For some reason, I always get anxious that I am missing some obvious or treatable diagnosis when diagnosing patients with cerebellar syndromes. In this issue of ACNR we have a fantastic review by Mark Wardle and Neil Robertson on how to approach the patient with progressive late-onset cerebellar ataxia. This review is wonderfully comprehensive but also packed with really helpful comments and strategies. I am sure it will become a standard text that many of us will take to clinic, and by so doing give us greater confidence and structure in our diagnostic attempts in such patients.

The surgical treatment of trigeminal neuralgia is not an uncommon discussion to be had in neurological practice, but what exactly this involves and how the patients do after such procedures is not especially well known by most neurologists (or at least not by me, anyway). It is therefore particularly useful to have such an expert as Hugh Coakham take us through this topic, highlighting that “microvascular decompression is now established as a safe and effective treatment for trigeminal neuralgia in patients where medication has failed. Our objective, patient orientated review has indicated that this procedure should be offered earlier and preferably as first line treatment before any injection therapy which can adversely affect the operative success rate”.

In the second of our neurogenetics series Ed Wild and Sarah Tabrizi summarise the current position with respect to genetic causes of dementia and which genes are worth testing for, in which patient. This is a succinct informative account with very useful summary tables and clear messages to be taken to the clinic.

Neuropathology returns in this issue, with a new series again kindly edited by Professor Roy Weller. In the first of the series, Rahul Phadke and Janice Holton take us through the clinical features and diagnosis of inflammatory myopathies, including the pathology of such disorders as revealed by muscle biopsy. This beautifully clear review continues the tradition of excellence that characterised the first series of such articles, and succeeds in distilling out the key factors in these disorders.

In the last issue of ACNR a case report of a patient in a vegetative state and Cushing’s disease was described, and the ethical dilemmas of their management discussed. In this issue, Martin Coleman and colleagues enlighten us on how functional imaging has modified our assessment and interpretation of such patients. They discuss how patients with clinically defined vegetative states actually retain the capacity to process complex sensory stimuli which can only be seen by recording activation patterns on functional scans. This highlights how advances in imaging can impact on the definition of what was previously only diagnosed using cruder, less sophisticated clinical and electrophysiological methods.

In our Drugs in Neurology series, sponsored on this occasion by Schwarz-Pharma, we have an article by Donald Grossett on the use of the rotigotine transdermal patch in patients with advanced Parkinson's disease. This article highlights the efficacy of this therapy, and complements the article we published in the ACNR last year on this drug.

In the patient perspective, Helen Thomas tells the story of her hereditary sensory motor peripheral neuropathy. She highlights her sense of isolation by the medical profession, and the support offered her by friends and family and her amazing self-reliance. Perhaps though the most revealing and moving part of the account is the judgements cast on her by those around her, unfamiliar with the condition and its manifestations. It is all so easy to undermine individuals with neurological disease by casual ill informed comments and to underestimate the impact of disease on one’s life.

Finally, I have always regarded the journal as having an intimacy and eclectic mix that makes it different to other journals, and it owes much of this to those who help set it up. I would therefore like to dedicate this issue to the memory of someone who taught me an awful lot about these aspects of life - Imogen Rose Barker, our 15-year-old daughter who was sadly knocked down and killed on the 24th February 2007.

Roger Barker
Roger@acnr.co.uk