Our first article is written by John Duncan, in which he discusses the role of MRI in epilepsy, not only in terms of identifying abnormalities, but in how it can be used to determine the success and consequences of surgery for this condition. In this richly illustrated article we benefit from an account from an authoritative author who has made a significant contribution in this area of clinical science.

In our second review article Mark Fish and Gareth Llewellyn summarise the current classification, pathogenesis, presentation, and treatment of Guillain-Barré syndrome. This relatively common, acute neurological problem has become more complex of late with the recognition that subtypes of it exist which are often associated with different anti ganglioside antibodies. This wonderfully succinct account helps clarify this and is a very useful summary of this condition.

At 8.52 am on the 8th October 2005 Arsalan Ahmad was doing a ward round on the Medical ITU in Islamabad when an earthquake struck killing 75,000 people. In the sobering account that follows he takes us through the process of trying to rehabilitate victims of the disaster using a more or less non existent system without any of the specialists many of us take for granted. Nevertheless, despite these problems the team took shape and helped in a way unimaginable before the natural disaster.

In our neurophysiology series David Allen and Ramamurthy Arunachalam treat us to a discussion on the investigation of patients with problems of muscle fibre excitability. In particular, they discuss how neurophysiology can help in the differential diagnoses of patients where this may be the case with a particular emphasis on critical illness myopathy – a condition which can often be hard to diagnose in the weak patient on ITU.

I have always assumed that infection in the context of stroke results from the physical disability that the stroke induces in the patient. Whilst this is true, Chris Price in his Controversies in Neurology article also introduces us to the concept that the stroke itself affects the immune system by suppressing it and by so doing increases the vulnerability to infections. Whether this is truly the case remains unproven but is an area eloquently covered in this article.

In a Medtronic sponsored article, Erlick Pereira, Dipankar Nandi and Tipu Aziz discuss the use of deep brain stimulation (DBS) in the treatment of a range of disorders that now extends to include psychiatric conditions (e.g. OCD) as well as pain syndromes. The evidence base for using DBS in these conditions is considered, as is the safety and cost-effectiveness for this therapy. In our other sponsored article in this issue of ACNR, Jane Bradshaw and Anita Rose discuss the important interplay between the affective and cognitive aspects of MS as well as fatigue. They emphasise the need to consider these aspects of disease in all cases of MS and that their optimal management may involve non-pharmacological measures as much as drug treatments.

As always we have our usual reviews, including a wonderfully comprehensive summary of the recent International Movement Disorder meeting in Chicago by Tom Foltynie.

So we hope you continue to enjoy the magazine and will let us know if there are other topics or areas you would like us to cover.

Roger Barker
Roger@acnr.co.uk