John Stein argues the case for dyslexia being a distinct neurological entity with a plethora of data to support its diagnosis and a rationale for how to treat it. This is a clear, thought provoking account by an acknowledged expert in this area and will be of great interest to neurologists and neuroscientists alike.

Simon Hammans reviews the approach to patients with mitochondrial disease in this supremely comprehensive and comprehensible account of this group of disorders. Simon, who worked with the late Anita Harding when the field was in its infancy, uses that perspective to distil the critical issues that are of value clinically as well as of interest scientifically.

Depression is common and its aetiology and treatment varied and complex. Professor Philip Cowan in his review takes us through the serotonin system and its fourteen different receptors to give us a clear account on the way in which 5HT could be best manipulated for maximal efficacy and for treating this condition with minimal side effects.

The origins of neuropathology can be traced back to Herophilus of Chalcedon in Greece around 300 years BC, according to Roy Weller in his article entitled “Neuropathology in Context”. Roy, who initially edited our neuropathology series, takes us through the history of this discipline and includes a discussion of its current standing and future position in neurological practice.

Katharine Symons in her article in the rehabilitation section discusses what happens with standing up patients with minimal conscious states or the vegetative state in terms of their behavioural capabilities. She comments that “this study demonstrates that simple interventions can enhance behavioural repertoires in some low awareness patients”, and thus highlights that assessments of such patients should involve relatively ‘low tech’ manoeuvres as much more ‘high tech’ assessments including functional imaging (see ACNR 7.2).

The management of chronic migraine, often in the context of analgesia abuse, is enough to induce a headache in all but the most robust of neurologists. It is therefore very useful to have Paul Shanahan and Manjit Matharu take us through their approach to this problem and how best to manage such patients in our sponsored Drugs in Neurology feature.

Dinesh Nayak and Kurupath Radhakrishnan, in their fascinating account on epilepsy in India, begin with the sobering fact that if all cases of epilepsy were seen by neurologists in this country then each neurologist would have to care for about 5,000 people with this condition! However, given that most of the population live in rural areas (away from tertiary centres and neurologists) then this is not the case but consequently they are seen by non-specialists who tend to favour expensive sub-therapeutic polypharmacy. This, coupled to the social stigma of having epilepsy (especially if you are a woman), makes management of this condition particularly difficult, when the only drug free of cost to patients is phenobarbitone.

In the neurophysiology series, Professor Louis Lemieux explores the potential of EEG coupled to fMRI in the assessment of epilepsy. This novel technique has now developed to the point that interesting data is emerging which suggests it can provide more information on the origin of focal seizures and so could become a more mainline tool in the assessment of epilepsy patients in the future.

Andrew Larner in the fourth of his series on headache concentrates on its descriptions in the ancient world. In the course of his typically illuminating discussions he informs us that “wisdom is born of headache by way of unsafe sex” as well as revealing that Aristotle felt “that those with lousy heads are “less than ordinarily troubled with headache”.” We have our usual regular items including journal, book and conference reviews, and don’t forget our website.

Roger Barker
Roger@acnr.co.uk