Paul Reading Maurice Curtis, Andrew Naylor, Richard Faull ... - ACNR

EditorialPaul Reading in the first in his twopart series on the NeurologicalSleep Clinic takes us through hisown views on how best to treat patientswho have excessive daytime sleepinessand hypersomnolence. This account,whilst being a very personal one, neverthelesscontains a very helpful frameworkin which to investigate and seepatients who complain of this disorder.Stem cells continue to be a majorarea of research interest in neuroscienceand in their review article MauriceCurtis, Andrew Naylor and RichardFaull discuss the adult neural precursorstem cell. They discuss the evidence forthe existence of two populations ofsuch cells in the adult mammalianbrain and how they respond to diseaseand might be manipulated in the futureto promote repair. A stimulating articleby one of the foremost groups workingon this system in human neurodegenerativedisorders.Dysautonomia reflects a disorder of paroxysmal changes in autonomicnervous system activity which may have its origins in a disconnectionsyndrome targeting the midbrain in a subgroup of patients with severeacquired brain injury. This condition is often not recognised and IainPerkes and Ian Baguely seek to educate us on this disorder and how it canbe treated with a concluding plea for bigger, more multi centre studiesinto this condition.Emma Matthews and Mike Hanna in our ‘Neurogenetics’ series editedby Tom Warner, provide an up to date account of novel therapies for musculardystrophies. In particular they discuss therapies designed to workon exon skipping, read through of premature stop codons by small moleculesthat suppress these, transfection of truncated dystrophic minigenes using viral vectors and the blocking of myostatin. This excellentreview highlights once more how the better identification of genetic causesof disease can lead to the development of novel disease specific therapiesfor patients.Peter Whitfield in our Neurosurgery article in this issue discusses theNICE guidelines on head injury. The guidance is summarized in a seriesof tables which is an extremely helpful distillation, and to date what isproposed seems not as contentious as other similar guidelines, as AndrewLarner and Mark Doran discuss in their piece for ‘Controversies inNeurology’. In this they discuss in detail whether the NICE/SCIE dementiaguidelines are as useful as they would initially appear; in particularthey question the wisdom in allowing neurological input to be peripheralrather than more central to the future development and managementof patients with dementia. This is an interesting, thought-provoking articlewhich again raises questions about the process by which one can bestarrive at guidelines for widespread clinical practice.The Neuropathology article is a clear informative account of thepathology of intracerebral haemorrhage byArundhati Chakrabarty and AdityaShivane. In this article, the authors highlighttwo important new concepts thathave emerged on the pathophysiology ofthis condition, namely, that many haemorrhagescontinue to grow and expand overseveral hours after the onset of symptoms,and secondly that most of the brain injuryand swelling occurs after intracerebralhaemorrhage as a result of inflammationcaused by thrombin and other end productsof coagulation. However, even knowingthis has not yet altered the poor prognosisassociated with this condition.Whilst MS is common in the UnitedKingdom, it is much less so in more tropicalcountries such as India, although LekhaPandit argues that this might not truly bethe case in her illuminating account of MSand related disorders in India. The contrastin the management of MS in the UK andIndia is brought into sharp focus but withit comes the real belief and excitement thatthings are about to change for the better and that Dr Pandit is one ofthose leading this.We also have a summary of a roundtable discussion on the cognitiveconsequences of MS which covers the extent of the problem and how itcan be better assessed and integrated into normal patient care is discussed.In our Neurophysiology series, Antonio Valentín and Gonzalo Alarcóndiscuss the technique of single pulse electrical stimulation (SPES) to showthat delayed responses to cortical stimuli are predictive and thus helpidentify epileptigenic areas of cortex. They present their data from 125patients and discuss why the technique may be an important additionalinvestigation in the pre surgical assessment of patients with refractoryepilepsy.Roald Dahl has made two significant contributions to neurologyaccording to the short article by Andrew Larner in this issue of ACNR.Firstly, he helped in the construction of a valve for hydrocephalus, andsecondly, developed a method for improving language recovery in aphasicpatients.Finally, we are sad to have to announce the loss of another great Britishneurologist, with the passing of Professor PK Thomas, who died on the25th January this year.We have our usual book, journal and conference reviews as well as ourfirst column from the ABNT. On our website more can be found, includingall the previous issues of ACNR a well as case reports. We hope thatyou continue to enjoy our journal and do let us know if we can improveon it.Roger Barker, Co-Editor,Email: roger@acnr.co.ukACNR is published by Whitehouse Publishing, 1 The Lynch, Mere, Wiltshire, BA12 6DQ.Publisher: Rachael Hansford • Email: rachael@acnr.co.ukAdvertising. Patricia McDonnell • Email. sales@acnr.co.uk • Tel/Fax. +44 (0)288 289 7023Editorial. Anna Phelps • Email. anna@phelps1972.freeserve.co.ukDesign & Production Email. design.dept@sky.comPrinted by. Warners Midlands PLC, Tel. +44 (0)1778 391000ACNRISSN 1473-9348 Volume 8 Issue 1 March/April 2008www.acnr.co.ukAdvances in Clinical Neuroscience & RehabilitationCopyright: All rights reserved; no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form orby any means, electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisheror a license permitting restricted photocopying issued in the UK by the Copyright Licensing Authority.Disclaimer: The publisher, the authors and editors accept no responsibility for loss incurred by any person acting or refraining fromaction as a result of material in or omitted from this magazine. Any new methods and techniques described involving drug usageshould be followed only in conjunction with drug manufacturers' own published literature.This is an independent publication - none of those contributing are in any way supported or remunerated by any of the companiesadvertising in it, unless otherwise clearly stated. Comments expressed in editorial are those of the author(s) and are not necessarilyendorsed by the editor, editorial board or publisher. The editor's decision is final and no correspondence will be entered into.Paul ReadingThe Neurological Sleep Clinic – Part 1 – The Sleepy PatientMaurice Curtis, Andrew Naylor, Richard FaullManipulation of Neural Stem Cells as a Rehabilitative TherapyEmma Matthews, Mike HannaPossible New Treatments in Muscular DystrophyConference News • Journal Reviews • Book Reviews • Diary of EventsNational Brain Science WritingPrize 2008www.youramazingbrain.org4 I ACNR • VOLUME 8 NUMBER 1 • MARCH/APRIL 2008