In this issue of ACNR we have two excellent review articles from leading European clinical scientists. The first article by Wenning and Geser discusses the clinical issues around multiple system atrophy whilst the second article by Josef Priller explores the scientific potential of adult bone marrow stem cells for repair in neurological diseases.

Wenning and Geser present in their account a comprehensive and up to date approach on the diagnosis and treatment of this not uncommon condition. This review is based on a wealth of clinical experience, with insightful updates being provided by the authors which comes as no surprise given the clinical work that Gregor Wenning and his team have done over the years on MSA. I particularly commend their tables, which are fantastic summaries of the core issues on diagnosis, investigation and therapy.

The second article covers the highly controversial area of bone marrow stem cells as a means of repairing the diseased CNS. We are therefore very fortunate to have Dr Josef Priller from Berlin to write this article, given his pioneering contribution to this work. Since the first publication that adult BMSCs may be able to migrate into the CNS and differentiate into neurons, there have been many debates as to whether this truly happens and if so at what frequency. Subsequently the view has emerged that these cells do not actually transdifferentiate into other cells of a different lineage (neurons in this case) but rather fuse to post-mitotic cells which then express the BMSC marker – a point that also been the subject of a recent Nature article (see Journal reviews in this issue).

In the rehabilitation section, Julkunen and Hänäläinen tackle the difficult topic of trying to improve visual field defects after strokes. This article is very thought provoking and delineates the approaches that have been adopted to treat this often very disabling sequelae of strokes. The results and lacunae in our knowledge are well presented along with future moves in this field.

Due to the sudden ill health of our author for the management topic, this article has not been included in this issue. However, as soon as it is ready we will publish it on the web site.

Brian McNamara comes to the end of his series of articles, which have been unique in their style!! In this his final article we took the rather controversial view that neurophysiology never tells you anything which you can’t get from a good clinical history and examination. Surprisingly Brian disagrees and puts forward cogent reasons for the value of nerve conduction studies and EMG in the diagnosis of nerve and muscle disease so I guess we should carry on referring patients for such tests! I would though like to thank Brian for his straightforward honest accounts which I have found very helpful and pithy in their presentation of peripheral nerves.

We also have our usual series of conference and journal reviews, which this issue feature some fascinating articles on Huntington’s disease and neuro-degeneration. Remember the journal is on the web at www.acnr.com, and the site will soon contain a mini quiz courtesy of our Case Report Meister (Alastair Wilkins) and Tom Foltynie – so do check back often.

ACNR is free to members of the profession, so do let us know if people are not on our distribution list. We have almost 4,600 readers in the UK as well as almost 900 internationally, so you are in good company!

Roger Barker
AdvancesinCNR@aol.com