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• Myelination, Imaging, Disease Myelin: how it appears in MRIs and diseases that affect it (review).

Until the advent of MR imaging, knowledge of the structure of myelin and the process of myelination were of little importance to the neuroradiologist. Other than some mild changes in the attenuation of white matter, myelination resulted in no significant alterations of CT or sonographic studies. MR studies, on the other hand, have been increasingly used for pediatric brain imaging. MR imaging´s greater sensitivity to small changes in the water content of brain tissue, to changes in the binding of free water (revealed by magnetization transfer), and to the extent and anisotropy of water diffusion (revealed by diffusion imaging) has cast new light on this very complex and important molecule. Assessing myelination has become a key component of evaluating the child with delayed development. Moreover, better understanding of the nature of myelin and the effect of its different components on MR imaging parameters may help us to understand and diagnose inborn errors of metabolism better. In this review, I discuss what is known regarding the function and structure of CNS myelin and the effects of the various components of myelin on the signal imparted to the MR image.

• Ion Channel Mutations How ion channel mutations cause neurological disorders (review).

Several neurological diseases - including neuromuscular disorders, movement disorders, migraine, and epilepsy - are caused by inherited mutations of ion channels. The list of these "channelopathies" is expanding rapidly, as is the phenotypic range associated with each channel. At present the best understood channelopathies are those that affect muscle-fibre excitability. These channelopathies produce a range of disorders which include: periodic paralysis, myotonias, malignant hyperthermia, and congenital myasthenic syndromes. By contrast, the mechanisms of diseases caused by mutations of ion channels that are expressed in neurons are less well understood. However, as for the muscle channelopathies, a striking feature is that many neuronal channelopathies cause paroxysmal symptoms. This review summarises the clinical features of the known neurological channelopathies, within the context of the functions of the individual ion channels.

• Receptor Pharmacotherapy The GABA receptor has binding sites for benzodiazepines, toxins, barbiturates, anesthetics, and other molecules. Understanding how its subclasses are distributed throughout the CNS will lead to design of drugs with more specific effects.

The clinical importance of benzodiazepines, barbiturates and general anesthetics, all of which act through the Gamma-aminobutyric acid (GABA)-A neurotransmitter receptor, is testament to its significance as a CNS drug target. These drugs were all developed before there was any understanding of the diversity of this receptor gene family. Recent studies using genetically modified mice and GABA-A receptor-subtype-selective compounds have helped to delineate the function of some of these subtypes, and have revealed that it might be possible to develop a new generation of selective drugs with improved profiles or novel applications.

• Serotonergic Syndrome Drugs that promote release of serotonin at synapses can have dangerous interactive effects.

The serotonin syndrome is a potentially life-threatening adverse drug reaction that results from therapeutic drug use, intentional self-poisoning, or inadvertent interactions between drugs. Three features of the serotonin syndrome are critical to an understanding of the disorder. First, the serotonin syndrome is not an idiopathic drug reaction; it is a predictable consequence of excess serotonergic agonism of central nervous system (CNS) receptors and peripheral serotonergic receptors. Second, excess serotonin produces a spectrum of clinical findings. Third, clinical manifestations of the serotonin syndrome range from barely perceptible to lethal. The death of an 18-year-old patient named Libby Zion in New York City more than 20 years ago, which resulted from coadminstration of meperidine and phenelzine, remains the most widely recognized and dramatic example of this preventable condition.

• Neuronal Stem Cells Motoneuron stem cells may help motor disorders (news article).

Timing is everything in the development of human stem cells, researchers from the University of Wisconsin in Madison have discovered. By exposing human embryonic stem cells to various biologic factors in a precisely timed manner, they succeeded in coaxing the stem cells to develop into motor neurons, which transmit messages from the central nervous system to the muscles. The research provides valuable insights into the unique challenges of working with human stem cells, and it may speed the development of treatments for such motor neuron disorders as amyotrophic lateral sclerosis.

• The Sense of Touch Read about our amazing sensitivity to tactile stimuli.

Imagine you´re in a dark room, running your fingers over a smooth surface in search of a single dot the size of this period. How high do you think the dot must be for your finger pads to feel it? A hundredth of an inch above background? A thousandth? Well, take a tip from the economy and keep downsizing. Scientists have determined that the human finger is so sensitive it can detect a surface bump just one micron high. All our punctuation point need do, then, is poke above its glassy backdrop by 1/25,000th of an inch - the diameter of a bacterial cell - and our fastidious fingers can find it. The human eye, by contrast, can´t resolve anything much smaller than 100 microns. No wonder we rely on touch rather than vision when confronted by a new roll of toilet paper and its Abominable Invisible Seam.

• Inability to Feel Pain A girl born with the inability to feel pain (CNN article).

Ashlyn Blocker´s parents and kindergarten teachers all describe her the same way: fearless. So they nervously watch her plunge full-tilt into a childhood deprived of natural alarms. In the school cafeteria, teachers put ice in 5-year-old Ashlyn´s chili. If her lunch is scalding hot, she´ll gulp it down anyway.

• Pain Review Understanding the different causes of pain can lead to better treatment strategies.

Although we tend to think of pain as a homogeneous sensory entity, several distinct types exist: nociceptive, inflammatory, neuropathic, and functional. The neurobiological mechanisms responsible for these different pains are beginning to be defined, providing insight into how distinct types of pain are generated by diverse etiologic factors, and in which patients. Moreover, we can now realistically expect to move from an empirical therapeutic approach to one that it is targeted specifically at the particular mechanisms of the type of pain experienced by an individual patient.

• How Touch Inhibits Pain A recent study analyses why touching a painful area reduces pain sensation.

Acute peripheral pain is reduced by multisensory interactions at the spinal level. Central pain is reduced by reorganization of cortical body representations. We show here that acute pain can also be reduced by multisensory integration through self-touch, which provides proprioceptive, thermal, and tactile input forming a coherent body representation. We combined self-touch with the thermal grill illusion (TGI). In the traditional TGI, participants press their fingers on two warm objects surrounding one cool object. The warm surround unmasks pain pathways, which paradoxically causes the cool object to feel painfully hot. Here, we warmed the index and ring fingers of each hand while cooling the middle fingers. Immediately after, these three fingers of the right hand were touched against the same three fingers on the left hand. This self-touch caused a dramatic 64% reduction in perceived heat. We show that this paradoxical release from paradoxical heat cannot be explained by low-level touch-temperature interactions alone. To reduce pain, we often clutch a painful hand with the other hand. We show here that self-touch not only gates pain signals reaching the brain but also, via multisensory integration, increases coherence of cognitive body representations to which pain afferents project.

• Post-Surgical Pain Awareness of the mechanisms that cause pain can reduce the pain that follows surgery.

Pain, which is often inadequately treated, accompanies the more than 23 million surgical procedures performed each year and may persist long after tissue heals. Preemptive analgesia, an evolving clinical concept, involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain. Surgery offers the most promising setting for preemptive analgesia because the timing of noxious stimuli is known. When adequate drug doses are administered to appropriately selected patients before surgery, intravenous opiates, local anesthetic infiltration, nerve block, subarachnoid block and epidural block offer benefits that can be observed as long as one year after surgery. The most effective preemptive analgesic regimens are those that are capable of limiting sensitization of the nervous system throughout the entire perioperative period.

• The Placebo Effect What you should know about "wishful thinking".

"People were crying," recalls Ted Kaptchuk. "They said they were drowsy all the time and wanted to cut their dosage in half. Two weeks into the study, nearly 30% of the subjects were experiencing adverse effects." Yet most patients´ pain also subsided - strangely so, because no one in Kaptchuk´s clinical trial had received "real" treatment.

• Headache Therapeutics Understand how drug interactions/overuse can induce headache.

Chronic overuse of all symptomatic headache drugs (ergotamine, analgesics, opioids, and triptans), alone or in combination, in patients with primary headache disorders, is frequently associated with the development of a secondary headache, called medication overuse headache (MOH). Its diagnosis and treatment represent a growing problem worldwide and a challenge for headache specialists. Objective.- The aim of this study was to evaluate the efficacy of a therapeutic regimen for withdrawal of the overused drug and prophylaxis of headache in a population of patients suffering from MOH in 8 hospitals of Piemonte - Liguria - Valle d´Aosta.

• Spina Bifida Outcomes Discusson of health problems related to spina bifida over lifetime.

Background and Methods: From 1963 to 1971, 117 babies with open spina bifida were treated non-selectively from birth. In 2002 we reviewed all the survivors by postal questionnaire and telephone call. The aims were to find out how many were living independently in the community or were in open employment or drove a car. In addition to these achievements we recorded health, medication and admissions to hospital and asked how much daily help they needed.

• Tethered Cord Syndrome How to detect and treat it.

Recurrent tethered cord syndrome (TCS) can lead to significant progressive disability in adults. The diagnosis of TCS is made with a high degree of clinical suspicion. In the adult population, many patients receive inadequate care unless they are seen at a multidisciplinary clinic. Successful detethering procedures require careful intradural dissection and meticulous wound and dural closure. With multiple revision procedures, vertebral column shortening has become an appropriate alternative to surgical detethering.

• Opioid Use Use and dangers of opioids to treat chronic pain

The recognition that opioid therapy can relieve pain and improve mood and functioning in many patients with chronic pain has led experts on pain to recommend that such patients not be denied opioids. Despite this recommendation, many physicians remain uncertain about prescribing opioids to treat chronic pain and do not prescribe them. Some physicians argue that opioids are only marginally useful in the treatment of chronic pain, have a minimal effect on functioning, and may even worsen the outo current practice. However, this seems to be a minority view. Key organizations that strongly support the use of opioids to treat chronic pain have published consensus statements to guide physicians in prescribing these drugs. These consensus statements emphasize the importance of a standardized approach.

• Local Anesthetics Pharmacology review.

This drug class has an impressive history of safety and efficacy, but all local anesthetics have the potential to produce significant toxicity if used carelessly. The purpose of this review is to update the practitioner on issues regarding the basic pharmacology and clinical use of local anesthetic formulations.

• Viral Meningitis A case of viral meningitis (NYTimes article).

"I can´t see a doggone thing. It started off as a headache, and now I can´t see." The middle-aged man´s face was flushed and shiny beneath a mop of prematurely white hair. His clear, blue eyes were shaded by a brow pulled together by worry. "I´d rather cut off my leg than lose my sight," he told the slender, dark-haired doctor at his bedside. Three days ago he was at work at a local animal hospital when his head began to pound. "It was like there was someone inside my head trying to get out." He made it to the end of the day, then went home and straight to bed.

• An Eye on Stem Cells A clinical syndrome involving degradation of the cornea is one of the few examples where stem cells have been used to cure a disorder.

Few people today dispute the enormous potential of stem cells for regenerative medicine. But, despite ever increasing reports on the Internet of stem cells being used to treat various disorders - from Alzheimer´s disease to spinal-cord injuries to severe heart conditions - proven stem-cell therapies remain few and far between. A paper published in the New England Journal of Medicine stands as a refreshing example of a scientifically documented advance in stem-cell therapies, in this case to treat certain types of blindness.

• How Anesthetics Work A Scientific American review on the mechanism of action of anesthetics and their effects on the body.

"Suffering so great as I underwent cannot be expressed in words ... but the blank whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, which swept through my mind, and overwhelmed my heart, I can never forget." Such was the experience of surgery before October 1846, when William Morton´s successful public demonstration of ether anesthesia at Massachusetts General Hospital led to its widespread acceptance by surgeons. Today, anesthesiologists employ a wide variety of drugs, some of which they use exclusively to produce general anesthesia. This review focuses on the inhaled anesthetics in current use: nitrous oxide, halothane, enflurane, isoflurane, sevoflurane, and desflurane. Our understanding of how these drugs reversibly alter central nervous system function has changed dramatically in the past two decades.

• Visual Perception Why do we see the world right-side up when the eye projects everything upside-down?

The lens in your eye casts an upside-down image on your retina, but you see the world upright. Although people often believe that an upsidedown image in the eyeball gets rotated somewhere in the brain to make it look right-side up, that idea is a fallacy. No such rotation occurs, because there is no replica of the retinal image in the brain-only a pattern of firing of nerve impulses that encodes the image in such a way that it is perceived correctly; the brain does not rotate the nerve impulses.

• Dizziness Dizziness can be a baffling symptom to treat. (NYTimes article)

On the Fourth of July, a 63-year-old man was taken by wheelchair into the emergency room of a suburban Virginia hospital, overwhelmed with dizziness and nausea and gripped by sweat-inducing anxiety. "I felt dim and lightheaded, like I was just going to fade out," said John Farquhar, a semiretired consultant in Washington. "I said, ´I´m going to die.´ "

• Phineas Gage The story of a famous neurological patient with damage to the prefrontal cortex.

When Phineas Gage died in 1861, no autopsy was performed, but his skull was later recovered. The brain lesion that caused his profound personality changes was presumed to involve the left frontal region, but questions have been raised about the exact location and involvement of other regions. Modern neuroimaging techniques were used to construct the accident and estimate the lesion location. Results show that the damage involved both the left and right prefrontal cortex in areas associated with rational decision making and emotional control.

• Prosopagnosia Fascinating video about a patient who cannot recognize faces after he had a traumatic accident.

Prosopagnosia is a disorder involving occipital and temporal cortex in which the patient cannot distinguish faces, including those of self or family that were previously well-known. This deficit is remarkably specific in that patients can still recognize other objects, e.g. a book, spoons/knives/forks, animals, etc. This disorder demonstrates that rather than cognitive function being an emergent property of general cortical activity, the brain processes information in highly specific ways, both in cortical location and method. (video - requires Real Player)

• Split Brain Studies 1 & 2 Youtube video about effects of cutting the corpus callosum.

In these 2 videos, Dr. M.Gazzaniga, who worked with Dr. R.Sperry (nobel laureate) in the original split brain studies in the 1960s, discusses the capabilities of the right and left hemispheres. Video 1 shows the ability of a patient to name objects flashed in the right or left visual field. Video 2 narrated by Alan Alda, discusses this patient in more detail, focusing on the capacity for conscious awareness. (video)

• Neuroplasticity
• Oliver Sacks writes about how the brain can change.(NYTimes article)

While some areas of the brain are hard-wired from birth or early childhood, other areas - especially in the cerebral cortex, which is central to higher cognitive powers like language and thought, as well as sensory and motor functions - can be, to a remarkable extent, rewired as we grow older. In fact, the brain has an astonishing ability to rebound from damage - even from something as devastating as the loss of sight or hearing. As a physician who treats patients with neurological conditions, I see this happen all the time. For example, one patient of mine who had been deafened by scarlet fever at the age of 9, was so adept at lip-reading that it was easy to forget she was deaf. Once, without thinking, I turned away from her as I was speaking. "I can no longer hear you," she said sharply. "You mean you can no longer see me," I said. "You may call it seeing," she answered, "but I experience it as hearing."

• Hemispherectomy Recovery after hemisphere removal for epilepsy.(Youtube video)

Watch the 20/20 news story of the remarkable recovery of Brandi Binder who at age 6 had half of her brain removed as a treatment for her seizures.

• Recovery After Stroke Paralized patients recover use of their limbs through training.

Dr. Edward Taub describes Constraint-Induced Movement therapy, which he developed to help stroke patients regain functions. The key to this therapy is in motivating patients to move/use the weak limb through repeated training sessions. Slowly over the period of many months, patients are able to move limbs that previously were paralyzed by their strokes.

• Transcranial Stimulation Small wire coils can be used to stimulate the brain.

Scientists reviving a decades-old technique for brain stimulation have found that it can boost learning. A small wire coil placed on the scalp and powered by a 9-volt battery can change the activity of brain cells. So what else can be done with some wires and a nine-volt battery?

• Coma How is coma assessed neurologically (review).

The neurologist is often required to evaluate the unconscious patient from both the diagnostic and prognostic perspective. Knowledge of the anatomical basis of coma is essential for competent evaluation but must be combined with an understanding of the many, often multi-factorial, medical conditions that result in impaired consciousness. Consciousness is a state of awareness of self and the environment. This state is determined by two separate functions: awareness (content of consciousness) and arousal (level of consciousness ).

• ChemoBrain Chemotherapy can cause cognitive impairment (NYTimes article).

Cancer can be a life-changing experience, both physically and mentally. And when cancer treatment delivers a knockout punch to cognitive abilities, patients with the resulting "chemo brain" often face major challenges trying to get their lives back on track. But those who recognize the cognitive effects of toxic cancer drugs, adjust their schedules and learn to compensate for what are usually temporary limitations have an easier time returning to a productive life.

• Tumor Therapy Treatment strategies for brain tumors (review).

Brain metastases occur in 10-30% of cancer patients, and they are associated with a dismal prognosis. Radiation therapy has been the mainstay of treatment for patients without surgically treatable lesions. For patients with good prognostic factors and a single metastasis, surgical resection is recommended. The management of patients with multiple metastases, poor prognostic factors, or unresectable lesions is, however, controversial. Recently published data will be reviewed.

• Parkinson's Disease A review of diagnosis and treatment strategies.

A 62-year-old man presents with an intermittent tremor in his left hand and some vague discomfort in the left arm. Physical examination shows a minimal rest tremor in the left hand that disappears with use of the limb, mild rigidity at the left wrist and elbow, slowness of finger tapping with the left hand, and decreased arm swing on the left while walking. How should he be evaluated and treated?

• Lou Gherig and ALS A retrospective analysis to determine when Lou Gherig began to show symptoms of his disease.

Lou Gehrig was one of the most talented baseball players of all time; yet he is also remembered for ALS, the disease that took his life and still bears his name as its eponym. There is speculation about when his symptoms began. Some authorities believe that Gehrig showed signs of ALS when he starred in the film Rawhide in January 1938, which would mean that he played the entire 1938 season with symptomatic ALS. Additionally, some photographs of Gehrig showing atrophy of hand muscles have been dated incorrectly because of misinterpreted logos on his uniform. We examined the film and photos taken of Gehrig from 1937 to 1939 to determine whether he showed signs of weakness in the film and when visible evidence of ALS could be documented.

• Memory Memory from a clinical and neurological perspective (review).

Memory function is vulnerable to a variety of pathologic processes including neurodegenerative diseases, strokes, tumors, head trauma, hypoxia, cardiac surgery, malnutrition, attention-deficit disorder, depression, anxiety, the side effects of medication, and normal aging. As such, memory impairment is commonly seen by physicians in multiple disciplines including neurology, psychiatry, medicine, and surgery. Memory loss is often the most disabling feature of many disorders, impairing the normal daily activities of the patients and profoundly affecting their families.

• Memory Deficits HM - the MOST famous Neurology patient EVER.

When a surgeon cut into Henry Molaison´s skull to treat him for epilepsy, he inadvertently created the most important brain-research subject of our time - a man who could no longer remember, who taught us everything we know about memory. Six decades later, another daring researcher is cutting into Henry´s brain. Another revolution in brain science is about to begin.

• NO Fear SM - a patient with no amygdala.

A rare genetic disease destroyed both sides of the amygdala in a woman known as SM in early childhood, preventing her from experiencing fear. Now, SM blithely reaches for poisonous snakes, giggles in haunted houses and once, upon escaping the clutches of a knife-wielding man, didn´t run but calmly walked away.

• Stroke Risk Factors Ten modifiable risk factors that explain 90% of stroke cases.

A large case-control study evaluating risk factors for stroke has shown that 10 risk factors are associated with 90% of the risk of stroke and that of these modifiable risk factors, hypertension is the most important for all stroke subtypes and is a particularly dangerous risk factor for intracerebral hemorrhage. "A lot of the evidence for stroke comes from inference from heart disease, and certainly the risk factors are the same, but the relative importance of the risk factors is different," lead investigator Dr Martin O´Donnell (McMaster University, Hamilton, ON) told heartwire . "We´ve gone through phases where we´ve thought the risk factors for heart disease and stroke were different, or where we thought they were the same. The important message is that these identified risk factors are important for reducing the risk of stroke, and some appear to be more important than anticipated."

• CT Perfusion Imaging CT perfusion imaging and its uses (review).

CT perfusion is an evolving technology that assesses the behaviour of intravenous contrast in cerebral tissue and provides quantitative information on cerebral blood flow parameters. It has been validated in many clinical situations against established techniques and is being increasingly applied in clinical situations to provide physiological information to direct medical therapies. This article reviews the evolution of perfusion measurements by CT, the principles of CT perfusion calculation and, with illustrated case histories, examines the clinical utility of this technique.

• Imaging Acute Stroke Excellent comparison of imaging technologies for stroke and their benefits (review).

The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy. A comprehensive evaluation may be performed with a combination of computed tomography (CT) or magnetic resonance (MR) imaging techniques. Unenhanced CT can be performed quickly, can help identify early signs of stroke, and can help rule out hemorrhage. CT angiography and CT perfusion imaging, respectively, can depict intravascular thrombi and salvageable tissue indicated by a penumbra. These examinations are easy to perform on most helical CT scanners and are increasingly used in stroke imaging protocols to decide whether intervention is necessary. While acute infarcts may be seen early on conventional MR images, diffusion-weighted MR imaging is more sensitive for detection of hyperacute ischemia. Gradient- echo MR sequences can be helpful for detecting a hemorrhage. The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra. The information obtained by combining various imaging techniques may help differentiate patients who do not need intravenous or intraarterial therapy from those who do, and may alter clinical outcomes.

• Do Children Get Strokes Story of cerebellar stroke in a 7-year old (NYTimes article).

Before June 23, 2008, my wife, Victoria, and I had never heard of a child´s having a stroke. Most people, many doctors included, still haven´t. In the agonizing months that followed, we heard it over and over: "But children don´t have strokes." How little we knew. It turns out that stroke, by some estimates, is the sixth leading cause of death in infants and children. And experts say doctors and hospitals need to be far more aggressive in detecting and treating it. Dr. Ichord, director of the pediatric stroke program at Children´s Hospital of Philadelphia, who continues to be deeply involved in Jared´s care, said that while conditions like migraines and poisoning could cause similarsymptoms, "front-line providers need to have stroke on their radar screen as a possible cause of sudden neurologic illness in children." Dr. Heather Fullerton, a leading pediatric stroke researcher at the University of California, San Francisco, was even more emphatic. "When a child comes into an emergency room with stroke-like symptoms," Dr. Fullerton said, "it should be considered a stroke unless proven otherwise."

• Neurodegenerative Disorders A current perspective of the mechanism of neurodegenerative disorders.

Genetic and environmental factors responsible for numerous neurodegenerative diseases vary between disorders, yet age remains a universal risk factor. Age-associated decline in protein homeostasis, or proteostasis, enables disease-linked proteins to adopt aberrant tertiary structures, accumulate as higher-ordered aggregates, and cause a myriad of cellular dysfunctions and neuronal death. However, recent findings suggest that the assembly of disease proteins into tightly ordered aggregates can significantly delay proteotoxic onset. Furthermore, manipulation of metabolic pathways through key signaling components extends lifespan, bolsters proteostasis networks, and delays the onset of proteotoxicity. Thus, understanding the relationship between proteostasis and aging has provided important insights into neurodegeneration.

• Alzheimer´s Disease Mechanisms, treatment, and pharmacotherapy (review).

Treatment of Alzheimer´s disease includes five major components: neuroprotective strategies, cholinesterase inhibitors, nonpharmacologic interventions an psychopharmacologic agents to reduce behavioral disturbances, health maintenance activities, and an alliance between clinicians and family members and other caregivers responsible for the patient. Treatment requires accurate diagnosis and increasingly is based on an understanding of the pathophysiology of the disease.

• Diagnosing Dementia: No Easy Task How is dementia diagnosed.

Background: From both clinical experience and research we learned that in complex progressive disorders such as dementia, diagnosis includes multiple steps, each with their own clinical and research characteristics.
Discussion: Diagnosing starts with a trigger phase in which the GP gradually realizes that dementia may be emerging. This is followed by a disease-oriented diagnosis and subsequently a care-oriented diagnosis. In parallel the GP should consider the consequences of this process for the caregiver and the interaction between both. As soon as a comprehensive diagnosis and care plan are available, monitoring follows.

• Diagnosing Dementia - Accurracy Can PCPs diagnose dementia correctly.

KEY POINTS of this study:
1) The GPs agreed with the memory clinic on a diagnosis of dementia in 76% of the patients, but their accuracy fell to 53% with respect to the differentiation between Alzheimer´s-type dementia and other types. 2) The GPs were well able to assess the firmness of their own dementia diagnoses, which supposes that they are able to make appropriate selection for referral. 3) Diagnostic support from a specialised team can particularly contribute to identifying the type of dementia.

• Therapies for Neurodegenerative Disorders A recent article about a unique drug therapy that stimulates elimination of misfolded, defective proteins that accumulate in neurodegenerative disorders, which might provide a general strategy to treat all such disorders.

Autophagy is an intracellular turnover pathway. It has special relevance for neurodegenerative proteinopathies, such as Alzheimer disease, Parkinson disease, and Huntington disease (HD), which are characterized by the accumulation of misfolded proteins. Although induction of autophagy enhances clearance of misfolded protein and has therefore been suggested as a therapy for proteinopathies, neurons appear to be less responsive to classic autophagy inducers than nonneuronal cells. Searching for improved inducers of neuronal autophagy, we discovered an N10-substituted phenoxazine that, at proper doses, potently and safely up-regulated autophagy in neurons in an Akt- and mTOR-independent fashion. In a neuron model of HD, this compound was neuroprotective and decreased the accumulation of diffuse and aggregated misfolded protein. A structure/activity analysis with structurally similar compounds approved by the US Food and Drug Administration revealed a defined pharmacophore for inducing neuronal autophagy. This pharmacophore should prove useful in studying autophagy in neurons and in developing therapies for neurodegenerative proteinopathies.

• Traumatic Brain Injury A wife´s journey caring for her husband with a TBI.

Until his accident, my husband and I - he a sculptor, I a writer - had built our marriage on supportive independence, sometimes spending whole summers apart. But following his traumatic brain injury in July 2004, he became totally dependent, and our marriage changed forever.

The accident happened in a remote beach cabin on a small Maine island without a doctor. At 2 a.m. the love of my life fell nine feet from a sleeping loft to the floor - breaking his ribs and feet, puncturing his lungs, and sustaining multiple blood clots in his brain. Several hours after I called 911, a rescue boat transported us to Maine Medical Center in Portland. Scott was 75 and I was 72.

• Schizophrenia What is it like to experience schizophrenic symptoms?

This reallistic video shows what the symptoms of schizophrenia are like for people. It will help you understand how difficult their lives are and the impact that their hallunications have on their interactions with other people. (thanks to Kevin Seals for this link)