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Book Reviews
Mar 2012

Primer on Multiple Sclerosis

Author Affiliations

Author Affiliation: Department of Neurology, Oregon Health and Science University, Portland, Oregon.

Arch Neurol. 2012;69(3):411-412. doi:10.1001/archneurol.2011.2004
by Barbara S. Giesser, MD, 504 pp, with illus, $75, ISBN-13 978-0-19-536928-1, New York, New York, Oxford University Press, 2010

Dr Giesser's comprehensive book, with 49 contributors, covers an impressive range of information on multiple sclerosis (MS). It includes a brief introductory chapter describing the history of MS followed by 4 short (approximately 15 pages each) chapters on the basic science of MS. The remainder of the book has a clinical focus, with parts on diagnosis and prognosis, clinical manifestations, therapeutics, psychosocial issues, and research. This book's stated goal is to provide for the practicing neurologist “the theory and the practice of providing comprehensive care to persons with MS,” and it successfully achieves this goal.

Although this book is not the first in its field, it provides a unique contribution. Other texts are either much longer and more detailed, generally aimed at the subspecialist or the individual with a special interest in MS, or shorter, with a focus on MS diagnosis and specific MS therapeutics. This book's unique features are the range of expertise it brings, particularly to the clinical management of MS-related symptoms and its comprehensive coverage of all aspects of patient management, including disease-modifying therapies, symptomatic therapies, approaches to psychosocial issues, and suggestions for conducting clinical research.

Parts 1 and 2, covering the history and the basic science of MS, provide information available in most texts or book chapters on MS. This includes an excellent chapter on the immunology of MS that covers this complex topic with remarkable clarity while also bringing up areas of controversy and uncertainty. Overall, part 2 of this book will provide the practicing neurologist with an in-depth review of our current understanding of the pathophysiology of MS.

Part 3 reviews the diagnosis and prognosis of MS and includes a particularly useful discussion of the differential diagnosis of MS, emphasizing the rarity of uncommon mimics of MS. The other chapters in this part discuss the nature and role of the tools used in the diagnostic workup of MS, including neuroimaging, cerebrospinal fluid studies, evoked potentials, and clinical course. These chapters bring together information on the diagnosis of MS likely familiar to many practicing neurologists, while also filling in the details of their specific strengths, limitations, and ideal application and discussing the potential roles of newer nonconventional or emerging techniques such as magnetization transfer imaging and diffusion tensor imaging.

Part 4 is the section that stands out as making a unique contribution to the literature on MS and to the clinician's bookshelf. It provides information on the pathophysiology, examination, and management of the myriad clinical manifestations of MS. Although the chapters vary in depth and focus, all include information on the underlying pathophysiology of the symptoms, the examination, and recommendations for management. Chapter 14 on mobility disorders in MS, chapter 20 on MS and pain, the part of chapter 15 on management of bowel complications, and the part of chapter 17 on clinical reproductive issues all stand out as providing specific guidelines for pharmacologic and nonpharmacologic management. Other chapters provide clear summaries of our present knowledge in areas of active research but, as of yet, without specific clinical implications, such as the role of sex hormones in MS as described in chapter 17. In addition, chapters 19 and 21 suggest management approaches for fatigue and sleep disorders in MS while describing and distinguishing the many potential contributors to these ubiquitous and similar symptoms in MS.

Part 5 of this book covers therapeutics. Chapter 23 on immunomodulatory agents provides an excellent summary of the research and recommendations for the use of disease-modifying therapies in relapsing MS. The information on other agents in trials and on the use of immunosuppressive agents and complementary and alternative medicine in MS is thorough and provides the practitioner with evidence-based practical recommendations.

Part 6 provides information on psychosocial issues in MS, including information on how patients and their families can be helped to adapt well to living with MS and a summary of typical legal and employment issues faced by people with MS. The final part of this book addresses clinical and basic research, including discussions regarding the strengths and limitation of available outcome measures, the dearth of head-to-head drug trials, and the challenges associated with the complexity, heterogeneity, and variability of the disease.

Overall, this book would be a welcome addition to the bookshelf of any practitioner who cares for patients with MS. Given the rapid pace of progress in MS, it is inevitable that some of the most recent changes in the field, such as the 2010 diagnostic criteria and the approval of the first disease-modifying oral drug for MS in September, 2010, are not included in the book. However, it provides a uniquely comprehensive evidence-based review of the management of MS from experts in the field and, of particular value to the practitioner, includes specific practical suggestions for the management of symptoms and psychosocial issues associated with the disease.

Prose ★★★
Illustrations ★★
Science ★★★★
Usefulness ★★★

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Article Information

Correspondence: Dr Cameron, Department of Neurology, Oregon Health and Science University, CR120, Portland, OR 97219 (cameromi@ohsu.edu).

Financial Disclosure: None reported.