JNNP Podcast

The Scheltens scale, disability after head injury, and cannabis for multiple sclerosis

This month, we explore the latest research on treating multiple sclerosis with cannabis extract. Editor Matthew Kiernan speaks to John Zajicek, professor of Clinical Neuroscience, Peninsula College of Medicine and Dentistry, UK. (0.54)Received wisdom is that if you are disabled shortly after a head injury, you are not going to see this improve. However Tom McMillan, professor of Clinical Neuropsychology, University of Glasgow, explains how he has shown long term outcomes are actually dynamic. (9.08)And the Scheltens scale. If you work with dementia patients you’ve probably used this simple rating of hippocampal atrophy. Philip Scheltens, director of the Alzheimer Center, VU University Medical Center, Amsterdam, talks about how he put the scale together 20 years ago, and why it still underpins practice. (14.21)See also:Multiple Sclerosis and Extract of Cannabis: results of the MUSEC trial http://tinyurl.com/a7vwezbAtrophy of medial temporal lobes on MRI in “probable” Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates http://tinyurl.com/bxlc2dxDisability in young people and adults after head injury: 12–14 year follow-up of a prospective cohort http://tinyurl.com/albh9k3

Early days of the Queen Square brain bank; rating dopaminergic replacement therapy response

The Queen Square brain bank was set up by Andrew Lees, and whilst there he co-authored two of JNNP’s most highly cited papers – one on the importance of Lewy bodies in Parkinson’s, and the other on the accuracy of clinical diagnosis of the disease. Now director of the Reta Lila Weston Institute of Neurological studies, University College London, he discusses the changing relationship between pathologists and clinicians, and the progress he’s seen in diagnosis.Assessing response to dopamine replacement therapy is essential for diagnosing idiopathic Parkinson’s disease, and for adjusting dose. One measure is to ask the patient how they feel, others are more objective such as the UPDRS or timed tests. However a paper in this month’s issue shows they are not always correlated. First author David McGhee (clinical research fellow in the division of Applied Health Sciences, University of Aberdeen) talks about the findings.And, movement disorders: where are we now? This month’s journal focuses on these conditions, so JNNP editor Matthew Kiernan and associate editors Nick Ward and Alan Carson debate the most important advances.See also:October’s JNNP: Movement disorder special http://tinyurl.com/a32m868Movement disorders: what lies beneath? http://tinyurl.com/a32m868A MODERN PERSPECTIVE ON THE TOP 100 CITED JNNP PAPERS OF ALL TIME: The relevance of the Lewy Body to the pathogenesis of idiopathic Parkinson’s disease: Accuracy of clinical diagnosis of idiopathic Parkinson’s disease http://tinyurl.com/as9dq32Comparison of patient rated treatment response with measured improvement in Parkinson’s disease http://tinyurl.com/bj57hu2

Oliver Sacks’s functional paralysis; progressive multifocal leukoencephalopathy

In 1974 Oliver Sacks was hiking through a remote part of Norway when he suffered a nasty injury to one leg. Although he managed to get to help and was successfully operated on, he struggled to relearn to walk and felt alienated from the limb. Jon Stone (consultant neurologist in the Department of Clinical Neurosciences, University of Edinburgh) explains why from Sacks’s writing he thinks this was a case of functional paralysis, and why the account is so valuable.And progressive multifocal leukoencephalopathy: the rare but potentially fatal condition which can follow monoclonal antibody treatment. Dirk Mentzer (Department of Safety of Medicinal Products and Medical Devices, Paul-Ehrlich-Institute, Germany) talks us through his new case definition, and offers some clinical advice.See also:‘A Leg to Stand On’ by Oliver Sacks: a unique autobiographical account of functional paralysis http://tinyurl.com/bc4oavvCase definition for progressive multifocal leukoencephalopathy following treatment with monoclonal antibodies http://tinyurl.com/aa2pmsqA poster presentation of the PML case definition http://tinyurl.com/b2db26e

Recovery after stroke; malingering after concussion

Derick Wade (professor and consultant in neurological rehabilitation at the Oxford Centre for Enablement) and Nick Ward (JNNP associate editor and reader in clinical neurology at UCL) discuss the past, present and future of measuring and predicting recovery after stroke.And poor effort, exaggeration and malingering can be used to explain why individuals post-concussion report persistent symptoms inconsistent with the severity of their injury. However Jonathan Silver (clinical professor of Psychiatry at New York University School of Medicine) writes in August’s JNNP that social psychology and behavioural economics reveal other factors. Killian Welch (consultant neuropsychiatrist in Edinburgh, UK) discusses them with him.See also:Functional abilities after stroke: measurement, natural history and prognosis http://tinyurl.com/awo4hv5Effort, exaggeration and malingering after concussion http://tinyurl.com/a7tgcf2

The future of glioblastoma therapy

Despite current standard care for glioblastoma being aggressive, mean survival is around 14 months. Clark Chen (director of Clinical Neuro-oncology, Beth Israel Deaconess Medical Center, Boston) argues we need a better understanding of the therapeutic concepts that have evolved over the past three decades to develop treatment, and in a JNNP article this month he lays out seven of these key ideas. Peter Warnke (JNNP associate editor) discusses them with him.See also:Key concepts in glioblastoma therapy http://tinyurl.com/ao8g8m3

Neurological symptoms from autoimmune syndromes; movement disorders and OCD; counting strokes

This month, editor Matthew Kiernan discusses new guidelines for recognising central nervous system neuronal surface antibody associated symptoms with Angela Vincent (emeritus professor of neuroimmunology at Oxford University).Danielle Cath (psychiatrist at Altrecht Academic Anxiety Outpatients Clinics, Utrecht University) explains what her review of the relationship between obsessive compulsive disorder and movement disorders reveals.And Charles Warlow (emeritus professor of medical neurology at the University of Edinburgh) looks back on his highly cited 1988 paper on incidence, outcome and type of stroke in Oxfordshire.See also:Central nervous system neuronal surface antibody associated syndromes: review and guidelines for recognition http://tinyurl.com/avn64slRelationship between movement disorders and obsessive–compulsive disorder: beyond the obsessive–compulsive–tic phenotype. A systematic review http://tinyurl.com/b8vk32gA prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project, 1981–86 http://tinyurl.com/ax26xlk

Idiopathic intracranial hypertension; discovering the neurological effects of critical illness

This month Beau Bruce (assistant professor of ophthalmology and neurology, Emory University School of Medicine, Atlanta) discusses what we do and don’t know about idiopathic intracranial hypertension, and offers some clinical advice on the syndrome for neurologists.And Charles Bolton (professor in the Department of Medicine, Queen’s University, Ontario, Canada) talks us through his investigations in the 1980s which discovered critical illness could cause neurological problems.See also:Update on the pathophysiology and management of idiopathic intracranial hypertension http://tinyurl.com/bhjc9h6Polyneuropathy in critically ill patients http://tinyurl.com/bbze6jc

Diagnostic criteria for CBS; tractography in ALS fifty years ago; better tests for bvFTD

In April’s podcast, we put a spotlight on amyotrophic lateral sclerosis and frontotemporal dementia.Maxime Bertoux, a neuropsychologist at Paris-Sorbonne University, discusses the problem of misdiagnosis of the behavioural variant of FTD, and how he’s shown the Social Cognition and Emotional Assessment is a more powerful tool than others in use (20.50).And Martin Turner, consultant neurologist at Oxford University Nuffield Department of Clinical Neuroscience, talks about early tractography work in ALS (13.23).We also take a look at corticobasal syndrome. JNNP editor Matthew Kiernan asks John Hodges, Neuroscience Research Australia, about his work looking to standardise diagnostic criteria (1.16).See also:Nerve fibre degeneration in the brain in amyotrophic lateral sclerosis http://tinyurl.com/ar8bolmDiagnostic criteria for corticobasal syndrome: a comparative study http://tinyurl.com/a7sskuxSocial Cognition and Emotional Assessment differentiates frontotemporal dementia from depression http://tinyurl.com/bkpfrruJNNP podcast: Martin Turner on athleticism and ALS http://tinyurl.com/an724hs

Surrogate outcomes; CAA and IH; Angela Vincent looks back

This issue we look at short-term outcomes used to assess multiple sclerosis treatments, and their power to predict long-term disability, with Douglas Goodin (professor of clinical neurology, University of California, San Francisco).We return to the association between cerebral amyloid angiopathy and intracerebral haemorrhage, as Neshika Samarasekera (Division of Clinical Neurosciences, University of Edinburgh) talks us through her research examining the link.And Angela Vincent (emeritus professor at the Nuffield Department of Clinical Neurosciences, University of Oxford) looks back at the beginning of her career investigating autoantibodies in neurological diseases.See also:Relationship between early clinical characteristics and long term disability outcomes: 16 year cohort study (follow-up) of the pivotal interferon β-1b trial in multiple sclerosis http://tinyurl.com/ab7sdd9The association between cerebral amyloid angiopathy and intracerebral haemorrhage: systematic review and meta-analysis http://tinyurl.com/bewdkzfAcetylcholine receptor antibody as a diagnostic test for myasthenia gravis: results in 153 validated cases and 2967 diagnostic assays http://tinyurl.com/axg6a98

Cerebral amyloid angiopathy; lifestyle and mortality after stroke; motor output patterns

This month, cerebral amyloid angiopathy. David Werring (Stroke Research Group, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery) discusses the importance of detecting it, especially as he feels it is under-recognised by physicians.What impact does a healthy lifestyle have on mortality following stroke? Amytis Towfighi (Division of Stroke and Critical Care, Department of Neurology, University of Southern California) tells us what her research found.And lastly, another dig into the JNNP archives. Mark Hallett (chief of the Human Motor Control Section at the US National Institute of Neurological Disorders and Stroke, NIH) has looked back on his early research on patterns of motor control for the third of our impact commentaries. He talks about how this opened a window onto movement disorder pathophysiology.See also:Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum http://tinyurl.com/anvtsekImpact of a healthy lifestyle on all-cause and cardiovascular mortality after stroke in the USA http://tinyurl.com/b3hjexrEMG analysis of stereotyped voluntary movements in man http://tinyurl.com/a2fvef4