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F RO M T H E E D I TO R ...Martin Turner and Gwenaëlle Douard provide us with astimulating account on recent thoughts about MND and howthe loss of inhibitory interneurons may underlie some aspectsof the disease. They discuss all this in the context of some of the knownassociations between MND and athleticism and this review certainlygets you thinking about neurodegenerative conditions in a completelynew way.The concept of involuntary musical imagery and a spectrum ofmusical symptoms is introduced to us by Lassi Liikkanen from Finland.It appears to be prevalent in that it occurs at least once a week in 90%of Finnish internet users who filled out an online questionnaire(presumably not during the Olympic closing ceremony). This imageryis not just about sticky tunes or unshakeable earworms, but can includepalinacousis: ‘the auditory illusion of persistence of sound impressionsafter cessation, sometimes music’, and musical obsessions.Stephen Price and colleagues in the article for the Neurosurgicalseries, take us through the diagnosis and treatment of high gradegliomas – tumours that carry with them a dire prognosis. They explainhow better defining molecular markers expressed within tumours hashelped to better predict their behaviour and responsiveness to therapy.This excellent up-to-date account also looks to the future and agentsthat may prove useful in the clinic including a range of targetedtherapies, some of which will hopefully be approved for use both inEurope and the US!Alys Mikolajczyk and Andrew Bateman in the article for theRehabilitation Section of ACNR discuss some of the more subtle, butclinically relevant, consequences of stroke in terms of emotional andaffective problems. They discuss how common these problems are andhow they can be approached through psychodynamic counselling bytaking us through a study they conducted in 15 patients.Ray Chaudhuri in a Brittania sponsored article discusses the use ofapomorphine and DuoDopa® in patients with advanced Parkinson’sdisease and how these two therapies match up in terms of helping allaspects of the disorder, not just the motor features of these conditions.Finally, Suffolk artist Jane Southgate weaves together neuronalstrands in her art that she describes in her short article.We have a large collection of conference reviews in this issue andour usual journal and book reviews, and as usual we hope you enjoythis issue of ACNR. lRoger Barker, Co-Editor.Roger Barker, Co-Editor,Email. Rachael@acnr.co.ukTAlastair Compstonis Professor of Neurology andHead of the Department ofClinical Neurosciences inCambridge; President of theAssociation of BritishNeurologists (2009-2010); andEditor of Brain (from 2004). He isa foundation Fellow of theAcademy of Medical Sciences,and Foreign Member of theNational Academy of Sciences ofGermany. His research on theclinical science of humandemyelinating disease has beenrecognised by award of the SobekFoundation International ResearchPrize (2002), the Charcot Awardof Multiple Sclerosis InternationalFederation (2007), and the ZülchPrize of the Max-Planck Society(2010).Alasdair Colesis co-editor of ACNR. He is aUniversity Lecturer inNeuroimmuniology atCHg g y y, jyears of research on multiple sclerosis. Over this time, a picture has emerged of this disease as aninflammatory disorder of the central nervous system, caused by a complex interplay of multiplegenetic susceptibility alleles and unknown environmental triggers. We have tried to illustrate this in ourchoice of landmark papers, at the same time being aware that strong cases could be pressed for otherstudies to be included. It is clear that many lines of scientific attack on the disease have benefited fromincreasingly potent weapons, and in many cases our papers reflect the application of the very latest technologyof the day. Finally we note that three of our ‘top ten’ were authored by Ian McDonald (1933-2006),testimony to his extraordinary contribution to understanding multiple sclerosis. 1 Here are our first threelandmark papers, which chart the beginnings of understanding of pathology, immunology and treatmentof multiple sclerosis.Figure 1: Mode of Action of Botulinum Toxin 3B O O K R E V I E W SInternet Addiction. A Handbook aEvaluation and Treatment1916: The pathological anatomy of thelesion in multiple sclerosisDawson JD. The Histology of DisseminatedSclerosis. Transactions of the Royal Society ofEdinburgh 1916;50: 517-740.James Dawson (1870–1927) left the greatestpathological account of multiple sclerosis inthe English language (Dawson 1916). First hesummarises the literature. The issue (then asnow for some contemporary logicians) iswhether the the disease is ‘inflammatory’ or‘developmental’ (degenerative). The primaryvascular, inflammatory, doctrine was espousedby Dejerine, 2 Williamson 3,4 and Marie, 5 whosuggested that infections initiate the changes inblood vessels. Bielschowsky 6 considered thatthe vascular process is directed primarily atnerve fibres. Strumpell 7 considered that exogenousinsults act upon an ‘intrinsically weakened’system; and Bramwell 8 also saw multiplesclerosis as primarily a developmental disturbance.Müller, 9 the most articulate teacher fromthe developmental school, proposed that anyInternet addiction is not universally recognised as aparticipation of the blood vessels within theclinical disorder as yet, although it will be included inlesion is secondary and his concept of ‘multipleREPRINTS AVAILABLEan appendix of DSM-V. The variety of names used forgliosis’ as the essential process rehearses thefinal position taken by Charcotthe condition – including problematic internet use,10 and most of hisschool. Redlich pathological internet use, online addiction, and11 and Huber 12 also saw the insultas a toxin- or microorganism-induced primaryinternet-enabled compulsive behaviour (135) –degeneration of the myelin sheath withperhaps reflect its uncertain nosological status. But thesecondary inflammation and blood vesselproblem is real enough, particularly amongst adolescents,such that in countries such as South Koreachanges. But, as often is the case, the bestaccount was the first: Rindfleisch 13 assignedpublic health treatment and prevention programmespriority to the blood vessels, proposing aare already in place (223-243). Screening tests such assequence in which a chronic irritative conditionof the vessel wall alters the nutrition ofthe Internet Addiction Test (22-24) are available.nerve elements, leading to atrophy with metamorphosisof the connective tissue producingular to pathological gambling, is repeatedly made (20,The link to impulse control disorders, and in partic-monster glia (Deiters or Rindfleisch cells).47, 144, 224), since all the core components of addiction(i.e. salience, mood modification, tolerance, withdrawalsymptoms, conflict, relapse) may be encountered. Withits “variable ratio reinforcement schedule” the internethas psychoactive properties (144) which may lead topathological use in predisposed individuals. Someargue, however, that the syndrome arises from behaviouralpatterns rather than the medium per se (249).Treatment is problematic for many reasons. Affectedi• Peer reviewed • ABPI compliant• Translations available • Multiple country coordinationFor more information & quotes, contact: reprints@whitehousepublishing.co.ukparents are also involved: 245-266)treatment facility in the US (214-2seem to be a feasible approach oAbstinence, a favoured strategy fo(alcohol, drugs, sex), is not really anthe ubiquity of the internet and itsboth domestic and occupationaabsence of controlled trials for anprevention (via education) would sattractive management approachimportance of assessing for andother, concurrent, psychiatric disobipolar disorder, substance abuemphasised.A number of psychosocial modetion are discussed in the book, butway of neurobiology: the basal ganare only mentioned in passing (e.pathological gambling in Parkinsotreated with dopamine agonists nolinks are established, and the nunderstood, it may be that this conaway from the psychiatric to the nW4 > ACNR > VOLUME 12 NUMBER 4 > SEPTEMBER/OCTOBER 2012