The Nocturnal Brain

Within the neurones of the suprachiasmatic nucleus, a complex dance occurs on a daily basis, with several genes with names like CLOCK and Period interacting with each other, feeding back to each other, conducting the ticking of our clock.

Our 24-hour rhythm influences our brain, our gut, our kidneys, our liver and our hormones — every cell in our bodies. In fact, remove a cell, place it in a Petri dish, and it will demonstrate a 24-hour rhythm in some form or other.

And, as neurologist Oliver Sacks so aptly put it: ‘In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.’

As a schoolboy, I vividly remember picking up a copy of Oliver Sacks’s book, The Man Who Mistook His Wife for a Hat. As I read these stories of a mariner unable to form new memories, of a man who could not recognise his own leg, of the woman who heard music as a result of epileptic seizures, I was gripped. But it was the context in which he put these symptoms, the impact on the lives of the human beings in front of him, that led to a deeper understanding of the nature of these conditions and how they affect us. And it was reading these stories that inspired my interest in neuroscience, and no doubt many of my colleagues too.

The best neurologists I have worked with are the ones who have the patience and the ruthless determination to extract the full history, like a forensic FBI interrogator.

From the second row, where the neurology registrars sat, it felt a little like being in one of the amphitheatres of Rome — and we were about to be fed to the lions. The craftiest registrars among us would find a patient that urgently needed assessment on the wards so that they could creep into the rear of the auditorium late, along with the hordes of junior doctors, medical students and visiting neurologists from abroad. The most devious would arrange for a colleague to page them early in the proceedings so they could make a show of leaving to deal with ‘an emergency’ before sneaking in at the back of the lecture theatre later on.

Robert is also not wh

Robert

some researchers have suggested that, in REM sleep, signals from the motor cortex, the part of the brain where movements are generated, simply bypass the basal ganglia, the areas involved in Parkinson’s disease that regulate movement in waking life.

The patient, who during the day had been unable to squat down, was very slow of movement and had a quietened voice, had been dreaming of being a police-duck, flying after a pigeon-thief.