Editorial
Recent issues of Brain contain several original articles describing the role of the brain as the organ of decision. How external stimuli are sifted and orchestrated into actions and behaviours that advantage us as individuals and members of society—motivated by enlightened self-interest or uncomplicated altruism—lifts the study of brain and behaviour above the mere nuts and bolts of microcircuits and how they sense and respond with knee-jerk predictability. In ‘Mind as Machine’ Stephen Jacyna reviews Margaret Boden's weighty history of cognitive science, of which over 1000 pages (but still only around 60% of the book) are devoted to the story of mind as nothing more than the product of brain functions that are, in turn, irrevocably yoked to structure (page 2526).The problem, if that is one's perspective, starts with that astonishing decade, the 1660s, when the brain came out of the skull and the question could be asked: ‘is that all there is?’ Written by Julien de la Mettrie in 1747, but published anonymously, L’homme machine (Man a machine) met the fate of most books from the Age of Enlightenment that challenged the doctrines of the Church. It was burned. At least the author, who had fled France to Prussia, did not join his printed work. He died from fever aged 43 years. Less fortunate had been Michael Servetus, burned at the stake on October 27, 1553 along with most copies of his heretical book and manuscripts: Christianismi restitutio (1553) discussed the structure of the brain and the physical seat of the soul—hence the trouble; and Servetus proposed that spirit containing the latter moved from the ventricles to the blood from where it was distributed throughout the body. In passing, he described the circulation of the blood 75 years before William Harvey. Of the book, it is thought that only three copies survive—in Paris, Vienna and Edinburgh (this being the copy once owned by Servetus's persecutor and incinerator, John Calvin). The materialist view of mind can be traced to the classical world: Leucippus, Democritus and Epicurus in Greece; and Lucretius in Rome (De rerum natura). Together, these luminaries considered the random motion of atoms as evidence for free will. Now, in an increasingly secular world, most commentators are De La Mettrieans; and molecular atheism is fully developed with the stated views of James Watson (‘there are only atoms ... everything else is social work’) and Francis Crick (‘our joys and sorrows, our memories and ambitions, our sense of identity and free-will ... are no more than the behaviour of a vast assembly of nerve cells’)—a position vigorously and persuasively challenged by two of our recent book essayists, Raymond Tallis and Rev. Alasdair Coles (see Brain 2004: 127; 2558–63; 2007: 130; 3050–4; and 2008: 131; 1953–9). These details and the debate are fully explored by Chris Nunn in De La Mettrie's Ghost (2005): Nunn's dualism, however, sees decision as ‘... a property of the tale not the apparatus with which it is told’, a story line hinting that the analysis of man a machine lies more in elucidating the nature of behaviour in the context of social neuroscience than the narrow conceptual framework of microcircuits. We must be grateful to Stephen Jacyna for his scrutiny of Mind a machine: a history of cognitive science since, in the event, he considers this to be a not-so-easily digested encyclopaedia rather than the definitive historical essay and synthesis that Margaret Boden aimed to write. Dr Jacyna is in The Wellcome Trust Centre for the History of Medicine at University College, London: his recently published full-length biography of Sir Henry Head, benefiting from access to a rich archive of personal papers and letters, is recently published and will be reviewed in a forthcoming issue of Brain.
‘The benign occipital epilepsies of childhood are classified into two apparently discrete groups comprising an early (Panayiotopoulos) and late (Gastaut) form’. In the present issue, Isabella Taylor and a team of epileptologists from Melbourne (Australia) bring classical genetic analysis (twin and familial recurrence rates) to this classification but describe overlap between the prototypic syndromes, leaving Messrs Panayiotopoulos and Gastaut placed at either end of a spectrum accommodating phenotypes that show features of each (page 2287). But Dr (CP) Tomis Panayiotopoulos and colleagues from London (UK) also review their position on the various benign childhood focal epilepsies (page 2264) coming at the problem from the perspective of clinical and laboratory phenotypes. Naturally, here the emphasis is on ‘Panayiotopoulos syndrome’, as originally described by the lead author in 1989, in which the autonomic features, especially vomiting, and occipital electroencephalographic activity both serve to disguise and confuse the diagnosis. We can presume that debate will continue on this topic. Brain receives many submissions evaluating pre-symptomatic biomarkers for various disorders. In the present issue, Thomas Hyde and colleagues from Mannheim (Germany), and Maryland and Pennsylvania (USA) show that, by comparison with siblings and unrelated controls, a history of childhood enuresis correlates with the subsequent development of schizophrenia and abnormalities of prefrontal structure and function that are themselves associated with psychosis (page 2489).
Most intact human nervous systems know whether they are vertical or tilted, to around 4° of accuracy between the perceived and real displacement. Dominic Pérennou and colleagues from Grenoble and Nimes (France) and London (UK) show that lesions involving the thalamo-parietal projections, especially those of the right hemisphere, are required correctly to judge postural and vertical tilts; defects manifest as ‘pushing’—active lateral tilt of the body when sitting (page 2401 and see cover). Most neurologists would be pleased to diagnose porphyria as the cause of acute peripheral neuropathy, but what is the mechanism? Based on direct electrophysiological measurement and mathematical modelling, Cindy Lin and the group of Mathew Kiernan from Sydney (Australia) suggest that abnormal porphyrin metabolism is associated with a reduction in the hyperpolarization-activated cyclic-nucleotide dependent current (IH) that may manifest as overt neuropathy when Na+/K+ pump activity is also impaired resulting in abnormal membrane depolarizations (page 2510).
Brain inflammation is implicated in many and diverse neurological conditions. One structure that gates any increase in lymphocyte surveillance of the brain is the Virchow–Robin space surrounding small vessels as they penetrate the parenchyma; these can often be visualized by magnetic resonance imaging and are usually considered not to be of any pathological significance. On page 2332, Jens Wuerfel and a team from Berlin and Frankfurt (Germany) challenge this perceived innocence showing that the collective volume of Virchow–Robin spaces, but not their number, is increased in people with multiple sclerosis—and serial change correlates with inflammatory activity marked by new contrast enhancing lesions but not parenchymal atrophy. Hence the view that detecting Virchow–Robin spaces by magnetic resonance imaging is a normal finding seen with advancing age may be misplaced. Martin Bendszus and investigators from Würzburg and Berlin (Germany) use the novel magnetic resonance contrast-enhancing agent gadofluorine M to improve the sensitivity, compared with gadolinium–DTPA (diethylenetriamine pentacetic acid), of detecting T1-weighted images, not seen on T2-weighted images, that correlate with inflammation and demyelination in the myelin-oligodendrocyte glycoprotein-induced model of experimental allergic encephalomyelitis (page 2341).
As part of our series of Occasional papers (page 2520), Peter Kempster and Jane Alty make a stab at retrospective clinical diagnosis in the case of John Ruskin, 19th century essayist and critic of art and architecture, who lived to the age of 81 years but suffered recurrent bouts of delirium and visual hallucination coinciding with alteration—many would judge, deterioration—in what had hitherto been an exemplary prose style: arguing that the early manifestations may actually have improved his creative writing, their diagnosis is ... CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy); others, no doubt, will argue differently.
With emerging interest in the option of cell-based therapies for a variety of neurological diseases, in 2005 we published details of the protocol and surgical technique used for stereotactic injection of focal traumatic spinal cord lesions with human olfactory ensheathing cells (see Brain 2005: 128; 2951–60, and the cover of that issue). Now, Alan Mackay-Sim and his team from Queensland (Australia) and Marseille (France) report safety of the trial at 3 years after this intervention; and the present status of medical, psychosocial, radiological and neurological outcomes in the single-blind controlled study designed to assess safety and procedural aspects rather than efficacy; they consider transplantation to be feasible and safe over this period—and apparently associated with clinical stability in all six patients, one of whom described modest improvements (page 2376). The authors are sufficiently encouraged to consider further trials; and the work will trigger hope for the many who wait patiently for therapies that reliably improve structure and function in a variety of brain and spinal cord diseases but especially spinal cord injury. Sadly, neither the as-yet unrealized expectations for a dividend from investments in basic neuroscience that enhances brain repair, nor the clinical needs of people suffering traumatic spinal cord injury are novel. In From the Archives, we review ‘The automatic bladder, excessive sweating and some other reflex conditions, in gross injuries of the spinal cord’ by Henry Head and George Riddoch (Brain 1917: 40; 188–263).
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