Editorial
Neurologists are usually advised to hold back on writing about the history of our chosen discipline until well into retirement. Critics of the amateur neurohistorian caricature such work as the cataloguing, usually erroneous, of claims for priority rather than scholarly assessments of medical achievement set in the social climate in which those discoveries were made. But, far from representing a pastime for those now declared past their time, the engagement with medical history puts contemporary work in context, and enhances its status through linkage to an illustrious past. That is why Isaac Newton wrote to Robert Hooke (borrowing the sentiments from Bernard of Chartres): ‘If I have seen further it is by standing on the shoulders of giants’. In ‘Once on this familiar spot of ground’ (a quotation from the historian G. M. Trevelyan writing on the romance of history), Jürg Kesselring reviews Multiple sclerosis: the history of a disease, written by Jock Murray, neurologist and professor of medical humanities at Dalhousie University in Nova Scotia, Canada, who traces the story from Lidwina the Virgin (a possible sufferer, with disease onset late in 1395) to the new criteria for diagnosis proposed in 2001. In distinguishing the philosophical mind from the professional scholar, Professor Kesselring takes as his authority Friedrich Schiller. Murray's book is encyclopaedic in detail, scholarly in the appraisals, and mature in its philosophy of medical history. The stuff of history happens in the present, and needs a skilful narrator. Reinhard Hohlfeld and Hartmut Wekerle express admiration for the literary skills of Howard Weiner in his semifictionalized account of Curing MS: How science is solving the mysteries of multiple sclerosis, in which Dr Weiner offers his school pal Norm, who is affected, a contemporary account of this difficult disease in a way that both the fully informed professional and the interested lay reader will admire.At present we are accepting 16% of submitted manuscripts for publication in Brain. The final selection of paper depends on favourable reviews, and the need to balance the contents of each issue across the spectrum of clinical neuroscience on offer, to recognize when fashion is spawning too many closely related papers on the same topic, and to take a few risks on material that may not be definitive but is likely to interest our readers. Rejected authors sometimes share their disappointments with the editorial office, and a few suggest that Brain is parochial. We try politely to dispel these concerns, but those who scrutinize such matters will spot that nine of the 21 manuscripts in the present issue come from one institution. Ordinarily we might have distributed these papers across a few issues. The present batch is together because, from July, the format of Brain will change and manuscripts set in the old style need to be printed in this, the final ‘Goudy pt 121’ issue. By way of reassurance, in the year to April 2005, Brain published papers from 22 different countries: whilst the UK was (just) in pole position, hot on its heels were the USA, Germany, Canada, Italy, France, Australia and the Netherlands.
The detection of regional atrophy has become a useful surrogate for registering the changes in tissue integrity that occur in a variety of neurological disorders. On page 1259, Nicholas Cordato and colleagues from Sydney and Melbourne correlate the statistical probability of regional orbitofrontal atrophy with behavioural features, and caudate and cingulate atrophy with motor deficits, early in the clinical course of supranuclear palsy. The clinical and radiographic predictors of atrophy observed in patients with primary progressive multiple sclerosis are described by Jaume Sastre-Garriga and investigators from the Institute of Neurology in London; the amount of inflammation and existing disability each predicted global atrophy, especially that affecting white matter, whereas there was no surrogate for loss of grey matter. On page 1461, Miguel Hernan from the Harvard School of Public Health and colleagues from Boston and California inflame an existing debate by adding to the evidence that smoking increases the risk of developing multiple sclerosis (but with an odds ratio having confidence intervals that lie only just above unity) and has a somewhat stronger association with conversion to secondary progression. Taken alone, these data may seem provisional but they complement two other studies pointing in the same direction. Michael Heneka and collaborators from Belgium and the USA (page 1442) use pharmacological inhibition successfully to inhibit the inflammatory process and the cascade of neurodegeneration in a mouse model of Alzheimer's disease, by inhibiting the nuclear peroxisome proliferator-activated receptor-
, thereby providing further evidence for the role of inflammation in amyloidogenesis. Two papers describe alterations in neurotransmitters and peptides that correlate with altered mood. Ai-Min Bao from Anhui, China, and colleagues at the Institute for Brain Research in the Netherlands show that immunocytochemical evidence for enhanced expression of corticotrophin-releasing hormone, co-localizing with oestrogen receptors, is detectable in neurons from the parventricular nucleus of the hypothalamus in individuals who suffered mood disorders during life (page 1301); and Phillippe Remy with investigators from Paris and London implicate reduced activity of dopamine and noradrenaline in the locus coeruleus and parts of the limbic system in patients with Parkinson's disease who had a history of depression and anxiety, whereas apathy correlates inversely with dopamine and noradrenaline transporter binding in the ventral striatum (page 1314).
We take it for granted that communication between individuals is better elaborated in humans than other species. We use speech or written symbols and gestures to understand and make known our own intentions. In The language of gesture (1939), Macdonald Critchley describes how his interest in this matter was aroused by caring for a deaf-mute at the National Hospital, Queen Square, who—following a small completed left hemisphere stroke—lost the ability to communicate in sign language. This ‘aphasia’ prompted Dr Critchley's general enquiry into a gestural system of speech that is independent of racial and linguistic barriers, instinctive in its nature, and similar to the sign-talk practised by aboriginal communities. Chapters IX and XVII deal with sign language in Oriental literature and theatre, respectively. In this issue, Kuniyoshi Sakai and a team from Tokyo describe the use of functional MRI to explore the commonality of hemispheric lateralization in the understanding of sentences and non-words, using Japanese sign language and spoken Japanese, in deaf signers, individuals able to use both systems through being the children of deaf parents, and appropriate controls (page 1407, and front cover). Activation patterns were identical in all groups under all conditions, with a left inferior frontal and temporoparietal dominance. Thus, these are the regions that play a universal role in processing linguistic information—whatever symbols are deployed. We review Macdonald Critchley's original case report (Brain 1938: 61; 163–9) and the paper by John Hughlings Jackson (Brain 1878: 1; 304–30) on which it leans, in From the Archives.
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Brain 2005 128: 1473-1474.[Extract] [FREE Full Text]
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