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better result from surgery. Vagal nerve stimulators (VNSs) have been used in patients with intractable epilepsy in the past, but newer stimulators that are activated by a sudden increase in heart rate (denoting the onset of a seizure) may be more effective than the original stimulators. Stereo EEG and responsive VNSs are not yet available in New Zealand. Another area of active research is the prediction of when a seizure will occur. If the onset of a seizure can be predicted, it opens the possibility of administering a treatment to prevent the seizure from starting. Parkinson’s disease Levodopa-containing medication (e.g. Sinemet and Madopar) is still the most effective method of treating Parkinson’s disease. The old idea that starting levodopa made patients worse in the long term has been debunked. A variety of other medications have a role in treatment in selected patients with Parkinson’s disease, but they are less effective than levodopa and they are associated with side effects. Deep brain stimulation (DBS) and apomorphine, which are both used in New Zealand, have a place in the treatment of carefully selected patients with advanced Parkinson’s disease. DBS also has a role in patients with severe essential tremor. Various strategies using transplantation have been tried, but so far none of these methods has been shown to change the course of Parkinson’s disease. Migraine The main development in the treatment of migraine has been the Calcitonin gene-related peptide (CGRP) antagonists that block CGRP or its receptor. These agents are the first drugs to have been specifically designed to prevent migraine. CGRP antagonists are used to prevent migraine in people experiencing attacks at least four times per month. They are administered by injection every one to three months. Randomised double-blind, placebo- controlled trials have shown that patients receiving these drugs have fewer migraines per month than those who received placebo. They are associated with minimal side effects. However, they are expensive and not yet available in New Zealand. Autoimmune encephalitis Stroke, epilepsy, Parkinson’s disease and migraine are common neurological conditions, but one of the most spectacular advances in treatment of neurological disorders has been made with a much less common disorder, autoimmune encephalitis. Ten years ago neurologists working in Barcelona and Philadelphia discovered that encephalitis (acute inflammation in the brain) can be caused by inappropriate activation of the body’s immune system (an autoimmune disease). Up until 2007, the cause of the encephalitis in these patients was unknown and most of these patients died or, if they survived, they had severe long-term neurological deficits. Since then several different antibodies causing encephalitis have been discovered. Recognition of these antibodies has led to a variety of treatments that down-regulate the production of the antibodies and most patients recover, sometimes with little or no residual problem. The most common type of autoimmune encephalitis is caused by an antibody directed against the N-methyl-D-aspartate receptor (NMDAR). NMDAR encephalitis was graphically depicted by Suzanne Cahalan in her autobiography “Brain on Fire”, and in the movie by the same name. Autoimmune encephalitis is uncommon, but it turns out that it is not as rare as once believed. Dozens of patients with autoimmune encephalitis are being diagnosed and treated in hospitals in New Zealand each year. “Progress may seem to be frustratingly slow, but it is only through research that new treatments will become available in the future.” – DR NEIL ANDERSON Headlines 15