Paul Reading in the first in his two part series on the Neurological Sleep Clinic takes us through his own views on how best to treat patients who have excessive daytime sleepiness and hypersomnolence. This account, whilst being a very personal one, nevertheless contains a very helpful framework in which to investigate and see patients who complain of this disorder.

Stem cells continue to be a major area of research interest in neuroscience and in their review article Maurice Curtis, Andrew Naylor and Richard Faull discuss the adult neural precursor stem cell. They discuss the evidence for the existence of two populations of such cells in the adult mammalian brain and how they respond to disease and might be manipulated in the future to promote repair. A stimulating article by one of the foremost groups working on this system in human neurodegenerative disorders.

Dysautonomia reflects a disorder of paroxysmal changes in autonomic nervous system activity which may have its origins in a disconnection syndrome targeting the midbrain in a subgroup of patients with severe acquired brain injury. This condition is often not recognised and Iain Perkes and Ian Baguely seek to educate us on this disorder and how it can be treated with a concluding plea for bigger, more multi centre studies into this condition.

Emma Matthews and Mike Hanna in our ‘Neurogenetics’ series edited by Tom Warner, provide an up to date account of novel therapies for muscular dystrophies. In particular they discuss therapies designed to work on exon skipping, read through of premature stop codons by small molecules that suppress these, transfection of truncated dystrophic mini genes using viral vectors and the blocking of myostatin. This excellent review highlights once more how the better identification of genetic causes of disease can lead to the development of novel disease specific therapies for patients.

Peter Whitfield in our Neurosurgery article in this issue discusses the NICE guidelines on head injury. The guidance is summarized in a series of tables which is an extremely helpful distillation, and to date what is proposed seems not as contentious as other similar guidelines, as Andrew Larner and Mark Doran discuss in their piece for ‘Controversies in Neurology’. In this they discuss in detail whether the NICE/SCIE dementia guidelines are as useful as they would initially appear; in particular they question the wisdom in allowing neurological input to be peripheral rather than more central to the future development and management of patients with dementia. This is an interesting, thought-provoking article which again raises questions about the process by which one can best arrive at guidelines for widespread clinical practice.

The Neuropathology article is a clear informative account of the pathology of intracerebral haemorrhage by Arundhati Chakrabarty and Aditya Shivane. In this article, the authors highlight two important new concepts that have emerged on the pathophysiology of this condition, namely, that many haemorrhages continue to grow and expand over several hours after the onset of symptoms, and secondly that most of the brain injury and swelling occurs after intracerebral haemorrhage as a result of inflammation caused by thrombin and other end products of coagulation. However, even knowing this has not yet altered the poor prognosis associated with this condition.

Whilst MS is common in the United Kingdom, it is much less so in more tropical countries such as India, although Lekha Pandit argues that this might not truly be the case in her illuminating account of MS and related disorders in India. The contrast in the management of MS in the UK and India is brought into sharp focus but with it comes the real belief and excitement that things are about to change for the better and that Dr Pandit is one of those leading this.

We also have a summary of a roundtable discussion on the cognitive consequences of MS which covers the extent of the problem and how it can be better assessed and integrated into normal patient care is discussed. In our Neurophysiology series, Antonio Valentín and Gonzalo Alarcón discuss the technique of single pulse electrical stimulation (SPES) to show that delayed responses to cortical stimuli are predictive and thus help identify epileptigenic areas of cortex. They present their data from 125 patients and discuss why the technique may be an important additional investigation in the pre surgical assessment of patients with refractory epilepsy.

Roald Dahl has made two significant contributions to neurology according to the short article by Andrew Larner in this issue of ACNR. Firstly, he helped in the construction of a valve for hydrocephalus, and secondly, developed a method for improving language recovery in aphasic patients.

Finally, we are sad to have to announce the loss of another great British neurologist, with the passing of Professor PK Thomas, who died on the 25th January this year.

We have our usual book, journal and conference reviews as well as our first column from the ABNT. On our website more can be found, including all the previous issues of ACNR a well as case reports. We hope that you continue to enjoy our journal and do let us know if we can improve on it.

Roger Barker
Roger@acnr.co.uk