This article reports a case of probable subcortical band heterotopia, also known as subcortical laminar heterotopia, which was published in the English medical literature in the first decade of the twentieth century by the neuropathologist Helen Gertrude Stewart (1874-1959).
William Richard Gowers (1845-1915) was a pioneer of British neurology [1]. He is credited with the first (or best) descriptions of numerous neurological disorders, including dystrophia myotonica, myasthenia gravis, ataxic paraplegia, vasovagal attacks, musicogenic epilepsy, sleep paralysis, palatal myoclonus, and many others. His “chief monument” (according to Gordon Holmes) was the Manual of Diseases of the Nervous System (1886, 1888; 2nd edition 1892, 1893; 3rd edition 1899 (volume I only)). In this essay, I discuss Gowers’ writings on migraine, specifically focussing on the subjective visual phenomena of migraine (aura), and his views on the link between migraine and epilepsy.
Risk communication in multiple sclerosis (MS) is structurally unbalanced. Patients receive detailed, regulator‑mandated information about the potential harms of disease‑modifying therapies (DMTs), yet no equivalent framework exists for describing the risks of untreated or undertreated MS. This asymmetry creates a misleading decision environment in which treatment risks appear concrete and quantifiable, while disease risks remain diffuse and poorly articulated. Drawing on natural‑history cohorts, contemporary registry data and relapse‑recovery studies, this article highlights four consistent findings: untreated MS frequently leads to disability accumulation; relapses often leave residual deficits; progression independent of relapse activity (PIRA) contributes substantially to long‑term decline; and delayed initiation of high‑efficacy therapy is associated with poorer outcomes. Together, these data show that "watchful waiting" is rarely neutral and may expose patients to irreversible harm. The article argues for a structured, patient‑facing disease‑risk summary to support genuinely informed, balanced treatment decisions.
Hemiplegic shoulder pain is a common complication after stroke which results in considerable morbidity. The management of this condition varies between clinicians in different rehabilitation settings. The authors propose a structured approach to manage hemiplegic shoulder pain that takes into account time since stroke, type of pain, spasticity, range of movement, muscle power and individual clinical presentation. Consensus multidisciplinary (physicians, therapists, nurses and patients) agreement was used to develop a step-wise approach to the assessment and management of hemiplegic shoulder pain. The management algorithm includes non-pharmacological and pharmacological treatment options for focal and neuropathic pain syndromes in acute, sub-acute and chronic phases after stroke. This pragmatic and multidisciplinary clinical management algorithm is likely to improve the quality of care provided to these patients and also potentially improve outcomes.
Background: Nabiximols (Sativex®) is a cannabis-based oromucosal spray, with each spray containing 2.7 mg delta-9-tetrahydrocannabinol (THC) and 2.5 mg cannabidiol (CBD). It is licensed for the treatment for spasticity in patients with MS (pwMS) but not other neurological conditions, and evidence for it’s efficacy in the latter is limited. We describe our experience using Nabiximols for spasticity management in the West of Scotland within a neurorehabilitation setting. Methods: A two-centre retrospective review of Nabiximols trial outcomes from 2019 and 2023 was performed for both patients with MS (pwMS) and non-MS diagnoses (pwNMS). Results: Fifty-five pwMS (86%) had a successful Nabiximols trial, with significant improvements in Numerical Rating Scales (NRS) for stiffness at 5.5 ± 2.4 (95% CI: 1.58–3.46, p<0.001), spasms at 4.8 ± 2.5 (95% CI: 1.71– 3.61, p<0.001) and pain at 3.7 ± 2.8 (95% Confidence Interval [CI]: 0.56–2.63, p=0.04),. Seven pwNMS (78%) had a successful Nabiximols trial (3 Hereditary Spastic Paraparesis [HSP], 3 Cerebral Palsy and 1 Stroke). Conclusion: The Nabiximols response rate in our cohort of pwMS is slightly higher at 86% compared to similar studies, likely as a result of patients presenting at a more advanced stage of MS within a specialist spasticity service. Nabiximols is also shown to be effective in HSP and other non-MS conditions in reducing spasticity-related symptoms and improving function.
Epilepsy care is a mainstay of general neurology workload, both in the outpatient and inpatient settings. Recent developments in therapeutics and monitoring have made it more essential than ever that this is structured. Epilepsy care requires much more than just counting seizures, and in this review, we have outlined the ways in which clinicians can maximise patient safety and treatment outcomes. This article is intended as a guide for general adult neurologists who need to remain aware of the diagnostic and therapeutic pitfalls that can emerge over months and years of follow up, being vigilant of the need to continually review diagnostic labels to ensure effectiveness of the current regimen. Clinicians supervising patients with epilepsy should be equipped to facilitate the use of the most appropriate treatments and interventions, either independently or following referral to a specialist epilepsy clinic, carefully balancing the risks of continued seizures with the risks of additional medication. The allotted time in a general neurology clinic should be enough also to screen for specific adverse effects and to highlight high-risk patients who may benefit from referral to specialist epilepsy clinics. A second opinion sometimes helps both patient and clinician, even if only for a one-off assessment.
We assess the current suitability of commercially available consumer wearable devices for sleep research and medicine (both from an observational and diagnostic perspective). Currently, the use of consumer wearable devices presents significant challenges for routine sleep research, with the exception of population-level studies, due to problems accessing raw data and with privacy, validity and transparency, Clinically, wearable devices may be useful for evaluating habitual patient sleep, especially when these data have been collected over multiple weeks or months. However, consumer wearable devices are currently unsuitable for diagnostic purposes in sleep medicine, due to a lack of validation in sleep disordered populations, but have the potential for large-scale diagnostic screening with appropriate.
Pruritus – itching – may not rank amongst the most common of neurological presenting symptoms but nevertheless it may on occasion be a consequence of neurological disease. Here we present a brief tabular listing of causes of pruritus which may need to be considered in the neurology clinic and which we hope may prove serviceable to practicing neurologists.
Epilepsy is a common neurological disorder with greatest incidence in older individuals. The bidirectional link between epilepsy and dementia is supported by epidemiological studies, molecular pathology and animal models. The effect of sleep on the interplay between epilepsy and dementia is an area of growing research. Sleep disruption is common in epilepsy with increased seizure activity observed across certain sleep stages, such as slow wave sleep. Dementia is associated with poor sleep and altered circadian rhythms. Recent evidence suggests that sleep may be the critical window when pathological hyperexcitability in both epilepsy and dementia occur. Poor sleep may underpin cognitive dysfunction in both conditions. A better understanding of the underlying mechanisms may, therefore, illuminate new therapeutic avenues to help cognitive difficulties in epilepsy and in dementia.
Neurology-led cognitive services play an important role in the diagnosis and management of dementia, particularly young onset and atypical dementias. Previous national audits have focused on psychiatry led memory services. Here we present the first audit of neurology led cognitive services across the UK. We present our findings covering a wide variety of services that offer biomarker supported diagnosis, with variable capacity for research and emerging therapies. This audit provides information to plan national priorities for neurology-led cognitive services.
Despite Functional Neurological Disorder (FND) being a common neurological condition, there are no national clinical guidelines to direct treatment, and few examples of how services should be designed to meet the needs of people with FND, particularly in community rehabilitation settings. This article outlines the structure of an FND rehabilitation pathway within a UK-based community neurorehabilitation service that was developed using the best-practice evidence base.
This paper exhumes from the archives a paper published in 1884 by Arthur Rannie in which he described a patient with aphasia and focal brain atrophy. This was some eight years before the first paper by Arnold Pick on this subject which helped to establish his eponymous fame.
In this overview article we discuss the backdrop and address the challenges facing Parkinson’s care in the UK. As organisations adapt to the changing and increasing complex landscape of Parkinson’s therapy, we propose areas in which investment and development may support and optimise future care.
The likelihood of a prisoner in the UK having a history of head injury is high with many having persisting disability. The characteristics of head injury are linked to challenging backgrounds and high social deprivation and are part of a complex ‘weave’ of multiple health morbidities. There is a case for head injury being a cause of criminal behaviour, although its high occurrence alone indicates a need for attention. Potential ways forward in relation to education, support and intervention for prisoners and training of staff are discussed.
This article reviews holistic neuropsychological rehabilitation (NR) for individuals recovering from acquired brain injuries (ABIs), emphasising the interconnected nature of cognitive, emotional, and social recovery. ABIs result in diverse impairments affecting independence and quality of life, necessitating a comprehensive, person-centred approach that focuses on collaboration among healthcare providers, families, and communities. Effective assessment, formulation and personalised interventions are essential for addressing individual needs. The article also discusses challenges in accessing rehabilitation services and the importance of evaluating outcomes to ensure sustainable recovery for ABI survivors.
Parkinson’s disease (PD) is the commonest neurodegenerative cause of parkinsonism and, in terms of prevalence, is fastest growing neurological disorder in the world. In the clinical setting, there are challenges in achieving an early and accurate diagnosis of PD due to clinical overlap with less common parkinsonian disorders, such as progressive supranuclear palsy (PSP), corticbobasal syndrome (CBS), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Furthermore, there is variability in disease progression both between and within PD, PSP, CBS, DLB and MSA such that it can be challenging to give patients accurate prognostic information. The combination of diagnostic uncertainty and varying rates of progression also impact on clinical trials which rely on studying homogenous disease groups. In this article we will review the current state of biofluid biomarker development and its potential applications to Parkinsonian disorders, the challenges and pitfalls of these techniques, and future directions.
This article examines some of the published references to John Hughlings Jackson as the “father of English neurology”, the “father of British neurology”, or even the “father of Neurology”. These publications show that, rather than being a retrospective, posthumous signifier, this terminology in fact dates from Jackson’s own lifetime.
Thomas Addison in 1855 described anaemia, general languor and debility, and a peculiar change of the colour in the skin in connexion with a diseased condition of the suprarenal capsules. But his famous monograph, did not mention a secretory role or vital humoral factor stemming from the adrenals. When the peripatetic experimental neurologist Brown-Séquard published (in1856) the results of his first experiments on the suprarenal glands it was not known that any of the vascular glands had a secretory function. He showed that animals dying from the absence in the blood of the secretion of those glands (after they had been removed) could be revived when they received an injection of a liquid extracted from healthy suprarenal capsules [glands]. Thus it was a neurologist Brown-Séquard who had established the essential secretory role of a glandular structure, the scientific foundation of endocrinology. Later, in 1902 Bayliss and Starling discovered secretin and introduced the word hormone.
