George Orwell in A Clergyman’s Daughter, has as one of his main characters, Dorothy develop a form of transient amnesia. This is probably psychogenic but how can one be sure. Chris Butler and Adam Zeman help us unpack this conundrum in their article on syndromes of Transient Amnesia. They explain the salient differences between transient global amnesia (TGA), transient epileptic amnesia (TEA) and other forms of this condition and do so from a position of great authority given their contribution to this subject especially TEA.

The role of inflammation in the pathogenesis of neurodegenerative disorders of the CNS is a controversial one and Andreas Hartmann takes us through the evidence for this in Parkinson’s disease. He argues that recent imaging studies looking at activated microglial, post mortem studies in MPTP treated animals and patients as well as in idiopathic Parkinson’s disease coupled to epidemiological studies, makes for a cogent argument in favour of a role for inflammation in the cell death seen in Parkinson’s disease. This is a thoughtful article from someone who has worked closely in the field which I am sure will be stimulating to all those involved in neurodegenerative disorders of the CNS.

As the shortage of intravenous immunoglobulin strikes the UK we are reminded of its value in GBS and the fact that we still do not know the identity of the major epitope at the heart of the acute inflammatory demyelinating polyneuropathies of the Guillain-Barré type. This failure to identify a putative antigen restricts our possible therapeutic options for a condition that has a global incidence of about 1 in 100,000. It is a theme developed and discussed in the context of all forms of Guillain-Barré syndrome by James Overell and Hugh
Willison – a lab that has provided significant insights into the pathogenic gangliosides and immune mechanisms underlying this form of peripheral nerve disorder. This is an enlightened and fascinating summary of an evolving field.

Andrew Larner embarks on a fascinating new series in this issue of the ACNR. He discusses entomopia a form of polyopsia in which a grid-like pattern of multiple copies of the same visual image is seen. This builds on an earlier article published in the ACNR by Dominic ffythche in 2004 on visual hallucinations and illusions.

The result of positive oligoclonal bands in the CSF is often taken as being diagnostic of MS without any real thought being given to what it actually means. Dr Maguire in an extremely helpful account tells us about the way that such bands are detected (or not) and the relevance of the differing patterns of such proteins seen in the CSF and blood.This clearly written account is a real gem and if you never understood isoelectric focusing you will after reading this article.

In the article on intrathecal baclofen by Sohail Ansari and Robert Redfern, we are taken through the necessary steps in the assessment, treatment and management of patients requiring this intervention for spasticity. It is clear that a multi-disciplinary approach both before and following the procedure is ideal, and that if done appropriately can have dramatically beneficial effects on patients with these types of problems.

The idea of restoring lower limb function in people with high spinal cord injuries has been a dream for many patients and the use of functional electrical stimulation to activate intact lower motor neurone/muscles is one way of attempting to do this. These devices have been around for some time but in her article Therese Johnston explains how they may be of benefit in children with spinal cord injury. Whilst the data in the article remains anecdotal it would seem to be an approach that has great potential in revolutionising the treatment of such patients….although may be superceded by other devices relying on motor cortical activity (See Journal Reviews).

Susanne Watkins and Geraint Rees bring to a close the wonderful Visual Neuroscience series, edited by Masud Husein. We are enormously grateful to Masud for his work in bringing together a memorable collection of articles, and this final review is a fitting conclusion dealing with visual attention – how we can focus on what we want to see. This ability to select visual items of interest involves a number of different processes which have been elucidated using functional imaging and lesion studies, and includes the famous study entitled ‘Gorillas in our midst’. To understand this reference, you will need to read this review!!

On a final serious note, it was pointed out to us that one of the articles in our last issue of the ACNR had been extensively borrowed and plagarised from another authors work. Such behaviour is wholly unacceptable and we have written to the offending author outlining this, and have apologised to the author whose work was copied. We have also had the offending article removed from the ACNR website. On a more happy note, I am pleased to inform you that two new clinical cases are now posted on that website.

Roger Barker
Roger@acnr.co.uk