisor in 2018. 14 Headlines