Functional Symptoms in Neurology
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ISSN 1473-9348 Volume 4 Issue 6 January/February 2005 ACNR Advances in Clinical Neuroscience & Rehabilitation www.acnr.co.uk Review Articles - Functional Symptoms in Neurology: Diagnosis and Management; Congenital Myasthenic Syndromes Neuropathology Article - Primary Brain Tumours Rehabilitation Article - Visual Stress in Neurological Disease Management Topic - The Management of Degenerative Lumbar Spine Disease Contents January/February 2005 8 Review Article 27 Conference News Functional Symptoms in Neurology: Diagnosis and International Symposium on PD and Management Restless Legs Syndrome; ECTRIMS; Vas-Cog Society Jon Stone, Alan Carson and Michael Sharpe News; Sino-British Joint Conference on Neurology 12 Review Article 33 Drugs in Neurology Pregabalin – a New Treatment for Partial Epilepsy Congenital Myasthenic Syndromes and Neuropathic Pain David Beeson John Paul Leach 16 Special Feature 35 History of Neurology & Neuroscience NICE Guidelines for Epilepsy Management The Neurology of ‘Alice’ Mark Manford Andrew Larner 17 Neuropathology Article 38 Management Topic The Management of Degenerative Lumbar Primary Brain Tumours Spine Disease Daniel du Plessis Nick Haden, Peter Whitfield and Anne Moore 22 Rehabilitation Article 40 Reviews Visual Stress in Neurological Disease Arnold Wilkins 45 Books 24 Events 46 News ACNR is published by Whitehouse Publishing, 7 Alderbank Terrace, Edinburgh EH11 1SX. Tel: 0131 477 2335 / 07989 470278, Fax: 0131 313 1110, Email: [email protected] Publisher: Rachael Hansford, Design & Production Email: [email protected] Printed by: Stephens & George Magazines, Tel. 01685 388888. Cover picture: Copyright: All rights reserved; no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, Novartis/Daily Telegraph electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a license permitting restricted Visions of Science 2004, photocopying issued in the UK by the Copyright Licensing Authority. Medicine and Life, was Disclaimer: The publisher, the authors and editors accept no responsibility for loss incurred by any person acting or refraining from action as a result of awarded to Dr Peter material in or omitted from this magazine. Any new methods and techniques described involving drug usage should be followed only in conjunction with drug manufacturers' own published literature. Keston who used imaging This is an independent publication - none of those contributing are in any way supported or remunerated by any of the companies advertising in it, unless equipment from Siemens otherwise clearly stated. Comments expressed in editorial are those of the author(s) and are not necessarily endorsed by the editor, editorial board or Medical Solutions. publisher. The editor's decision is final and no correspondence will be entered into. For more information visit www.visions-of-science.co.uk The TMS equipment preferred by leading Neurologists and com Neurophysiologists in the assessment and improvement of nervous system function in various applications. Spring Gardens, Whitland, Carmarthenshire, Wales, UK SA34 0HR +44 (0) 1994 240798 . +44 (0) 1994 240061 [email protected] www ACNR • VOLUME 4 NUMBER 6 • JANUARY/FEBRUARY 2005 I 3 Leave gardening to the occasional, untrained volunteer Spend your hard-earned savings on a gardener Just do the gardening yourself Let your pride and joy turn into a jungle ® ropinirole PUT THEIR LIVES BACK IN THEIR HANDS Editorial Board and contributors Roger Barker is co-editor of ACNR, and is Honorary Consultant in Neurology at The Cambridge Centre for Brain Repair. His main area of research is into neurodegenerative and movement disorders, in particular parkinson's and Huntington's disease. He is also the university lecturer in Neurology at Cambridge where he continues to develop his clinical research into these diseases along with his basic research into brain repair using neural transplants. Alasdair Coles is co-editor of ACNR. He has recently been appointed to the new position of University Lecturer in Neuroimmunology at Cambridge University. He works on experimental immunological therapies in multiple sclerosis. Stephen Kirker is the editor of the Rehabilitation section of ACNR and Consultant in Rehabilitation Medicine in Addenbrooke's NHS Trust, Cambridge. He trained in neurology in Dublin, London and Edinburgh before moving to rehabilitation in Cambridge and Norwich. His main research has been into postural responses after stroke. His particular inter- ests are in prosthetics, orthotics, gait training and neurorehabilitation. David J Burn is the editor of our conference news section and Consultant and Reader in Movement Disorder Neurology at the Regional Neurosciences Centre, Newcastle upon Tyne. He runs Movement Disorders clinics in Newcastle upon Tyne. Research interests include progressive supranuclear palsy and dementia with Lewy bodies. He is also involved in several drugs studies for Parkinson's Disease. Andrew Larner is the editor of our Book Review Section. He is a Consultant Neurologist at the Walton Centre for Neurology and Neurosurgery in Liverpool, with a particular interest in dementia and cog- nitive disorders. He is also an Honorary Apothecaries' Lecturer in the History of Medicine at the University of Liverpool. Alastair Wilkins is our Case Report Co-ordinator. He is Specialist Registrar in Neurology in Cambridge. His main research interests are the study of axon loss in multiple sclerosis and the molecular biology of axon-glia inter- actions in the central nervous system. Roy O Weller is ACNR’s Neuropathology Editor. He is Emeritus Professor of Neuropathology, University of Southampton. His particular research interests are in the pathogenesis of Multiple Sclerosis, Alzheimer’s disease and Cerebral Amyloid Angiopathy. International editorial liaison committee Professor Riccardo Soffietti, Italy: Chairman of the Neuro-Oncology Service, Dept of Neuroscience and Oncology, University and S. Giovanni Battista Hospital, Torino, Italy. President of the Italian Association of Neuro- Oncology, member of the Panel of Neuro-Oncology of the EFNS and EORTC Brain Tumour Group, and Founding member of the EANO (European Association for Neuro-Oncology). Professor Klaus Berek, Austria: Head of the Neurological Department of the KH Kufstein in Austria. He is a member of the Austrian Societies of Neurology, Clinical Neurophysiology, Neurological and Neurosurgical Intensive Care Medicine, Internal and General Intensive Care Medicine, Ulrasound in Medicine, and the ENS. Professor Hermann Stefan, Germany: Professor of Neurology / Epileptology in the Department of Neurology, University Erlangen- Nürnberg, andspecialises in the treatment of epilepsies, especially difficult to treat types of epilepsy and presurgical evaluation, including Magnetic source imaging (MEG/EEG) and MR-Spectroscopy. Professor Nils Erik Gilhus, Norway: Professor of Neurology at the University of Bergen and Haukeland University Hospital. Research Dean at the medical faculty, and Chairman for the Research Committee of the Norwegian Medical Association. He chairs the scientist panel of neuroim- munology, EFNS, is a member of the EFNS scientific committee, the World Federation of Neurorehabilitation council, and the European School of Neuroimmunology board. His main research interests are neuroimmunol- ogy and neurorehabilitation. ACNR • VOLUME 4 NUMBER 6 • JANUARY/FEBRUARY 2005 I 5 Editorial his is the final issue of the fourth year of ACNR, and different imaging, clinical and neuropathological character- comes at a time that the website is attracting over istics of brain tumours and complements well an earlier T3000 visitors a month – a great tribute to Rachael article by Jeremy Rees on their treatment (see volume 2, Hansford, the force behind the logistical organisation of issue 2, available at www.acnr.co.uk). The article is lavishly the journal and developer of the website. The site is home illustrated and appears at a time when “brain-cancer stem to our case reports and the latest, a case of tuberculous cells” (Singh SK et al. Nature 2004;432:396-401) are begin- spinal arachnoiditis, is now available for you to download. ning to be found which, in turn, may lead to further refine- The two review articles in this issue come from Oxford ments in classification and therapy. and Edinburgh with David Beeson concentrating on con- The rehabilitation article tackles the interesting topic of genital myasthenic syndromes and Michael Sharpe on visual stress in neurological disease. Professor Arnold “functional” disorders. The congenital myasthenic syn- Wilkins, who has pioneered this concept, presents a thought dromes (CMS) are rare, and although many of us will not provoking account which highlights the basic tenets of the see such cases, are of great scientific value in revealing how theory and how this translates into effective therapies. In the neuromuscular junction is organised and maintained. particular he discusses the use of coloured filters for glasses We are therefore fortunate to have David Beeson, who has for disorders such as dyslexia and migraine. made such a significant contribution to this field, lay out Andrew Larner in our historical series takes us through the various types of CMS and their basis ranging from the “looking glass” into the neurological world of Alice. In abnormalities in the acetylcholine receptor and channel to mutations in this fascinating account