JNNP Podcast

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

The early days of chronic fatigue syndrome research; Clues to functional weakness mechanism

In this first podcast of 2012 editor Matthew Kiernan talks about JNNP’s new impact commentaries - a series which will explore influential papers from the journal. A paper by Simon Wessely (King’s College London) comparing postviral fatigue with that of neuromuscular and affective disorders is the first covered, and he and Matthew discuss this seminal research.Also, Jon Stone (University of Edinburgh) explains what his investigation into the nature of functional weakness onset indicates about the mechanism of the condition.See also:A MODERN PERSPECTIVE ON SOME OF THE MOST HIGHLY CITED JNNP PAPERS OF ALL TIME: The nature of fatigue: a comparison of chronic “postviral” fatigue with neuromuscular and affective disorders http://tinyurl.com/ajr665zWhat is impact? http://tinyurl.com/ah23rzeFunctional weakness: clues to mechanism from the nature of onset http://tinyurl.com/a8c6h33

Diagnosing delirium

This month we discuss the issue of diagnosing delirium in older hospital patients. Despite being linked to a range of poor outcomes, the syndrome is often missed and evidence on its measurement is sparse.Professor Alasdair MacLullich tells us how a device he’s designed with colleagues at the University of Edinburgh, which tests for delirium’s attentional deficits, can benefit clinicians and researchers.See also:Detecting deficits of sustained visual attention in delirium http://tinyurl.com/aswwbaw

Diagnosing conversion disorder; exercise to prevent falls in Parkinson’s patients

In this edition Richard Kanaan (Institute of Psychiatry, King’s College London) talks about his work on conversion disorder, and gives his advice for neurologists and psychiatrists on making this tricky diagnosis.And Vicki Goodwin (Peninsula College of Medicine and Dentistry, University of Exeter) discusses her trial on whether an exercise intervention could prevent falls in those with Parkinson’s disease.See also:Conversion disorder: a problematic diagnosis http://tinyurl.com/agrtdxsAn exercise intervention to prevent falls in people with Parkinson’s disease: a pragmatic randomised controlled trial http://tinyurl.com/b2d697b

The natural history of Parkinson’s; the latest on MS and latitude

Current treatments for Parkinson’s ameliorate the core, motor symptoms. However as we look for therapies to modify the underlying course of the disease there’s a need to better understand its development. Jonathan Evans, from the Cambridge Centre for Brain Repair, University of Cambridge, UK, explains what his work has revealed, and how it can progress treatment.And the latest evidence in the debate on whether multiple sclerosis prevalence increases with latitude. Steve Simpson Jnr, Menzies Research Institute, Tasmania, Australia, tells editor Matthew Kiernan how his meta-analysis supports the link, and clears up some of the questions around the association.See also:The natural history of treated Parkinson’s disease in an incident, community based cohort http://tinyurl.com/bc6grncLatitude is significantly associated with the prevalence of multiple sclerosis: a meta-analysis http://tinyurl.com/bedfy9c

Athleticism and ALS; understanding peripherally induced movement disorders

Movement disorders following head trauma are well recognised, but we know much less about those occuring after a peripheral injury. Diana van Rooijen, Leiden Medical Center, the Netherlands, tells us what her review on this group of conditions reveals (0.58).Clinicians are used to seeing ALS patients who are or have been athletic. So is there a link, and if so, could exercise have a direct effect on the condition? Dr Martin Turner, John Radcliffe University Hospital, Oxford, talks us through his investigations (8.58).See also:Concordance between site of onset and limb dominance in amyotrophic lateral sclerosis http://tinyurl.com/b3bdzc7Peripheral trauma and movement disorders: a systematic review of reported cases http://tinyurl.com/b977yzm

Thrombolysis for elderly stroke patients; disability with organically-unexplained symptoms

Intravenous thrombolysis is the only curative treatment for acute ischaemic stroke, but is only licensed for patients up to 80 years old. Dr Paul Guyler, Southend Hospital NHS Trust, UK, discusses the evidence for outcomes in those over this limit, and whether or not doctors should treat off-licence.Also in this July edition, Dr Alan Carson, Western General Hospital, Edinburgh, UK, on his research into disability, distress and employment in neurology outpatients who’s symptoms can’t be explained organically, and why they don’t fit the stereotypes.See also:Intravenous thrombolysis in acute ischaemic stroke: a systematic review and meta-analysis to aid decision making in patients over 80 years of age http://tinyurl.com/ar9emm3Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease’ http://tinyurl.com/acmtha7

Finger length ratio and ALS; psychotherapy for dizziness

Dizziness can significantly complicate peoples’ lives, especially if it does not have a satisfactory medical explanation. We talk to Dr Gabriele Schmid of the Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Germany, about how psychotherapy might be beneficial for these patients.Also in this month’s podcast, Professor Ammar Al-Chalabi of King’s College London discusses the link between prenatal testosterone levels and ALS.See also:Psychotherapy in dizziness: a systematic review http://tinyurl.com/a4eughgLow index-to-ring finger length ratio in sporadic ALS supports prenatally defined motor neuronal vulnerability http://tinyurl.com/ay29ovu

Frontotemporal dementia reviewed; temporal orientation and dementia

Recent clinical, neuropsychological, imaging, genetic and pathological developments have changed our understanding of frontotemporal dementia, its classification and criteria. Dr Jonathan Rohrer, Dementia Research Centre, UCL Institute of Neurology, London, talks about these advances and future research directions.Also in this edition, Dr Shaun O’Keeffe, Merlin Park University Hospital, Dublin, explains how simple questions about time are, and should be, used to assess dementia and delirium.See also:Clinical, genetic and pathological heterogeneity of frontotemporal dementia: a review http://tinyurl.com/barrt7sOrientation to time as a guide to the presence and severity of cognitive impairment in older hospital patients http://tinyurl.com/ajaqsa4