First of all many congratulations to Rachael Hansford on the safe delivery of her first child, Charlie. Rachael (as many of you will not know) is the person who devised the ACNR, chases up all the articles, sorts out the structure of each issue and is the mastermind behind each issue. We hope she has a restful maternity leave and spends time looking after her most important baby, whilst we also extend a welcome and thanks to Patricia McDonnell for stepping into the breach.

Mark Edwards completed his research at the Institute of Neurology in London studying DYT1 dystonia. In his article he details the nature of this mutation, including a discussion on its cellular and clinical consequences, and highlights the pathophysiology that underlies this condition. In particular he highlights the fact that the failure to present before the age of 25 means that it is extremely unlikely that the individual will go on to develop dystonia despite carrying the mutation. This is a beautifully written article from someone who has provided intriguing new insights into this condition.

The review article by Scheler et al explains MEG and its value in the localisation of foci of epileptic activity, especially in cases where surgical resection is being considered. This is a difficult area of epilepsy management, as not only does one have to have accurate localisation of the epileptogenic focus but also one has to ensure that its removal does not induce any significant new deficits.

The non invasive technique of MEG, according to the authors, is more sensitive than scalp EEG but, not surprisingly, is less good than intracranial EEGs in terms of localising the source of epileptic seizures. As a result it can help in the decision making process in the presurgical evaluation of patients with epilepsy in a significant proportion (approximately 10%) of cases.

Understanding circadian rhythms is an area of intense biological and clinical interest and we are thus very fortunate to have a review by Mick Hastings and Liz Maywood, two leading researchers in this area. Their article provides us with a wonderful example of ‘genes-to-cells-to-behaviour’ and discusses how the suprachiasmatic nucleus of the hypothalamus co-ordinates a number of local clockworks in different organ systems, and
how this can go wrong with neurological disease. This is a beautifully clear account, which summarises a fascinating topic and includes up-todate studies from the authors themselves.

The article in the excellent series on visual neuroscience (edited by Masud Hussain) is by Bach and Poloschek and treats us to some rather mindchurning optical illusions. This article presents a plethora of images, many of which can leave one feeling slightly
spaced out and nauseated. However the authors argue that optical illusions, whilst being entertaining, can also inform us on mechanisms of visual processing as well as aspects of visual perception.

The neuropathology series heads to the peripheral nervous system, where Roz King takes us through the normal structure of nerves to pathology and the features distinguishing demyelinating from axonal neuropathies. The article contains some extremely helpful tables as well as summarising the indications, methods and analysis of a nerve biopsy, with helpful comments on the distinguishing pathology of the different
aetiological causes of neuropathy. As with all articles in this series, it is beautifully illustrated, succinct and combines scientific excellence with pragmatism.

Rehabilitation following traumatic brain injury (TBI) is a common scenario and Helen Seeley and Peter Hutchinson take us on a sobering tour of this area, highlighting the dearth of facilities available for delivering such a service. This in part relates to ignorance as to its worth, and the need to develop a team of co-ordinated and dedicated specialists. The authors, who work in the Eastern region, have therefore used this area to investigate the nature of the problems associated with differing types of TBI and how they can best be tackled at a network level. This raises many issues, not least the
cost implications that any such services would impose on the NHS, which in turn has consequences for their national adoption.

“Orthoses are external devices designed to affect body function and/or assist function” so write David Abankwa and Alan Llewellyn in their article on the use of such devices in the management of lower limb spasticity. This nicely illustrated account may cover familiar ground to those involved in rehabilitation, but will certainly be an eye-opener to those working outside this discipline but who nevertheless see such patients.

In Drugs in Neurology, Donald Grossett in a sponsored article discusses rotigotine, which is the first dopamine agonist to be delivered successfully by transdermal application. This drug thus offers a new option for patients with early-stage Parkinson’s disease as it may produce less pulsatile stimulation of dopaminergic receptors, which may have implications in the genesis in the long term of drug induced dyskinesias.

Andrew Larner in his second treatise on headache in literature concentrates on the work of Ian McEwan as well as Jack London, whilst also exploring the different types of headaches exhibited by the Little Women of Louisa M Alcott. As always with Andrew, the article is beautifully constructed and thought-provoking.

We have our usual journal, conference and book reviews, and don’t forget
the website where you can freely download any of the articles from the ACNR.

Roger Barker
Roger@acnr.co.uk