Some readers will no doubt have watched the 1990 movie, Awakenings starring Robin Williams and Robert de Niro, about a group of patients who had suffered a form of encephalitis and survived, only to be permanently in a state of reduced awareness and responsiveness. The movie was based on a book by the famous neurologist, Oliver Sacks, and explores the potential use of a new treatment for these patients. In his memoir of the same name, Sacks was referring to the possible beneficial effects of L-DOPA, a medication that is first-line treatment for Parkinson’s Disease. That book was written 40 years ago, so what have we learnt since then about this condition?

In this issue of JNNP, Wijemanne and Jankovic have reviewed this topic and have provided an insightful update on this condition http://jnnp.bmj.com/content/86/8/825.full . As noted in their review, catatonia can occur in numerous conditions, both neurological and psychiatric, and it is no longer regarded purely as a form of schizophrenia. In addition, there are a number of systemic conditions in which it can occur including cardiovascular, renal and connective tissue disorders. It can also occur as an adverse reaction to numerous medications.

While the exact pathophysiology remains unclear, the role of changes in GABA neurotransmission have been explored in depth and Zolpidem, a GABA-agonist, has been suggested as a possible treatment. Electroconvulsive therapy (ECT) remains a very potent treatment for this condition and neuroleptic medications are also trialled in some patients. However, as noted in their review, the question of why this occurs remains unresolved and is a question for future research.

Infectious diseases of the nervous system are an evolving and extremely interesting area of neurology. There always seems to be a new infection on the horizon and this means that neurologists constantly need to stay up-to-date on how these infections present clinically. Importantly, many are treatable and this means that you have to be on the ball to ensure that patients can receive early treatment with a reduction in long-term disability.

In this issue of JNNP, Misra et al from Lucknow in India have presented a comprehensive analysis of patients admitted to their institution in 2012-2013 who had been diagnosed with Scrub Typhus, a condition transmitted by a rickettsial organism that is usually spread by ticks, lice and fleas http://jnnp.bmj.com/content/86/7/761.abstract. There are certain areas of the world where this organism is endemic, including India, Pakistan, Russia, Japan and Australia.

Amazingly, the authors identified 38 cases in this short period of time and have provided a wonderful overview of how these patients present. Meningitis and encephalitis are common presentations with patients often experiencing headache, fever and disorientation. The condition can also be life-threatening and some patients in this series were admitted to intensive care units with lung involvement or kidney failure. The most important aspect of this paper is that ~90% had a good response to antibiotic treatment with doxycycline. As suggested by the authors, scrub typhus should be included in a list of conditions that can cause encephalopathy with fever, particularly in patients who live in or who have travelled to areas where this condition is endemic.