“If the cell body were about thirty yards across the axon of a typical motor neuron would be about the size of a tube train tunnel connecting London and New York”. So writes Ammar Al-Chalabi of the motor neuron, the demise of which underlines motor neurone disease. In his short review Ammar lays out a logical, thorough, yet pragmatic approach to this condition highlighting recent advances as well as a range of useful statistics on its frequency and prognosis.

Neurodegenerative disorders of the CNS are viewed as conditions where the primary deficit is neuronal loss. Whilst there is no doubt that this is the case, this is a relatively late event with the early manifest problems being a consequence of more subtle abnormalities in the neuron at the level of neurotransmission and synaptic plasticity.

In this issue Tony Hannan and Nektarios Mezarakis explore this concept in murine transgenic models of Huntington’s disease highlighting the extent to which such an abnormality exists and can be modified by manipulation of the environment. This is a succinct account in an exciting area of neuroscience by acknowledged experts in this area who have done much to throw light on the significance of gene environment interactions in neurological disorders.

In a third review article, Thomas Bak takes us through the differing cognitive profiles of parkinsonian syndromes – an area to which he has made a substantial contribution. In this review, Thomas makes the point that documenting the profile of cognitive deficits in atypical parkinsonian syndromes is not only a useful exercise in its own right, but can be used to help define and refine the diagnosis. Indeed, as he writes, “with growing understanding of fronto-striatal connections it seems likely that at least some cognitive and motor symptoms are different manifestations of the same underlying pathology”.

Special care dentistry forms the topic for the Rehabilitation article. This “forgotten strand in rehabilitation” covers the dentistry needs of people with ‘special needs’ and the article by June Nunn provides a clear and informative narrative on how to prevent and recognise problems and their optimal management which will significantly impact on my practice with such patients.

The identification of intracranial metastases carries with it a poor prognosis and often it is not clear what treatment should be offered. In the Neurosurgery series, Peter Whitfield and oncologist Steve Kelly take us through the various different approaches and the evidence for their adoption or use in different clinical scenarios. This is a clear account based on a detailed analysis of the published literature and highlights the merits of surgery and whole brain irradiation in selected, affected, groups of individuals.

We are extremely privileged to have writing for us in this issue Professor Raymond Adams, still active at the age of 95! In his article Professor Adams lays out the vast number of neurological conditions to which he has made seminal contributions. Thus it was difficult to know what to ask Professor Adams to write about given this, but we settled on central pontine myelinolysis, and he takes us through the original description of this case outlining how the syndrome came to be recognised in collaboration with his colleague Maurice Victor. This is an absolutely fascinating article which I am sure many will find of great intellectual interest as well as being of huge historical significance.

We also have a short article on a new initiative in MS, the Atlas of MS, organised by the Multiple Sclerosis International Federation (MSIF). This resource is designed to highlight and report on different aspects of MS across the globe and looks to be a very useful resource.

Finally it would not be right as we enter November 2006 not to have some mention of Alois Alzheimer – as it is now a 100 years since he described the first case of his disease, patient Auguste D, Andrew Larner delivers his usual scholarly account of this historical event and reassuring tells us that his presentation “prompted no comments or
reaction from the audience”.

We have our usual regular articles, including journal and book reviews, and as always we are keen to hear from you as to what we can do to improve and expand the journal that now has a circulation of over 4500.

Roger Barker
Roger@acnr.co.uk