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Don't Slip Through The 611 EDITORIAL J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.73.6.611 on 1 December 2002. Downloaded from The internet www.jnnp.com,4 as have customised ................................................................................... @lerts, collected resources, and emailed tables of contents, with free back issues, rapid responses, and electronic manu- Don’t slip through the net script submission via Bench>Press in- troduced recently. In this issue, the first R Al-Shahi, C Kennard of a series of review articles deals with 5 ................................................................................... the internet itself. Subsequent articles will focus on resources for neurology JNNP could help you become a technophile (including neurophysiology and neuro- radiology), neurosurgery (including neuropathology), and psychiatry (in- t is possible to thrive in the modern people across the world (almost 10% of cluding neuropsychiatry). Every review world without recourse to the internet. the global population) were online in will be free at www.jnnp.com, and But only just. If you are a “techno- May 2002 (www.nua.com). Health is I the recommended web sites are available phobe”, deterred by the daunting size probably the largest single category of as downloadable Bookmarks/Favorites and complexity of this continually evolv- information hosted by the world wide at http://jnnp.bmjjournals.com/misc/ ing medium, JNNP could help you web, and over two thirds of the online bookmarks.shtml. If you are already a become a “technophile”. public—known as “cyberchondriacs”— 1 “technophile”, or if we succeed in con- Fewer than four decades ago, the cold seek information about it. verting you, join us in our attempt to war motivated the creation of the inter- Despite its impact, the internet is still keep pace with the internet in the net. Academic inspiration subsequently flawed. Access in the developing world monthly Neuronline filler section.6 harnessed the internet’s potential in its remains limited, but initiatives like Digital two best-known components: email and Island seek to broaden the availability of J Neurol Neurosurg Psychiatry 2002;73:611 the world wide web. Born of a need for material—such as JNNP—and make the communication and maturing through a world a smaller place.2 While freedom to hunger for information, these two publish is part of the essence of the world ..................... human desires have made the internet wide web, cultural constraints will pre- Authors’ affiliations indispensable. clude consensus about what constitutes R Al-Shahi, Web Editor, JNNP, Department of The overwhelming size of the internet appropriate censorship.3 The notorious Clinical Neurosciences, Western General makes it a formidable repository of excess of poor quality information— Hospital, Crewe Road, Edinburgh EH4 2XU, largely due to lack of regulation and com- UK; [email protected] knowledge. The figure below shows the C Kennard, Editor, JNNP, Division of Internet Software Consortium’s latest mercial exploitation—has become Neuroscience and Psychological Medicine, internet domain survey (www.isc.org), enough of a priority for the BMJ to devote Imperial College School of Medicine, Charing copyright. which estimates that there are >160 mil- its 9 March 2002 (Evaluating the quality of Cross Hospital, Fulham Place Road, London lion “hosts” and that their greatest prolif- health information on the internet) theme W6 8RF, UK; [email protected] eration has occurred in the last four years. issue to it. A recent survey is cause for It is, of course, impossible to know some optimism; almost half of the how many people use the internet, but “cyberchondriacs” in the USA and France REFERENCES an educated guess is that ∼580 million were found to visit medical journals and 1 Four-nation survey shows widespread but academic or research institutions, closely different levels of Internet use for health followed by commercial health web sites.1 purposes. Health Care News 2002;2:1–4. (www.harrisinteractive.com) Furthermore, the entire contents of two 2 Kennard C. Getting our Journal to online evidence based health resources developing countries. J Neurol Neurosurg (Clinical Evidence and the Cochrane Psychiatry 2001;71:711. 3 Gittings J. Google is back in China but don’t http://jnnp.bmj.com/ Library) were made available to the try asking any difficult questions. The public in September 2002 through the Guardian 14 September 2003: 3. National Electronic Library for Health 4 Kennard C. Same name, new face for JNNP: (www.nelh.nhs.uk). www.jnnp.com. J Neurol Neurosurg Psychiatry 1999;66:415. So how can JNNP help you cope with 5 Al-Shahi R, Sadler M, Rees G, et al.The this immortal yet imperfect (but improv- internet. J Neurol Neurosurg Psychiatry ing) medium? 2002;73:619–628. 6 Macleod M. Neuronline: PubMed: Figure 1 Internet domain survey host count. Since 15 March 1999 the full text of http://www.pubmed.org. J Neurol Neurosurg on September 29, 2021 by guest. Protected Reproduced with permission. the Journal has been available at Psychiatry 2002;73:764. www.jnnp.com 612 EDITORIAL COMMENTARY J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.73.6.611 on 1 December 2002. Downloaded from Huntington’s disease Huntington’s disease—expanded CAG ................................................................................... repeats within the huntingtin locus— resulted in an explosion of research on the pathogenesis of the disease. Recent Fetal striatal transplantation in advances include the development of several murine genetic models and the Huntington’s disease: time for a pause identification of various molecular proc- esses as potential therapeutic targets. I R L Albin believe the likelihood of an effective treatment emerging from these lines of ................................................................................... investigation is considerably higher than The need to look at the rationale for fetal striatal the likelihood of marked improvement with fetal striatal engraftment. transplantation Given the practical and theoretical objections to fetal striatal engraftment for n this issue of the Journal (pp 678– subjects is unacceptable. It is imperative Huntington’s disease, the best approach 685),1 the NEST-UK consortium re- that efficacy trials be controlled appropri- would be for the NEST-UK investigators Iports safety data on four subjects with ately. The recent experience with fetal tis- and other groups in this area to complete Huntington’s disease receiving unilateral sue engraftment for Parkinson disease their safety trials and then pause. revealed the existence of large magnitude intrastriatal transplantation of human J Neurol Neurosurg Psychiatry 2002;73:612 fetal striatal tissue. This well designed and and remarkably long duration placebo carefully executed study adds to the small effects. Some form of sham surgery amount of previous data on fetal striatal control is necessary. The NEST-UK proto- ..................... 234 col involves general anaesthesia, the sur- grafting for Huntington’s disease. Authors’ affiliations gery, a week of postoperative hospital Groups in California and France reported R L Albin, Department of Neurology, University a total of eight subjects receiving bilateral care, and immunosuppression with fre- of Michigan, and Geriatrics Research, engraftment without complications and quent blood monitoring. Designing an Education, and Clinical Center, Ann Arbor adequate and safe sham surgery protocol VAMC, room 4412D, Kresge III Building, 200 either no change in clinical outcome will be a challenge. Zina Pitcher Place, Ann Arbor, MI 48109-0585, measures or some improvement.23 In The rationale for the fetal striatal USA another series of seven patients undergo- transplantation is questionable. Success- ing bilateral engraftment, there were four Correspondence to: Dr R Albin; ful striatal engraftment is likely to have [email protected] subdural haematomas (in three subjects), 4 limited effects. The hallmark of Hunting- two requiring neurosurgical drainage. ton’s disease is striatal degeneration, but copyright. These latter subjects may have had more the disorder affects the whole brain. REFERENCES advanced Huntington’s disease with a There is significant whole brain atrophy, 1 Rosser AE, Barker RA, Harrower T, et al. greater degree of brain atrophy, and this Unilateral transplantation of human primary and neurodegeneration of the neocortex, fetal tissue in four patients with Huntington’s may be a contraindication to engraft- hippocampal formation, thalamus, sub- disease: NEST-UK safety report ISRCTN ment. The NEST-UK investigators plan a stantia nigra, and cerebellum have all no 36485475. J Neurol Neurosurg Psychiatry second phase safety study examining been documented. Fetal striatal trans- 2002;73:678–685. bilateral engraftment with a total of 10 2 Kopyov OV, Jacques S, Lieberman A, et al. plantation has shown efficacy in animal Safety of intrastriatal neurotransplantation for subjects (including the four in the present models of Huntington’s disease, but Huntington’s disease patients. Exp Neurol report), and a two year follow up to these models use mainly toxin destruc- 1998;149:97–108. generate preliminary efficacy data. This 3 Bachoud-Levi AC, Remy P, Nguyen JP, et al. tion of the striatum and do not mimic Motor and cognitive improvements in patients systematic approach is commendable. the systemic nature of Huntington’s dis- with Huntington’s disease after The accumulated data, however,
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