Editorial
James Joseph (‘Gene’) Tunney (1897–1978) was heavyweight boxing champion of the world winning 82 of his 88 fights and with 48 knock-outs. He twice defeated the legendary Jack Dempsey, their 1927 duel—known as the Long Count Fight—being considered one of the most famous bouts in boxing history. But in that year Tunney records: ‘. one day whilst [sparring] with Frank Muskie . we bumped heads . I was terribly dazed . [and] as I straightened up, a long hard swing landed on my jaw . without going down or staggering, I lost all consciousness of what I was doing . I have no recollection of anything that occurred until the next morning . when I was awakened . wondering who I was and what I was doing . for 3 days I could not remember the names of my most intimate acquaintances . I decided that any sport in which such accidents could occur was dangerous. I realised I had concussion. The first seed of retirement was sown .’ (G Tunney. A man must fight, 1932). And wisely Gene Tunney did retire the following year, becoming a minor movie star and living another 50 years. In Apoplexia and lethargus (page 2746) David Shaw reviews an entirely new version of a classic book: Plum and Posner's Diagnosis of stupor and coma, now re-written in a 4th edition by the two original authors and two colleagues after an interval of 41 years since its first appearance in 1966. Just as the neurological examination in children requires special tricks, so too Plum and Posner described how to assess coma clinically providing a memorable analysis that illuminated inter alia the functional anatomy of eye movements. Professor Shaw draws on a rich literature of coma and prolonged sleep from Shakespeare to Snow White, and of science that spans Hippocrates to John Cheyne writing at the dawn of modern neurology. David Shaw is a former professor of neurology in the University of Newcastle-upon-Tyne, past dean of medicine in that University and ex-President of the Association of British neurologists. He worked with Dr Plum in the 1960s. As a Scot, he cannot resist supplementing his Shavian learning and affectionate critique of ‘Plum and Posner’ with a well aimed blow at the inferiority of bourbon by comparison with Scotch whisky.On page 2596, Dietmar Krex and colleagues from Dresden, Dusseldorf, Berlin, Heidelberg, Bonn, Tübingen and Hamburg (Germany) report a molecular analysis showing show that long-term (>3 years) survival in glioblastoma multiforme is associated with lack of 1p and 19q chromosomal deletions and with the presence of MGMT (O6-methylguanine methyltransferase) hypermethylation; youth and a good initial Karnofsky performance score also provide favourable prognostic features. Amongst papers dealing with aspects of demyelinating disease, Yann Mikaeloff on behalf of the KIDSEP study group (Paris, France and Montreal, Canada) use robust epidemiological methods to suggest that passive smoking in the home imposes an increased relative risk on children for developing a first episode of multiple sclerosis (page 2589). Ranjan Dutta and a team from Cleveland (Ohio) and Vanderbilt University (Nashville, USA) propose ciliary neurotrophic factor, molecules associated with its signalling pathway and Bcl 2 as participants in the response to injury of cortical neurons threatened by the disease process in multiple sclerosis (page 2566). Hannelore Ehrenreich and investigators from Göttingen (Germany) report an early phase clinical trial that adds erythropoietin to the list of therapies that might prove neuroprotective in managing the secondary progressive phase of multiple sclerosis (page 2577). Anna Williams and colleagues from Edinburgh (UK) and Paris (France) suggest that semaphorin 3A and 3F play a role in orchestrating the migration of remyelinating oligodendrocytes towards active demyelinating lesions, that retain the potential for remyelination, but not the chronic lesions where repair evidently has failed (page 2554).
Amongst four papers on behavioural neurology, Suvama Alladi and a group from Cambridge (UK) describe 34 of 120 individuals presenting consecutively with cognitive impairment who show a strictly focal onset of Alzheimer's disease, proven at autopsy; this phenotype may remain stable for many years and so, for a while, is easily confused with posterior cortical atrophy, corticobasal syndrome and progressive non-fluent aphasia but less frequently with semantic dementia or frontotemporal dementia (page 2636). In this respect, Norman Foster and investigators from the Universities of Utah, Michigan, Pennsylvania, California and Washington (USA) show that visual interpretation of stereotactic surface projection metabolic and statistical maps derived from fluorodeoxyglucose positron emission tomography (FDG-PET) is the most sensitive biomarker for distinguishing Alzheimer's disease and frontotemporal dementia, proven at autopsy, and so reliably tilting the diagnosis in one direction or the other in situations where the clinical data are ambiguous (page 2616).
Four papers deal with the story of head injury with which we began. Joshua Bell and colleagues from Toronto (Canada) model traumatic cerebellar Purkyn
cell loss to show that this involves both physical stress and excitotoxic mechanisms involving AMPA receptor switch to the GluR1/3 phenotype leading to rapid protein kinase C-dependent endocytosis and increased calcium permeability; 1-naphthylacetyl spermine and Go6976 are protective, adding these compounds to the list of putative protective molecules for neuronal loss in head injury (page 2528). Marilyn Kraus and a team from the University of Illinois (Chicago, USA) wait 12 months before using fractional anisotropy of white matter diffusion tensor imaging to catalogue extensive axonal loss throughout the cerebrum following even mild traumatic brain injury, and show behavioural effects on executive functions, attention and memory (page 2508, and see cover). Tom McMillan and Graham Teasdale add to this evidence for late consequences of head injury by showing an increased mortality beyond the acute phase across a period of observation up to 7 years, especially in young people, explained by the lifestyle consequences of such injuries (page 2520). And Martin Coleman and colleagues from Cambridge and University College London (UK) and Kingston (Ontario, Canada) add to the disturbing report of a patient in the persistent vegetative state nonetheless able to register the processes of playing tennis (Owen et al., Science 2006: 313; 1402), now describing awareness for sophisticated nuances of language comprehension in 14 individuals with persistent vegetative or minimally conscious states (page 2492; and see commentary page 2482). Often the result of trivial yet catastrophic carelessness, the neurological consequences of conditions that disturb consciousness are frequently profound and the ensuing personal tragedies calamitous. In From the Archives, we review: On the mechanism of brain injuries by Alexander Miles, Brain 1892: 15; 153–189; and Experimental cerebral concussion by D. Denny Brown and W. Ritchie Russell, Brain 1941: 64; 93–164.
Many of our readers will know that John Newsom Davis, former editor of Brain, (1996–2004), died in a road accident on 24 August whilst on holiday in Romania with his wife Rosemary. (It is an unfortunate matter of timing that this editorial, From the Archives and several articles in the present issue focus on traumatic brain injury, and I regret any additional distress that may cause.) John combined the qualities of a fine doctor with those of a distinguished scientist making him an acclaimed clinical neuroscientist internationally. In his editorial work, John had a knack for sniffing out work that was forward looking and contemporary so that our reputation and bibliometric indices both increased during his tenure. He introduced electronic processing and online publication well ahead of other journals in the field. John's achievements and involvement with academic medicine earned him a high reputation amongst peers outside his speciality where he was rightly credited with having taken British neurology into the world of molecular medicine. Forever youthful in appearance, a tireless traveller and a brilliant speaker who prepared carefully and performed perfectly, John was a key figure in contemporary neurology held in high regard and with affection by all with whom he interacted. We will be publishing a more detailed analysis of John Newsom-Davis's life and work in a later issue.
Cambridge
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||