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Carphology by A Fo Ben

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Think MS, think cortex?

It has always been difficult to assess cortical involvement in multiple sclerosis (MS)at an early stage as lesions tend to remain hidden from MRI. Investigators studied early MS among a cohort of 563 patients who had a brain biopsy (to rule out diseases other than MS) within days or weeks after presentation. 53/138 (38%) who eventually were diagnosed with MS had histological evidence of cortical demyelination. The lesions were inflammatory and associated with meningeal inflammation. This may contribute to disability independently from white matter lesion load.

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The ears have it

A Fo Ben recently learnt the importance of MRI and biopsy of the ear, in the investigation for ataxia. Although routinely boring holes into the pinna of those with an unusual gait is normally best left to body piercers, it can help to secure a diagnosis of relapsing polychondritis. A 57-year-old man presented with 2 months of unsteady gait and deafness. Ear oedema was visible on diffusion MRI (figure 1). Once the diagnosis was made he was successfully treated with oral steroids.

Figure 1

Inflammation of the ear seen both with the naked eye (left) and on MR imaging (right).

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Sick and tired

A Fo Ben tries to steer away from amateur post-publication peer review but admits to giving a chronic fatigue syndrome paper published in Science a bit of a roughing-up: the paper has now been partially retracted (Pract Neurol 2010;10:124). To redress the balance here is a double-blind placebo controlled chronic fatigue syndrome paper. Norwegian researchers performed phase II studies on the effect of rituximab on self-reported fatigue scores and B cell populations. Ten of the fifteen people with chronic fatigue responded well to treatment. Fatigue improved significantly at 6 months and beyond (although not at 3 months, the study's primary end point). The authors suggest that this delayed response is in keeping with auto-antibody depletion. In passing, the authors failed to replicate the findings of the controversial Science paper.

The missing 90%

A Fo Ben is aware that many readers have better things to do during the day than listen to BBC Radio 4, and may be unaware of the excellent series of programmes broadcast about the brain in November 2011. Over a few weeks there was a fabulous 10-part series on the history of our understanding of the brain over the last 5000 years—just the thing to bring your practice up to date and, perhaps most usefully, a wonderful 30 min dealing with many myths about neurology and neuroscience, including the basis of the commonly held belief that we only use 10% of our brains. All these delights are still available on the BBC Radio 4 website for your future dinner-party conversational use and come highly recommended. (08.11.11)

How many Facebook friends do you have?

On-line networking and media sites have become frighteningly ubiquitous. Some would question whether e-friendships are as meaningful or socially relevant as those in what we might term ‘real’ life. A recent paper from University College London suggests that, at least among students, people with a greater number of Facebook friends have more grey matter in relevant parts of the brain compared with those with fewer. This accords with previous work showing similar effects with more traditional friendship groups. Do people with more grey matter make more friends, or does increasing social complexity put greater demands on the brain? This study cannot unpick the causality, though a more recent study in macaques housed in groups of externally-determined sizes demonstrated a relationship between social group size and grey matter in similar regions, suggesting that social networks really can influence brain function.

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