From Epidemic Meningitis Vaccines for Africa to the Meningitis Vaccine Project.

Background: Polysaccharide vaccines had been used to control African meningitis epidemics for >30 years but with little or modest success, largely because of logistical problems in the implementation of reactive vaccination campaigns that are begun after epidemics are under way. After the major group A meningococcal meningitis epidemics in 1996-1997 (250,000 cases and 25,000 deaths), African ministers of health declared the prevention of meningitis a high priority and asked the World Health Organization (WHO) for help in developing better immunization strategies to eliminate meningitis epidemics in Africa.

Methods: WHO accepted the challenge and created a project called Epidemic Meningitis Vaccines for Africa (EVA) that served as an organizational framework for external consultants, PATH, the US Centers for Disease Control and Prevention (CDC), and the Bill & Melinda Gates Foundation (BMGF).

Some movement disorders.

As with my previous writings on the neurology of literature, all the references used have been personally read. Indeed, I should hasten to stress that the prime motive in my reading has been a love of literature, a secondary gain being an insight into the way in which a variety of writers has viewed neurological disease. Some of the descriptions leave no doubt as to the condition being described: in other descriptions, I have used a degree of imagination! All the references to foreign texts have been read in translation.

The neurology of literature.

The confines of this chapter are necessarily arbitrary. Its limits are partly imposed by the extent of my reading (all the references have been read in full!) and partly by the restrictions of space - as a consequence of that restriction there are innumerable examples which I have been unable to cover. I have concentrated, though not exclusively, on the literature of the 19th century.

The dyslexic student and mathematics in higher education.

Difficulties that are encountered by dyslexic undergraduates with their learning and understanding of mathematics are explored. Specific consideration is given to issues arising through mathematical content, its delivery, the procedures and processes of 'doing' mathematics, and its assessment. Particular difficulties, which have emerged through exploratory and explanatory multiple-case studies, and witnessed through the provision of one-to-one support to a dyslexic and dyspraxic engineering undergraduate, are detailed.

Paraneoplastic "stiff person syndrome" with metastatic adenocarcinoma and anti-Ri antibodies.

A 43-year-old woman presented with clinical and electrophysiologic features of stiff person syndrome (SPS), without abdominal or lumbar paraspinal muscle involvement. Investigations revealed metastatic adenocarcinoma of the lung with positive anti-Ri antibodies. Her clinical condition improved with diazepam, baclofen, tizanidine, and palliative chemotherapy.

Polyglutamine expansion induces a protein-damaging stress connecting heat shock protein 70 to the JNK pathway.

Polyglutamine diseases, including Huntington's disease, designate a group of nine neurodegenerative disorders characterized by the presence of a toxic polyglutamine expansion in specific target proteins. Using cell and mouse models, we have shown that expanded polyglutamine led to activation of the stress kinase JNK and the transcription factor AP-1, which are implicated in neuronal death. Polyglutamine expansion-induced stress shared common features with protein-damaging stress such as heat shock, because activation of JNK involved inhibition of JNK phosphatase activities.

Trigeminal Neuralgia.

The initial treatment for trigeminal neuralgia is medical. Carbamazepine is the drug of choice. If the patient proves to be intolerant of carbamazepine, a number of second-line drugs are available, though data on their relative efficacy are nonexistent.

The peripheral benzodiazepine binding site in the brain in multiple sclerosis: quantitative in vivo imaging of microglia as a measure of disease activity.

This study identifies by microautoradiography activated microglia/macrophages as the main cell type expressing the peripheral benzodiazepine binding site (PBBS) at sites of active CNS pathology. Quantitative measurements of PBBS expression in vivo obtained by PET and [(11)C](R)-PK11195 are shown to correspond to animal experimental and human post-mortem data on the distribution pattern of activated microglia in inflammatory brain disease. Film autoradiography with [(3)H](R)-PK11195, a specific ligand for the PBBS, showed minimal binding in normal control CNS, whereas maximal binding to mononuclear cells was found in multiple sclerosis plaques.

A conversation with the leaders of the Gates Foundation's Global Health Program: Gordon Perkin and William Foege.

Over the past 3 years, the Bill & Melinda Gates Foundation has committed more than $1.7 billion to help prevent and eradicate diseases that afflict people living in the world's poorest nations. The gifts have revitalized a number of major global health initiatives that in recent years had lost momentum and helped to refocus the world's attention on the health crises facing many developing nations.

The effect of oral and intravenous methylprednisolone treatment on subsequent relapse rate in multiple sclerosis.

We investigated the effect of oral and intravenous methylprednisolone treatment on subsequent relapse rate in patients with multiple sclerosis. Following a double blind trial designed to compare the effect of oral and intravenous methylprednisolone treatment on promoting recovery from acute relapses of multiple sclerosis, 80 patients were followed for two years with six-monthly assessments during which all subsequent relapses were recorded. The annual relapse rate was slightly higher in the oral compared with the intravenous methylprednisolone-treated patients (1.

Lamotrigine monotherapy in newly diagnosed untreated epilepsy: a double-blind comparison with phenytoin.

Purpose: Lamotrigine is an effective add-on therapy against a range of epileptic seizure types. Comparative studies with carbamazepine (CBZ) as monotherapy in newly diagnosed epilepsy suggest similar efficacy. In this study, lamotrigine (LTG) and phenytoin (PHT) are compared.

Neurology and the gastrointestinal system.

Both achalasia and Hirchsprung's disease arise from defects of innervation of the oesophagus and distal large bowel respectively. Their consequences are confined to disorders of motility in the relevant part of the gastrointestinal tract. Many neurogenic and primary muscle disorders are associated with abnormalities of gut motility.

Lymphocyte-endothelial cell interactions in multiple sclerosis: disease specificity and relationship to circulating tumour necrosis factor-alpha and soluble adhesion molecules.

This study addressed two questions; first, whether the supranormal adherence of blood lymphocytes from patients with multiple sclerosis (MS) to endothelial cell monolayers treated with tumour necrosis factor-alpha (TNF alpha) was a feature common to other inflammatory disorders; and second, whether the adherence properties of blood lymphocytes from MS patients were related to changes in disease activity and to levels of circulating TNF alpha and soluble adhesion molecules. In the first part of the investigation, lymphocytes from 14 patients with MS were more adherent to TNF alpha-treated endothelial cells (P < 0.01) than those from healthy controls, whereas the adherence properties of lymphocytes from 12 patients with rheumatoid arthritis, eight patients with psoriasis and ten patients with neurological diseases other than MS were normal.

Clinical features and management of two cases of encephalitis lethargica.

Two patients with presumed encephalitis lethargica are presented with clinical features suggestive of two forms of the disease described by Von Economo: One patient had a psychosis and a mute-akinetic syndrome associated with myoclonus. The second patient presented with a psychosis and fever, developing severe dyskinesias involving the mouth, trunk and limbs, together with respiratory irregularities and presumed hypothalamic disturbance and disturbance of consciousness. In both cases, initial cerebrospinal fluid (CSF) examination revealed an elevated white cell count (predominantly lymphocytes), elevated protein in case 2, and oligoclonal bands in both cases.

Randomised trial of oral and intravenous methylprednisolone in acute relapses of multiple sclerosis.

Background: An intravenous rather than oral course of methylprednisolone is often prescribed for treating acute relapses in multiple sclerosis (MS) despite the lack of evidence to support this route of administration. Our double-blind placebo-controlled randomised trial was designed to compare the efficacy of commonly used intravenous and oral steroid regimens in promoting recovery from acute relapses in MS.

Methods: 42 patients with clinically definite relapse in MS received oral, and 38 intravenous, methylprednisolone.

Facial myokymia in multiple system atrophy.

Two patients are described with clinical and neuroimaging features consistent with a diagnosis of multiple system atrophy (MSA). The patients are unusual in that facial myokymia became apparent clinically at some stage in their illness. In each patient, the nature and severity of the involuntary facial movements evolved over the course of the illness.