Welcome to another year of ACNR. The journal is now into its fourth year, with a distribution of well over 5000 and the hope of even greater international presence in the next year with input from all our European members of the editorial board. We also recommend the website, which has all the previous issues of the journal along with case studies and a small radiological quiz. Indeed the website is proving to be very successful, with about 900 individual visitors a month, as well as being in receipt of a commendation at the recent Scottish Magazine awards (many congratulations to Rachael Hansford on this).

We have our usual two review articles, which in this issue cover Huntington’s disease and saccadic eye movements. The molecular pathology of Huntington’s disease is discussed by Dr Jenny Morton and follows on from a series of other articles on this and related topics - such as the excellent account last year by Gen Sobue and colleagues on SBMA. In her article, Jenny Morton leads us through the emerging complex array of intracellular events that lie downstream of the mutant huntingtin, and makes the important point that intracellular protein inclusions may have different functions at different times in the illness. This is a view that may help reconcile those who believe that inclusions are protective to the cell as oppose to those that view them as toxic.

Roger Carpenter presents a beautiful and thought provoking article on saccadic eye movements – a movement which we make about a quarter of a million times a day. This review sets out the various levels of control that the CNS exerts on this system, and how this may go awry in a range of disorders. In this latter respect, the ease with which saccadic latencies and duration can be recorded nowadays means that we may be able to gain greater insight into disease processes and progression using these measures.

In our series on movement disorders, I have taken on the topic of tremor which is commonly seen in clinic and which is often difficult to treat. I have tried to lay out a pragmatic approach to the clinical problem with a classification that reflects this, and a therapeutic strategy which largely reflects our ignorance and the paucity of proper trials. In this respect there are a number of well known therapies which most of us would use in the clinic in patients with essential tremor, along with a long list of those “worth a go” without much to support their approach. Of course the advent of deep brain stimulation has helped the minority of patients with severe tremor, but how one manages patients with cerebellar/midbrain tremors is still very poor and worthy of much more work, given how disabling this type of movement disorder is to the patient.

This issue also presents a Medtronic sponsored article by Michael Vloeberghs and colleagues, outlining a planned national randomised control study on the use of intrathecal baclofen (ITB) in the treatment of spasticity in children with cerebral palsy. This is clearly an important topic, for which the data on what represents the best therapy is not known. However, there are very encouraging open label studies using ITB. Indeed this article presents data from Vloeberghs et al in which 48 out of 52 patients report that they were satisfied with the ITB treatment, although it is not without some significant side-effects in some individuals.

The rehabilitation article discusses “Rehab without walls”, and the use of rehabilitation centres abroad, with particular reference to a patient who went to a German neurorehabilitation centre. This use of specialist centres outside the UK is an interesting one, especially in the current climate of greater integration within Europe on so many other issues, and the article discusses the advantages and disadvantages of adopting such an approach.

We also have our usual features and I would particularly draw your attention to the excellent meeting report by Dr Kevin Talbot which explores new developments in motorneuron disease and is a useful adjunct to the excellent article last year by Pam Shaw and colleagues.

So that’s about it, Do keep the feedback coming, and we look forward to sharing another exciting year, with ACNR continuing to bridge the clinical-scientific divide of neurology and neuroscience.

Roger Barker
AdvancesinCNR@aol.com