We have two contrasting review articles in this issue of ACNR. The first concerns epilepsy, the second paraneoplastic syndromes. Using a ketogenic diet to treat epilepsy has always been controversial since it was first reported in 1921. Helen Cross in her review gives us a clear account on the efficacy of this treatment in children with refractory epilepsy, albeit in studies that are largely open label in nature. Nevertheless, the data is persuasive and raises questions about the extent to which dietary manipulation in adults with epilepsy may be useful. The treatment of paraneoplastic neurological syndromes is often very disappointing. The need to identify the primary malignancy is clearly paramount but often therapies used to treat the neurological problem itself, are ineffective. Anette Storstein and Christian Vedeler from Bergen, Norway review this area and conclude that immunotherapies for these type of disorders do work occasionally, especially if the problem lies outside the CNS and in the periphery and in particular at the neuromuscular junction.

“A survey undertaken by Neurologists (n=661) in the USA revealed that 71% of patients with epilepsy forgot to take their AED (anti-epileptic drug) at least once per month and it was evident that the chance of a patient missing a dose increased with the number of tablets prescribed. Of patients that missed a dose, 45% reported a seizure.” So writes Professor Hermann Stefan (a member of our international editorial board) in his article on the importance of drug compliance in the effective treatment of epilepsy. This article reports on an interesting study involving Episenta – a form of sodium valproate that is packaged as minitablets, each one of which is a prolonged delivery unit containing 3mg of the drug and which can therefore be used once-a-day. This is a challenging article as for most of us in clinical practice, we often forget about compliance as a factor in failed medical therapies for neurological disease, including the control of epilepsy.

In our neuropathology series, Kathreena Kurian discusses recent advances in glioma biology, including a detailed discussion of the cancer stem cell that lies at the heart of these tumours. A concept that opens up a radically different therapeutic approach through using techniques and therapies that force these stem cells to undergo a differentiation programme, and by so doing lose their malignant potential. This coupled to a detailed discussion on the genetics and epigenetics of gliomas completes a thoroughly interesting account of one of the most difficult of tumours to treat.

The Rehabilitation article in this issue touches upon a difficult area of clinical practice, the transition of patients from the paediatric to the adult health care system. Often the impact of such changes is not appreciated by those who sit on either side of the divide and Professor Magid Bakheit on behalf of an expert panel discusses this transition with respect to cerebral palsy. They provide a useful table on what is minimally required as opposed to what would be ideal in such a process, and the discussion that revolves around this, could equally well apply to most areas of neurological practice and rehabilitation.

In his ongoing series of articles on Headache in the Neurological literature series, Andrew Larner describes the range of approaches that have been recommended by various authors over the years – including a rather definitive approach by Charles Dickens! As with all his articles, one cannot but be impressed by the detail and knowledge of literature that Andrew displays.

Talking of literature, we are also very fortunate to have an account by (Sir) Terry Pratchett on his dementia and how it presented and came to be diagnosed. This article, which he originally wrote for the Alzheimer’s Society (and which they have kindly allowed us to reproduce), is a very eloquent account of how this disease can creep up on individuals and rob them of certain faculties, whilst allowing them to function entirely normally in other areas of life. I would strongly recommend that you read this moving and challenging account.

Finally we have all our usual reviews and once again I would encourage you to become an active member of this journal through either reviewing journals and/or conferences for ACNR as well as providing us with feedback and suggestions.

Roger Barker
Roger@acnr.co.uk