After decades of research, large-scale clinical trials in patients diagnosed with frontotemporal lobar degeneration (FTLD) are now underway across multiple centres worldwide. As such, refining the determinants of survival in FTLD represents a timely and important challenge. Specifically, disease outcome measures need greater clarity of definition to enable accurate tracking of therapeutic interventions in both clinical and research settings. Multiple factors potentially determine survival, including the clinical phenotype at presentation; radiological patterns of atrophy including markers on both structural and functional imaging; metabolic factors including eating behaviour and lipid metabolism; biomarkers including both serum and cerebrospinal fluid markers of underlying pathology; as well as genetic factors, including both dominantly inherited genes, but also genetic modifiers. The present review synthesises the effect of these factors on disease survival across the syndromes of frontotemporal dementia, with comparison to amyotrophic lateral sclerosis, progressive supranuclear palsy and corticobasal syndrome. A pathway is presented that outlines the utility of these varied survival factors for future clinical trials and drug development. Given the complexity of the FTLD spectrum, it seems unlikely that any single factor may predict overall survival in individual patients, further suggesting that a precision medicine approach will need to be developed in predicting disease survival in FTLD, to enhance drug target development and future clinical trial methodologies.

Acupuncture-related injuries to the central nervous system are a rare but well-documented occurrence. This report describes the case of a self-introduced acupuncture needle migrating into the brainstem following an initial failed attempt at surgical extraction. The patient displayed no neurological deficits, and the needle was eventually successfully removed under direct vision intraoperatively. We discuss the role of various imaging modalities in pre- and post-operative assessment of penetrating foreign bodies in the brainstem. We also discuss the options available for the management of such foreign bodies, including possible approaches for operative intervention, and the risks involved with both surgical and conservative management.

No abstract