There are a number of risk factors that we commonly associate with stroke, including hypertension, smoking history, and diabetes. The current issue of JNNP explores the role of stress resilience in the aetiology of stroke http://jnnp.bmj.com/content/85/12/1331.abstract . The authors have assessed a large Swedish male population and have provided interesting insights into the role of stress in the development of stroke. They have demonstrated that low stress resilience during adolescence was associated with a subsequent higher stroke risk. They also note that the association was independent of socio-economic status and general physical health. The results are particularly interesting given the emerging associations between early life stress and the development of metabolic conditions, such as diabetes.

The authors suggest that their study highlights the importance of measures for stroke prevention incorporating ways of reducing psychosocial stress.

The issue of whether excessive work may lead to increased weakness in hereditary neuropathy is a vexing one and critical for patient management.  in this issue of JNNP this notion has been categorcially dismissed.  There was no worsening weakness with overwork in a  large CMT1A cohort.

Read more:   http://jnnp.bmj.com/content/85/12/1354.abstract

• Neuromuscular

• Research paper

In the last decade or so, we have seen numerous major advances in our understanding of multiple sclerosis (MS). While the condition was traditionally viewed as a disease of the brain white matter, this hypothesis has been turned on its head with the discovery that grey matter involvement occurs in MS. Furthermore, we now know that this can happen quite early in the disease course and that it may underlie physical disability. A lot of MS patients report cognitive changes that occur even in the earliest stages of the disease and it is very possible that these changes may be due to the loss of grey matter.

In the current issue of JNNP, Haider and colleagues present a very interesting study that demonstrates that involvement of the deep grey matter may play an important role in the development of disability in MS http://jnnp.bmj.com/content/85/12/1386.abstract . In addition, they also show that these changes were associated with accumulation of iron in the brain. This is a very important finding as iron has been postulated to play a role in the development of brain oxidative injury.

This is a very interesting study which provides important insights into our understanding of the pathology of MS.

ALS is a rapidly progressive neurodegenerative disorder of the motor neurons with median survival of 3-5 years.  The site of disease onset, and the timing of disease onset remain controversial, although

a sudden and catastrophic degeneration of the motor neurons does occur.  In this issue of JNNP a though provoking review by Eisen and colleagues suggests a long term pre clinicla period, perhaps stretching beck to the in utero period.  In an

accompanying letter,  neuronal dysfunction (preceding degeneration) was reported in a zebra fish model.  Interestingly, this dysfunction was slowed down by riluzole.  The question remains as to whether we are too late by the time the patients present.  But then, who should be treated/monitored.  The genetic cases, or all relatives of sporadic cases.  Clearly there are more answers than questions, although headway has been made, and more research is needed.