The Lancet Neurology launched

N.B. Please note that if you are outside North America the embargo date for Lancet Neurology press material is 0001hours London Time Tuesday 16 April 2002

TLN Editor James Butcher comments: "Neurology has the potential to be one of the biggest growth areas in medicine over the coming decade. Because of the nervous system's complexity, progress up until now has been slower than in other medical specialties. However, it is realistic to hope that major breakthroughs will be made in the not-too-distant future. THE LANCET NEUROLOGY intends to be at the forefront of this medical endeavour, and will report the most important advances in a timely and comprehensive way."

HIGHLIGHTS FROM THE FIRST ISSUE

Predicting who is at risk

New technologies, especially in genetics and imaging, mean that neurologists will soon be able to predict which of their patients are at the greatest risk of developing a neurological condition. Some of the recent developments in this area are discussed in this month's issue:

1. There is now mounting evidence that epileptic seizures begin minutes to hours before clinical onset. In this issue, Brian Litt and Javier Echauz describe the techniques that are being developed for seizure prediction. They suggest that implantable devices that can detect impending seizures and then deliver preventative therapy are a realistic goal.

2. The ability to detect the onset of dementia at an early stage is essential if therapeutic interventions are to have the greatest chance of success. At the end of their review on the use of structural magnetic resonance imaging (MRI) for the practical assessment of dementia, Philip Scheltens and colleagues discuss how MRI might be used to identify patients at risk of developing Alzheimer's disease.

3. Some of the ethical implications of the use of genetic testing for Alzheimer's disease are described by Melissa Barbour and Peter Whitehouse in their "Reflection & Reaction" commentary article. They propose that the use of genetic testing needs to be discussed not just by academics and clinicians, but within the community as a whole.

Treatment

Hardly a week goes by without a report in the popular press that describes the therapeutic potential of gene therapy or stem cells for the treatment of neurological disorders. The first issue includes two reviews that discuss experimental therapies that have yet to make it to the clinic.

1. New approaches for treating neurological disease, including gene-based therapies, nervous-system growth factors, stem cells, novel vaccines, and modulation of the immune system, offer the potential to prevent cell loss and degeneration in the brain, rather than attempting to compensate for loss after it has occurred. Mark H Tuszynski reviews one of these prospective therapies: growth factor gene therapy for Alzheimer's disease, an approach that is currently the subject of a phase I clinical trial.

2. Within the past 12 months, patients with multiple sclerosis have received intracerebral implants of autologous myelinating cells in an attempt to repair demyelinated lesions. In this issue of TLN, Christopher Halfpenny and colleagues review the clinical and biological problems presented by multiple sclerosis disease processes, and the background to the development of myelin repair strategies. They also speculate on how remyelinating therapies are likely to develop in the forseeable future.

Neurology in the developing world

Not everyone in the world has access to expensive imaging equipment, or to cheap but effective antiepileptic drugs. Traditionally, THE LANCET has had a global outlook, and TLN plans to continue in this vein wherever possible. In this issue Gretchen Birbeck, who was awarded an International Fellowship by THE LANCET in 2001, describes her experiences as a western neurologist in Zambia.

CONTENTS

The leading edge
Looking into the future
Newsdesk
News in brief
Dosing in phase II trial of Alzheimer's vaccine suspended
Acutely ill neurological patients get raw deal in UK
Role of DARPP-32
Mini-genes to treat muscular dystrophy
"Neural integrator" may go awry in torticollis
Can a cursor be moved by thought alone?
Transplantation of embryonic stem cells in Parkinson's disease
Does copper have a role in ALS?
Blood test to detect Alzheimer's developed
Gene found for another idiopathic epilepsy
Tuning into congenital tone deafness
Reflection & Reaction
Predictive value of MRI findings in multiple sclerosis
    Massimo Filippi
Susceptibility testing for Alzheimer's disease: race for the future
    Melissa Barber and Peter J Whitehouse
Do leisure activities protect against Alzheimer's disease?
  Colette Fabrigoule
Reviews
Structural magnetic resonance imaging in the practical assessment of dementia: beyond exclusion
    Philip Scheltens, Nick Fox, Frederik Barkhof, and Charles De Carli
Prediction of epileptic seizures
    Brian Litt and Javier Echauz
Cell transplantation, myelin repair, and multiple sclerosis
    Christopher Halfpenny, Tracey Benn, and Neil Scolding
Management of acute stroke
    Kennedy R Lees
Growth-factor gene therapy for neurodegenerative disorders
    Mark H Tuszynski
Personal view
A neurologist in Zambia
    Gretchen L Birbeck
Forum
How should stroke services be organised?
    Peter Langhorne, Dominique Cadilhac, Valery Feigin, Richard Grieve, Ming Liu Media watch
Where on the web
The last word
The first word
    John McCrone