Welcome to another issue of ACNR. In this, our fifth issue of the year, we have the usual variety of articles, including some from our international colleagues.

The two review articles in this issue include one from Professor Tysnes from Bergen in Norway, about the epidemiology and management of motor neurone disease. The second is by Paola Piccini and Ann Cheesman from the MRC Cyclotron Unit at the Hammersmith Hospital in London, and covers functional imaging in movement disorders.

The article by Professor Tysnes and colleagues is a very clear example of how the management of neurological conditions has evolved over the last few years. The typical approach to patients with motor neurone disease used to be rather limited, but now it is becoming increasingly clear that there are a number of things that can be done to help the patient, in the absence of any curative therapy. In this article, we not only hear about how motor neurone disease epidemiology has changed over recent years, but also
how we should set about caring for such patients using a multidisciplinary approach. This beautifully crafted article is clearly written from a great deal of personal experience, and as result it is something that many units would aspire to in the management of this devastating disorder.

The second review article by Paola Piccini and Ann Cheesman is from the leading UK (possibly world) centre for functional imaging in movement disorders. The article takes us through various Parkinsonian states, as well as a range of other involuntary movement disorders, and highlights the contribution that functional imaging has made to our pathophysiological understanding of these disorders. In particular, it has not only identified defects in transmitter networks but also abnormalities in circuitry
using activation studies, as well as the microglial response to disease. Indeed the development of new PET ligands has also meant that this field is likely to expand in the next few years, and with this we will gain even greater understanding on the normal organisation and functional capacity of the brain, as well as how it changes in disease and over time.

Peter Whitfield, in the third in his series on Neurosurgery, discusses the assessment and management of patients with head injury. This common condition has of late become an area of intense research with respect to its optimal management. Certainly in the past, managing patients with head injuries was somewhat eclectic, with mannitol and hyperventilation being the mainstay of therapy, and little in the way of active monitoring, all of which has changed with the birth of Neuro Critical Care Units. In this article Peter presents the rules and needs for the optimal assessment and treatment of patients with any type of head injury, highlighting possible interventions available at differing levels of severity. As usual this article is clear in its message, and again is steeped in experience.

The neuropathological review article in this issue is written by the retiring head of neuropathology at the Institute of Neurology in London, Professor Francesco Scaravilli. He sets out to discuss the pathogenesis, clinical presentation and pathology of neurosarcoidosis and paraneoplastic neurological syndromes. The former condition is often difficult to diagnose, but it is important to distinguish it from MS or other CNS inflammatory disorders, so that appropriate long-term treatment can be instigated. In contrast, paraneoplastic neurological syndromes carry with them a poor prognosis, and long-term clinical response to immunotherapy or chemotherapy is often poor. We are very fortunate to have such an expert account, which as with all articles in these series is well illustrated with histological examples.

The cognitive primer concentrates on the fascinating topic of agnosia – the perceptual disorder of preserved sensation but a loss of stimulus meaning. This is explained in a clear, beautifully illustrated and educational account written from a position of great experience and authority by Eric Ghadiali. It tackles not only the phenomenology of these disorders and their neuroanatomical basis, but also how one can easily test for these deficits and differentiate them from other conditions such as semantic dementia.


The rehabilitation article has taken as its topic botox injections and the sonographic imaging of muscles. Steffen Berweck and Jörg Wissel from the University of Munich present a very cogent argument for the adoption of this technique, especially in the setting of cerebral palsy in children. The use of ultrasound as opposed to EMG to localise muscle targets is much better tolerated without any loss of anatomical fidelity, and thus improves the accurate delivery of botox to appropriate muscle groups. An illuminating read, especially as this technique might well gain prominence in adult neurological practice.

We also include a new item, which we are hoping to make a regular feature – namely Drugs in Neurology. In this first article David Burn and Naomi Warren have written about amantadine, a drug first developed as an anti-viral agent but which has a long association with Parkinson’s disease (PD). Of late this drug has come back into fashion because of its reported benefit in the treatment of L-dopa induced dyskinesias of
advanced PD. This article takes us through all the drug trials of amantadine in PD and concludes with comments on what this drug has been proven to do in PD and related conditions.

Finally, don’t forget this web site where you can find a wonderful article by Berek and Mayr on the neurological prognosis after cardiopulmonary resuscitation – including clear tables highlighting predictors of outcome, as well as an article by the Oliver Zangwill Centre, responding to our earlier rehabilitation article on rehab abroad. You can also find an additional conference report on the joint BSRM/Nederlandse Vereniging
van Artsen voor Revalidatie en Physische Geneeskunde meeting, held recently in Edinburgh, UK.

So we hope you enjoy this issue with all the above, and its usual selection of journal reviews and conference reports. Happy reading.

Roger Barker
AdvancesinCNR@aol.com