It is strange, when you think about it, that we see the visual world as complete – there are no gaps or missing pieces of information where the vessels and optic nerve fibres cross and disappear through the retina. The ability of the visual system to fill-in for this missing information is very successful, and in their article Rimona Weil and Geraint Rees explain how this may occur. In addition they provide a series of figures which allow you to experiment on yourself with this fillin phenomena.

What does it mean to have mild cognitive impairment (MCI) in terms of the risk of developing dementia in the immediate and short term future? In the review article by Alex Mitchell we learn that "MCI is not a uniform prodromal condition but rather a collection of disorders united by a propensity towards modest memory (and to a lesser extent non-memory) cognitive difficulties." As a result most studies now show that only the minority of patients with MCI go on to dement. The challenge therefore is in better identifying this subgroup of individuals with the hope that we can delay or arrest the degenerative process that underlies their emerging cognitive dysfunction.

Alexander Jeans and Olaf Ansorge in their article offer a useful complimentary account to that of Jemeen Sreedharan and Chris Shaw (ACNR 9.2), covering the neuropathology of motor neurone disease. They highlight how the new genetic causes of some forms of familial MND have changed our perspectives on the pathology and the nature of the pathogenic pathways leading to the demise of these cells.

Geophagia is the main symptom (and sign?) discussed by Andrew Larner in his ongoing series of articles entitled Neurological signs. The consequences of such a habit are not good, as Dr Livingstone commented when he was the first to observe and comment on this phenomena! Indeed Andrew and his colleague Dr Ford also treat us to an interesting tour of neurology as seen on the big screen.

Boyd Ghosh has kindly taken on editing a new series of articles, discussing the challenges of research for those in training and how this can best be accommodated in the changing landscape of the NHS and the expectations placed on the next generation of Consultant Neurologists. In the first of the series, Boyd lays out how the series came about and how it will evolve, and includes an article by Geraint Fuller discussing “Doing Research in the post MMC world”. This series should help those planning to do, or those actually doing, research, explaining how this can best be achieved – and this includes achieving it within the new European Working Time Directive! This is the topic that Biba Stanton takes as the theme for discussion in the ABNT section. Talking of which, Paul Morrish has responded to an earlier article in this series and discusses his views on how neurology and neurologists can best plan for the future demands that will be increasingly placed in this field of medicine.

Continuing in a similar vein we are also seeking to have the occasional article written about leading neurologists of the last century, who have now passed away. In the first of these, Alastair Compston gives a very personal account of the late Anita Harding. A neurologist who sadly died at the age of 42 and who had done so much to change our understanding of many neurological conditions - especially hereditary neuropathies and cerebellar ataxias, as well as introducing us to mitochondrial disease. Who knows what Anita could have achieved, but even in her short life, Alastair reveals much about her as a person as well as summarising all she did academically.

In our Personal Perspective, we are fortunate to have a most eloquent account by a patient who suffers from a Congenital Insensitivity to Pain (CIP) due to problems in the SCN9A gene. This article summarises the traumas (literally) of living with this condition and how she has learnt to cope with it, along with the frustrations of trying to explain her condition to the medical community, most of whom have never heard of it, and thus don’t believe it exists! The account that the patient gives us should make us all sit and think about how much we listen to patients and their problems. She prefers to remain anonymous for personal reasons.

In our Neurophysiology series, Professor James Gilchrist and George Sachs discuss how neurophysiology can be used not just for diagnosis, but also in the longitudinal assessment of patients and then how this can be used to help guide decisions on management.

We have in addition a short article in which there is a discussion on whether the Department of Health should reconsider drug substitution plans for epilepsy and we also have our usual book reviews along with our eclectic mix of conference summaries and journal reviews. Finally, we have some more great case reports, some in the journal, but more on the web edited by Alastair Wilkins. See www.acnr.co.uk for more information.

Roger Barker
Roger@acnr.co.uk