There are few issues in clinical neurology that create as much controversy as the basis and definition of consciousness and the persistent vegetative state. We are therefore very fortunate to have an authoritative account of this subject from Adam Zeman, a neurologist who has written extensively on this topic. In his article Adam sets out the differences between wakefulness and awareness and suggests that the vegetative state may represent wakefulness without awareness – the patient is clearly awake but there is no evidence of responsiveness to stimuli. Obviously such assessments on patients are fraught with difficulty, including the effects of sedation from drugs and anxieties about the patient being “locked-in”, but within the article there is a very helpful Table delineating the cardinal features of these different states of altered consciousness.

The second review article in this issue by Mosimann and Ian McKeith tackles the topic of Lewy bodies and dementia. This is again a contentious issue – namely to what extent is dementia with Lewy bodies (DLB) different from Parkinson’s disease with dementia? Indeed those who went to the International Movement Disorder meeting in Florida last November, will remember the debate between Andrew Lees and Charles Duyckaets on this topic (ACNR 2(6): 24). In their article Mosimann and McKeith give a measured account of the subject and whilst they feel more work is needed to resolve the relationship between these 2 disorders, favour the view that they are “different representations of the same neurobiological process”.

Yianni and Aziz continue their series on surgery for movement disorders and this time tackle the topic of unusual movement disorders and deep brain stimulation (DBS). This article lists a range of conditions and the anecdotal success that DBS has made in some cases and leaves an impression of what may be possible in the future, rather than what has been proven to work.

Adam Zermansky provides the second in the Management Series on movement disorders, delineating the features of a range of parkinsonian conditions and Doug MacMahon describes his experiences with apomorphine in the more elderly (and more typical) Parkinson’s disease patient. In this article he highlights the importance of patient selection – namely those that do best with this therapy tend to be younger with a history of a good L-dopa response.

Tony Redmond’s “rehab” article tackles the issue of the assessment of the traumatically injured patient and the need to identify all problems early on, and by so doing ensuring appropriate treatment is started as soon as possible. If this is not done, then catastrophic consequences may result and an argument is made that intensive therapy not only refers to the immediate acute phase of injury but the early stages of rehabilitation.

The usual features are also well represented in this issue. Brian McNamara reveals his approach to the radial nerve and is probably one of the few (if not only) in the neurological fraternity to cite Homer Simpson as a reference source! Again the article is extremely clear, practical and informed and is very helpful to all those encountering this clinical problem. We also have a good selection of meeting reports – some of which can be found only on our website. Each meeting report lists the main points distilled for easy consumption and we have our normal selection of reviewed papers that have recently entered the literature.

Don’t forget the website, which contains all issues of the journal, conference reports as well as clinical cases. Finally, keep the feedback coming as it has (and will continue) to shape this unique journal.

Roger Barker
AdvancesinCNR@aol.com