Restorative Neurology. Advances in Pharmacotherapy for Recovery After Stroke.

Until 30 years ago, the acupuncturist or reflexologist knew more about neural plasticity than most clinical neuroscientists, who were taught that the adult central nervous system was hard-wired and the consequences of damage immutable. However, over the last 15 years an increasingly extensive literature has described activity-dependent remodelling of CNS pathways, particularly in cortex but also in other parts of the brain and spinal cord, and has paved the way for a clinical interest in recovery of neural function. Although these descriptions of neural plasticity have considerably influenced therapy techniques, they have yet to result in effective pharmacological facilitation of neural recovery, as Goldstein's book illustrates. Rehabilitation programmes aim in general to increase functional activity and participation in social roles, and to improve quality of life. In recent years there has been particular focus, driven by a need to demonstrate effectiveness in the market place, on the study of outcome at these levels, and \`whether' rather than \`how' rehabilitation works. As class 1 studies confirm that organized care is better than unorganized care, study of how treatments ameliorate the effects of loss of physiological or psychological function, or anatomical structure, collectively known as impairments, after neurological damage becomes crucial to advances in rehabilitation. This is restorative neurology, and it is an area in which the clinical neurosciences can make a unique contribution. Recovery after neurological damage is complex, particularly when it …