This is the final issue of the fourth year of ACNR, and comes at a time that this website is attracting over 3000 visitors a month – thank you to all of our regular visitors. The site is home to our case reports and the latest, a case of tuberculous spinal arachnoiditis, is now available for you to download.

The two review articles in this issue come from Oxford and Edinburgh with David Beeson concentrating on congenital myasthenic syndromes and Michael Sharpe on “functional” disorders. The congenital myasthenic syndromes (CMS) are rare, and although many of us will not see such cases, are of great scientific value in revealing how the neuromuscular junction is organised and maintained. We are therefore fortunate to have David Beeson, who has made such a significant contribution to this field, lay out the various types of CMS and their basis ranging from abnormalities in the acetylcholine receptor and channel to mutations in proteins such as rapsyn and ColQ. This account encapsulates all that ACNR hopes to achieve through linking neurology to neurobiology.

Michael Sharpe and colleagues in their article take on the thorny issue of functional symptoms in neurology – an all too common scenario for those practising general neurology. Typically such patients are thought not to have a real neurological problems by neurologists and not to have a real psychiatric disorder by Psychiatrists – and so they are left floundering with little hope of receiving help. In this beautifully written review, Sharpe and colleagues tackle our prejudices head on with a series of helpful comments and strategies which will help convert a nihilistic approach to such patients into a more constructive one.

The neurosurgery series moves south to target the lumbar spine. Degenerative disease of the lumbar spine is common and often requires no major interventions, a point clearly made by Haden et al in their article. The authors take us through the anatomy, pathology and clinical presentations of lumbar spine disease before discussing how best to manage such patients. In particular they highlight that surgical treatment is rarely needed and that when it is indicated, relatively simple procedures may be as successful as more complex operations.

The neuropathology series in this issue, by Dr Daniel du Plessis, tackles brain tumours and lays out our current understanding of their histological classification and genetic basis. This review clearly describes the different imaging, clinical and neuropathological characteristics of brain tumours and complements well an earlier article by Jeremy Rees on their treatment (see volume 2, issue 2). The article is lavishly illustrated and appears at a time when “brain-cancer stem cells” (Singh SK et al. Nature 2004;432:396-401) are beginning to be found which, in turn, may lead to further refinements in classification and therapy.

The rehabilitation article tackles the interesting topic of Visual stress in neurological disease. Professor Arnold Wilkins, who has pioneered this concept, presents a thought provoking account which highlights the basic tenets of the theory and how this translates into effective therapies. In particular he discusses the use of coloured filters for glasses for disorders such as dyslexia and migraine.

Andrew Larner in our historical series takes us through the “looking glass” into the neurological world of Alice. In this fascinating account Andrew discusses a range of disorders which link incidents and characters in the two fictional works about Alice with the neurological problems of Dodgson and his acquaintances. This article is a real treat.

Mr and Mrs Burn provide our conference reports with Aileen reporting from Vienna on the ECTRIMS and RIMS meetings whilst poor old David only gets to go to Beijing to attend the Joint Sino-British conference on neurology. Both reports serve as very useful updates on several different neurological fields, including the various effects of different immunomodulatory drugs in MS.

We also have the second in our “Drugs in Neurology” series with John Paul Leach from Glasgow discussing pregabalin – a new drug for epilepsy and neuropathic pain.

We also have an overview of the UK NICE guidelines on epilepsy from Mark Manford and our usual book and journal reviews.

So that’s about it for another year. Thanks for all your support and feedback (see our “Letter to the Editor,” an author’s response to one of our earlier reviews), and do keep letting us know what you think and would like to see in ACNR – this includes any suggestions for relevant case reports, organised by Alastair Wilkins. We look forward to our fifth year!

Roger Barker
Roger@acnr.co.uk