In the last issue of the ACNR we had a critique of the recent ABN guidelines on disease modifying therapy in MS by Neil Scolding and colleagues as part of our controversies in Neurology and Neuroscience series. In the next issue we hope to publish the ABN response to this, but in the meantime my co-editor Alasdair Coles debates this issue further in his journal review of the BENEFIT study.

Professor Simon Baron Cohen, in his short review on autism, highlights the key issues in this not uncommon disorder - up to 1% of the population lie somewhere on the autistic spectrum. The cause of this condition is not known but various models and genetic influences are discussed in this article, along with some suggestions on how best to manage individuals with it. This short review article written by such an acknowledged expert is extremely informative and helpful.

It is very common to be asked to see a patient who has collapsed in order to establish the cause and instigate appropriate treatment. Often, however, the case remains a conundrum and undiagnosed. In their excellent review article Joe Anderson and Phil Smith take us through their approach. They conclude that “misdiagnoses are common and that the best way to avoid this is to retake the history from different sources and at different times, and to resist premature diagnoses”.

Dr Ravishankar, in an illuminating review article on headache in India, reveals why there are problems in the diagnosis and treatment of this common disorder in a country with 16% of the world’s population. As he comments, “headache medicine is still not a recognised sub-specialty in India and myths and misunderstandings abound. Headache patients end up being seen by many different specialists, each one of whom looks at the problems through the window of their own specialty. For all these reasons, headache patients in India do not receive adequate sympathy, care and attention.” This is the first in a new series on Neurology in India edited by Dr Khadikar and promises to offer unique insights into a different world of neurological practice.

If you had a spare £1.5 million would you invest in magnetoencephalography (MEG)? Dr Rugg-Gunn explains why we may want to do this, as he discusses the merits of this technique in neurological practice – especially epilepsy. This article is the first in a new series on emerging neurophysiological techniques edited by Dr Andy Michell and this is ellillustrated in this excellent first article.

The review by Chong and Hester makes for sobering reading. They take as their theme the evidence base of medical treatment of trigeminal neuralgia which is shaky at best. However, this comprehensive review makes it clear that there are treatments worth trying in this condition, and this includes interesting new data on the use of triptans. This article nicely complements the one we had recently by Professor Coakham on the surgical treatment of this disorder.

In the series on the patient perspective, Steve Pape discusses the mental problems of a serious head injury. Steve survived a horrific motor bike accident and whilst making great progress with his physical disability struggled with a mixture of cognitive and affective difficulties. His account therefore delineates with great clarity these problems, highlighting how he readjusted to them after a major head injury and how complicated and unrecognised these are in contrast to the physical disability that such patients experience. This theme is to some extent taken up by the two articles of Andrew Hanrahan and Christine Collin and Lloyd Bradley.

In their article, Andrew Hanrahan and Christine Collin highlight the value of long term rehabilitation therapy by taking us through the case history of a young man with Wilson’s disease who over the course of four years of therapy went from being “totally dependent” to obtaining a degree and being able to “run, swim and play some sport”.

Lloyd Bradley, on the other hand, explores the issue of the “soul” in Doctor Faustus by Thomas Mann. This fascinating essay discusses the issues of what defines people, their soul, and how this can be understood through literature and the neurological disorders of fictional characters and what this may mean in patients with brain injury.

The diagnosis of a vasculitis of the CNS is a difficult one to make and included in this is the problem of defining the extent and basis of that vasculitic illness. Mark Walker discusses all this in his contribution to our Neuropathology series, highlighting the salient features of the different types of vasculitides and illustrated with a plethora of instructive pathological images.

Andrew Larner continues his series on neurological signs, this time taking as his subject carphologia or floccillation. If you are not sure what these terms refer to then read this article, so that you do not mistake them for self harm! Our sponsored article on Drugs in Neurology explores the value of glatiramer acetate as a disease modifying therapy in patients with relapsing remitting multiple sclerosis especially in patients who have failed beta interferon treatment for whatever reason.

We hope you enjoy this new issue of ACNR - do feedback to us on our articles, especially the controversies and finally, don’t forget to look at the list of latecomers to the neurologists ball.

Roger Barker
Roger@acnr.co.uk