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Clinical research in the UK: back from the brink, but are neurologists missing the boat?
  1. Peter Rothwell
  1. Correspondence to Professor P Rothwell, Professor of Clinical Neurology, University Department of Clinical Neurology, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; peter.rothwell{at}clneuro.ox.ac.uk

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It is axiomatic that clinical research is central to effective patient care. However, although Archie Cochrane's plea that everyday clinical practice should, where possible, have a scientific basis was made nearly 40 years ago,1 there is still an enormous amount of work to be done in order to achieve this goal for patients with neurological disorders. Clinical research by practising neurologists is as essential now as it has ever been. Even the most basic descriptive epidemiology and natural history of common neurological syndromes are still only now beginning to be adequately described. Examples from recent issues of Practical Neurology include reversible cerebral vasoconstriction syndrome2 and transient epileptic amnesia.3 The importance of high quality clinical description, coupled with good neuropathology should not be underestimated. It is unlikely, for example, that disorders such as variant Creutzfeldt–Jakob disease or CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) would otherwise have been recognised as distinct disease entities.

Even when diseases have been identified and the molecular pathology elucidated, it is all too common to find that relatively little is known about the reliability of diagnostic tests, about the factors that influence prognosis or about the effectiveness of available treatments. Yet these issues are usually of most concern to patients and clinicians. Consider corticosteroids and antiepileptic drugs, for example, two ‘old stagers’ in the neurologist's therapeutic armoury. It is only recently that it was finally shown …

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