Singular symptoms

A cornerstone of scientific method is reproducibility. But when it comes to disorders of the human brain, the situation is far more murky. How can we start to standardise the complex, highly individual and often bewildering patterns of actual behaviour, seen in people with brain damage or some other type of mental disorder? To a certain extent, animal models of, say, Parkinson's disease or schizophrenia can comply with the requirement of a large sample size, all matched for strain, gender, age, dietary requirements and so forth - but then of course, the subjects do not actually have the fully faceted condition in question. Epidemiology provides invaluable input in identifying risk factors, causes and so forth for a particular disease, while the measurement of brain chemicals or some other postmortem variable obviously generates a large number of observations and hence finally a clear, specific statistic. But in population studies, as in laboratory-based animal models or in postmortem biochemical assessments, some salient feature or features must initially be pinpointed. Surely, it is from individual patients that one must first expect to find clues.

Neurocase publishes reports from the standpoint of neuropsychology, neuropsychiatry and behavioural neurology, where perhaps the potential is greatest for painting the complete clinical picture. Whereas there are recognised profiles of symptoms in disorders such as Parkinson's disease, even in such well-documented conditions generalisations must always be tempered with variations in the progress of each individual case. People, unlike laboratory rats or guinea pigs, do not have identical diets, a complete absence of medical history and no confounding medication.

Moreover nature, unlike the scientist, does not consistently position damage in any given brain region, time after time, to comply with the requirements of experimental protocol. Aside from recognised neurological and psychiatric disorders, an individual may well present a unique case because of a unique configuration of damage to a certain part of the brain. The fact that each patient may vary according to the extent of the brain damage within a similar brain region, is yet another reason why clinical data is perforce so anecdotal.

Neurocase focuses strongly on the value of the single case report. On the other hand, anecdotes on their own cannot really have much power until they are placed into a larger pattern of ideas, and also seen to have certain similarities with similar, not necessarily identical, cases. Neurocase caters for these three stages in furthering understanding of the human brain. There are some half-dozen original papers per quarterly issue. At the same time, it is refreshing to see a clear and unambiguous request for papers that are replications of earlier work. All too often, especially among the laboratory-based scientists, reproducibility by another group, though covertly valued and needed, is publicly denigrated by many journals explicitly giving priority to "novel" findings. Hence supportive, confirmatory work is often never publicised very widely in easy-to-obtain journals, or worse, ends up never being published at all.

Neurocase helps this second, essential process of data assimilation further by following each article, where possible, with a summary of papers on a similar topic, published elsewhere. These summaries, depending on popularity of the field, can reach as many as 30 or so, and are standardised into an easy-to-scan format, after the usual reference details, of "primary diagnosis of interest", "author's designation of case", "key theoretical issue", "key words", "scan, EEG and related measures", "standardised assessment", "other assessment", "lesion location" and "lesion type." The plan is to build up an electronic data base from this material, so that the identification of patterns, themes, common factors and true replications is facilitated. Once this meticulous search for common ground, so much harder in patients than in the laboratory, starts to produce a coherent picture, then Neurocase caters too for this final stage, and publishes one review per issue.

The pages are richly sprinkled with the usual specialist graphs and tables as well as individual, clearly presented brain scans. The material covers a good range of problems relating to dyslexias, sensory neglect, memory problems, developmental issues and types of movement. Above all, it is signs and symptoms led: hence the need for as efficient a system as possible for extracting whatever generalisations might eventually be possible from a morass of data. The accruing of a database is undoubtedly valuable, though it is not clear what criteria the editors have used to select the summaries to follow each article, nor how they decide just how similar to, or discrepant from, the full paper, each summary has to be. In any event, despite the existing alternatives of one's own library and data bases, these summaries do provide a very ready source of reference, whether for oneself or perhaps even for teaching.

The clear and focused remit of this journal places it firmly in the court of the neuroclinician. The tone of the articles would not make life easy for philosophers of mind, nor broad-minded neuroscientists straying beyond their normal territory and keen to have an immediate window onto the human mind. If we are to understand consciousness, that ultimate riddle and essence of the individual, then sooner or later it is to the type of individual case studies published here, anecdotal though they may be, that we will have to return. To this end, Neurocase offers a rich and direct source.

Susan Greenfield is professor of pharmacology, University of Oxford.