About 50 years ago, our understanding of how the cerebral cortex is organised was revolutionised by the development of single cell recordings in the sensory cortices of animals. This pioneering work by Vernon Mountcastle, Tom Powell, David Hubel and Torsten Wiesel led to the concept of cortical columns. In this issue of ACNR, R Quian Quiroga discusses how this technology has now been used to study the human brain in patients undergoing epilepsy surgery, with results that reveal how and where we store memories and semantic knowledge.

Of late, mutations in the mitochondrial DNA-polymerase gamma gene (POLG) have been recognised as causing neurological disease. In this issue, one such presentation is discussed in this context – namely MSCAE [mitochondrial spinocerebellar ataxia and epilepsy]. In their article, Charalampos Tzoulis and Laurence Bindoff present the background to the genetic basis of this condition, before discussing the clinical phenotype, investigation of it and its management. In particular they highlight the helpfulness of MRI and the need to think about the diagnosis in the first place, so that the gene can be sequenced. The neurosurgery article takes as its topic the vexed issue of AVMs and how they can best be treated. The authors clearly lay out the therapeutic options and conclude that “The management of a patient with an AVM is an individualised pathway that requires the multidisciplinary input of a neurovascular surgeon, an oncologist and a stereotactic radiosurgeon.” However, they also acknowledge there is much that is not known about the natural history of different types of AVMs, which makes the decisions on treatment options not as straightforward as one would wish.

For those who understood the basic MRI article by Justin Cross, now comes the advanced one dealing with ADC maps, FA, DTI, DWI, MRS and fMRI. This article combines just the right mix of physics and clinical application, such that all these acronyms will have meaning.

“Telemedicine is the assessment, diagnosis, direct treatment, education, monitoring and support of patients at remote sites via telecommunications, ranging from the plain old telephone service (POTS) to real-time videoconferencing through the Internet”. Dr Elsie Hui discusses how this technology has evolved and can be used to deliver telerehabilitation. This approach, if successful, would have a major impact on freeing up hospital services for in-patient care whilst ensuring that patients after discharge continue to receive appropriate rehabilitation. In addition it will allow health care systems to reach out into traditionally deprived areas. This is a most exciting area of development in health care delivery and raises many possibilities.

Helen Beaumont gives a very graphic description of how corticobasal degeneration affected her husband Clive, with major changes in his personality early on in the presence of a well preserved motor system. This moving account is motivation for anyone working in this area, to find a cure and better treatments for this type of progressive neurodegenerative disorder. We also have our usual collection of reviews and conference reports. If you would like to contribute please do get in touch.

Roger Barker
Roger@acnr.co.uk