Gerald Finnerty and Claire Cheetham in their review article discuss the different levels of plasticity in the adult central nervous system, from functional changes such as those that underlie LTP to anatomical ones at the level of axonal growth and arborisation.
These processes are of interest not only in terms of how they can be
harnessed to effect repair but also in terms of how it becomes maladaptive
in some disease states.

Neil Greenberg, Simon Wessely and colleagues have attempted to convey the facts about Gulf War Syndrome and in so doing have given us a wonderful synopsis of this mysterious disorder. Their review is a superb distillation of the literature and as they state, it would appear that “Gulf veterans seem to experience more symptoms, endorse more conditions, feel worse but are still physically functioning almost as well as those deployed to another busy and stressful operational theatre”.

In the last issue of ACNR, Helen Thomas discussed what it was like to have a hereditary neuropathy and the problems and issues that this disorder throws up for the affected individual. It is therefore timely to have Mary Reilly and Matilde Laura educate us about this condition in their wonderfully comprehensive review - the third in our Neurogenetics Series edited by Tom Warner. This review highlights the way in which genetics has opened up this field and how one can try and organise the plethora of such conditions into some workable format for the clinic.

Dural fistulae can be difficult to diagnose and if suspected, angiography still remains the investigation of choice. In their review, William Adams and Peter Whitfield outline the various presentations of different types of dural fistulae and how they can best be classified, which in turn has prognostic and therapeutic implications. This clearly written account is lavishly illustrated with a plethora of angiograms.

In our ‘Living Legends’ series we are delighted to have Jean Paul Vonsattel take us through the derivation of the pathological staging system for Huntington’s disease brains. In this illuminating account he leads us through the early discussions between himself, Dr Bird and Dr Richardson and unnamed others as they decided how best to tackle the neuropathology of 65 Huntington’s disease brains. Their dedication to the task and their deductive powers led to the staging system that is now synonymous with Vonsattel and Huntington’s disease. Again this article is an inspiration to all involved in research, especially those in the field of neuropathology.

Neuropathology in this issue takes us to the peripheral nerve and the tumours that can be found there – schwannomas and neurofibromas. The former are typically benign in nature and cause problems by local compression whilst a subtype of neurofibroma can undergo a malignant transformation. Ute Pohl explains in detail all of these differences in her excellent review and how these different tumours relate to NF1, NF2 and Schwannomatosis.

The winners of the ABN case report, Stephen Jaiser and Martin Duddy, present a patient with a myelopathy secondary to copper deficiency. The retired clergyman, who was the subject of the case, presented with a myelodysplastic syndrome and an evolving subacute combined degeneration like syndrome of the cord. Only after extensive investigation and research did the possibility of copper deficiency emerge, which on treating promptly reversed his haematological abnormality whilst stabilising his neurology. This case is therefore a reminder that copper should be looked at in cases of unexplained myelopathy especially if the patient has a haematological disorder.

Neil Scolding and colleagues have taken on the recent new guidelines for the use of β-interferon and glatiramer acetate in MS. This article (which we hope will be followed by more in a series of controversies in Neurology and Neuroscience) argues that guidelines should be balanced and evidence based and that these recent ones for MS fail on these counts. They further go on to comment that the implementation of these guidelines will have substantial economic implications for our already stretched health service. This thoughtful account is stimulating in its content and we hope readers will feel encouraged to respond and write to us about their conclusions.

How would you react to being told you have a chronic neurological problem? Ian Rogers tells us how he responded to being given a diagnosis of MS and how his computer internet search engine suffered as a result. This illuminating article highlights the advantages and disadvantages of the internet for understanding disease and its treatment. Thus whilst it led to him being enrolled in a clinical trial of disease modifying therapy it also revealed that he may develop ‘brain atrophy’.

Andrew Larner once more treats us to an article on Epilepsy in the series on Neurological Literature. In this account he concentrates particularly on the work of Margiad Evans who was diagnosed with the condition in 1950, four weeks after her first seizure – well within the government guidelines!! As always, Andrew draws out many interesting points from the writings of people witnessing or experiencing epilepsy including the effects of anti-epileptic medication.

We have had some interesting names put forward as a result of our email to Consultant Neurologists, asking for suggestions for late-comers to the neurologists ball. Now we are looking for titles for films for neuroscientists and neurologists – email me at rab46@cam.ac.uk and the best will win a mystery prize.

Roger Barker
Roger@acnr.co.uk