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Headlines – Special Edition 6 How does it feel knowing a migraine treatment is available but your patient might not be able to access it? It's a bit unfair, isn't it? I work in the public hospital, so I've got no patients on these drugs because they can't afford it. So, it is frustrating and disappointing. On the other hand, those medications don't totally prevent migraines, so it's not as if they are miraculous cures. Do you think public understanding and empathy for people with migraine has improved over the past 35 years? There's still quite a bit of prejudice. People say, “He or she's not at work again because they've got another migraine.” I don’t know whether that's really changed. We’re hearing a lot about head injuries, particularly in sports. As a neurologist, what is your view on contact sports, for example? Repeated head injury is bad in the long term. Realistically, body contact sports will not be banned, but I think the right approach is to try to minimise head injuries. As far as I know, most sporting bodies have become aware of this and are doing their best to reduce the risk of head injuries – for instance, by teaching the correct way of tackling. And, of course, there's still a lot of research going into that area. A lot of it is, in fact, funded by the Neurological Foundation. Epilepsywasoneof thediseasesmentioned in issueone of Headlines .What progresshasbeenmadesince then? New medications have become available in the last 35 years. They're not necessarily more effective, but they are usually better tolerated, and they give more treatment options. Philip Wrightson was one of the pioneers in surgical treatment for epilepsy in New Zealand, and that treatment continues. The methods of assessing patients are better now. They come into hospital for a week or more to observe seizures while they're recorded with an EEG and video. Doctors can do special brain scans to find out what part of the brain the seizures are coming from. That's been an advance. What about Huntington's disease? That usually presents in adult life with dementia and movement disorder. Before 1990, we knew Huntington’s must be a genetic thing because it ran in families. Since then, the gene that causes it has been identified, which was a major scientific breakthrough. But there's still a long way to go in terms of treatment. What about Parkinson's disease? That depends on how you look at it. It’s disappointing in a way, because the big breakthrough in treatment of Parkinson's disease came in the 1960s when it was found that the part of the brain that produces dopamine degenerates. That led to the introduction of treatment with levodopa in the 1960s. Since then new drugs and treatments have appeared, but none of them are as effective as levodopa. One new treatment is deep brain stimulation, but that's really for people who are in more advanced stages of Parkinson's disease. The other advance is apomorphine infusion, also given in the later stages. There's still a huge amount of research that needs to be done in Parkinson’s disease. Interestingly, the only thing that probably slows the underlying progress of Parkinson’s disease is exercise. Predicting stroke recovery? The focus has shifted somewhat towards acute treatment and prevention. Having said that, many people require physiotherapy and rehabilitation after a stroke. The Foundation has funded some very good research in the last 10 years, and Cathy Stinear’s research group has done really important work in developing tests to predict which patients are going to recover with physiotherapy. Early years: Neil outside Memorial Sloan Kettering Cancer Center after an overnight snowstorm.