by Neil Scolding, 446 pp, Oxford, Boston, Mass, 2001.
The attractive style and the lucid review chapters prepared by more than 30 European authors will please any reader of this book. For an elderly clinician who remembers neurology when it meant esoteric diagnosis, therapeutic nihilism, and patients soon transferred to other specialties for more definitive care, the astounding therapeutic advances of the past 50 years is like a new spring.
The book begins with a detailed discussion of design, analysis, and interpretation of therapeutic trials—a good chapter to copy for our residents and fellows and perhaps even for our institutional panels. All of the authors are consistent in emphasizing useful therapies supported by accepted scientific research. They also recognize that some treatments, for example, for tuberculosis meningitis, can be so pressing that double-blind studies with placebo control are hardly ethical. Some conditions are so rare or sporadic that study design is complicated, perhaps for a few even impossible. Nevertheless, every author of every chapter presents data that are currently available to document the benefits of therapy, reviews therapy that has been proven successful, and several authors supply additional comments regarding their personal experiences. The studies cited in this book offer evidence-based opinions and the references are topical and recent. In some chapters, the discussion of pathogenesis is almost too detailed, as in the discussion of channelopathies. The authors offer detailed discussion of potential future treatments based largely on current laboratory observations in some chapters, such as the one on multiple sclerosis. It is understandable that in certain chapters, for example, the chapter on metabolic storage diseases, only a selection of examples can be used; the fine chapter on headaches deliberately ignores secondary causes of headache to concentrate on recent therapeutic advances for vascular pain. Some areas are not reviewed at all. The superb article on cervical myelopathy offers no help if you wish to look up lumbar stenosis, and conditions such as back pain, Bell palsy, and Wilson disease are largely ignored. Although the discussion of Tourette syndrome mentions optimal therapies for depression or obsession and there is proper caution regarding the use of neuroleptics in Lewy body disease, the psychiatric aspects of neurologic disease are conspicuously missing throughout this book. For example, there is an elegant 5-page discussion of surgical approaches in Parkinson disease but the discussion of psychosis and hallucinations is thin in comparison; the even more common and treatable depression is not mentioned at all. Human immunodeficiency virus did not make it into the index, and the chapter on neurologic infections does not include information about acquired immunodeficiency syndrome because it is "not usually dealt with primarily by a neurologist." It will be possible for any neurologist to find areas of his or her particular interest slighted.
George Paulson. Contemporary Treatments in Neurology. Arch Neurol. 2002;59(5):871–872. doi:
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