Brain, Vol. 122, No. 1, 173-174,
January 1999
© 1999 Oxford University Press
Book Reviews |
CLINICAL NEUROMYTHOLOGY AND OTHER ARGUMENTS AND ESSAYS PERTINENT AND IMPERTINENT.
By W. M. Landau. 1998. Armonk, NY: Futura Publishing Company. Price $70. ISBN 0-879-93-6983..
London, UK
European neurologists attending meetings in the USA are often struck by the fulsome tributes which follow in the discussion of what seems a very ordinary paper as though it were somehow improper to voice any criticism of the speaker in public. I have never to my knowledge attended a meeting with Dr Landau, but things must be very different when he is around. There seems to be no limit to his capacity for disagreement and his thirst for conflict as he prepares, like some latter-day Don Quixote, to take a tilt at any number of distinguished adversaries, real or imagined, alive or dead. In this provocative and unusual book, based on a series of essays published in the journal Neurology, Dr Landau sets out to expose a number of neurological myths, by which he means cherished beliefs hallowed by tradition rather than by hard evidence.
His technique is simple and effective; he selects a topic in medicine which may be a hypothesis, a physical sign, a diagnostic test or a treatment—sometimes well outside his own field of expertise—and proceeds to discredit it, often unkindly, sometimes unfairly and occasionally inaccurately. He usually begins by presenting an illustrative case-history or by quoting the original paper, adding his own waspish comments in parenthesis. He then describes the way in which the original idea has evolved in the light of subsequent experience. For instance, in the case of the carotid sinus syndrome originally described by Soma Weiss, Landau points out the confusion in the minds of the authors between convulsions and cerebral ischaemia, the oversimplified interpretation of the baroceptor reflex and the dangers to the patient of carotid sinus massage. Moreover, he points out the lack of evidence in many cases that the spontaneous attacks are related in any way to reflex-induced asystole.
These forcibly expressed views are the initial stimulus and they are followed by a predictable reflex response from the victim or his supporters, often longer than the original essay and containing an equal mixture of indignation, wounded pride, sorrow and resentment. A lively and acrimonious exchange of letters then follows until eventually the editor declares the matter closed or the next controversy begins.
Some of the neuromyths, such as Marcus Gunn pupil and the swinging flashlight test, have arisen as a result of a simple misunderstanding; some, such as the clinical evaluation of dysmetria and ataxia in cerebellar disease, are matters of opinion rather than fact. In some, such as the selegiline controversy, Dr Landau has been vindicated by subsequent events, and in others, such as the cholesterol hypothesis, it seems he has not. Dr Landau makes the valid point throughout that attractive hypotheses such as carotid sinus hypersensitivity and neuroprotective therapy in Parkinson's disease (the suclavian steal syndrome is another good example) continue to be cherished and quoted long after they have been shown to be untenable.
Often irritating, sometimes infuriating but never dull, this ageing neurological gadfly buzzes on in search of the next sensitive victim.
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