Brain, Vol. 122, No. 11, 2195,
November 1999
© 1999 Oxford University Press
Book reviews |
IMMUNOLOGICAL AND INFLAMMATORY DISORDERS OF THE CENTRAL NERVOUS SYSTEM.
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Max-Planck Institute for Neurobiology, Department of Neuroimmunology, Martinsried, Germany Institute for Clinical Neuroimmunology, Ludwig-Maximilians-University, München, Germany
Our growing knowledge of fundamental immunological mechanisms in the central nervous system, and consequently the therapeutic options for these diseases, reflects the importance of the book Immunological and inflammatory disorders of the central nervous system. It is essential reading for the neurologist as well as the experimental immunologist interested in autoimmune reactions to neural elements.
After depicting a somewhat ironic view of neuroimmunology in the Preface, Neil Scolding provides an impressive overview of the most important diseases affecting the central nervous system via inflammatory and immunological mechanisms. The clinical, pathophysiological and therapeutic aspects of these disorders are thoroughly covered. Only disorders of peripheral nerves and muscles are not included. The 10 chapters of the book have been mainly written by the editor himself, thus ensuring a consistent style and the avoidance of redundancy.
After a short general introduction to the immune responses and their relation to the nervous system, the next three chapters are dedicated to multiple sclerosis, related disorders, and current and future therapies for multiple sclerosis. The multiple sclerosis chapters not only provide clinical, epidemiological and diagnostic outlines, but also a well-substantiated summary of current knowledge about the pathogenesis of inflammatory demyelination. The syndromes and disorders related to multiple sclerosis are discussed in a separate chapter. This subdivision helps the clinician to distinguish between classic multiple sclerosis, historically associated variants, different disease courses and distinct clinical entities. The impact of our growing understanding of multiple sclerosis pathogenesis on therapeutic strategies is succinctly summed up in the next chapter, entitled `Current and future therapies for multiple sclerosis'. As Scolding mentions in his Preface, the `historical' approach that differentiated neurological diseases into steroid-responsive and steroid-unresponsive cases seems to come from another age in the light of today's numerous treatment strategies.
The chapter on `Neurological complications of rheumatological and connective tissue disorders' is one of the most important in this book, especially in view of their prevalence today. Most of the emphasis is on the description of different aspects of systemic lupus erythematosus and the neurological implications. The sections on therapy for the underlying diseases are less extensive than in the multiple sclerosis chapter.
The book succeeds in depicting the overlap and `crosstalk' between immunologists and neurologists. The section on cerebral vasculitis provides fascinating reading on this very heterogeneous group of disorders by focusing on vasculitis that affects mainly the cerebral vessels. Nevertheless, a classification and short descriptions of virtually all vasculitic syndromes are given, and here Scolding's own achievement is considerable: the survey of classification, diagnosis and management of cerebral vasculitis given here are extremely valuable and helpful for the reader.
Another interesting chapter to be highly recommended to the reader is dedicated to paraneoplastic disorders of the central nervous system. Knowledge of the neurological symptoms and associated antibodies can lead to the detection of an occult malignancy.
The book contains three additional concise chapters: one on sarcoidosis of the CNS; one on organ-specific autoimmune diseases with involvement of the CNS (e.g. autoimmune diseases of the bowel and thyroid); and finally one on the clinical and immunological features of the `Stiff man syndrome'. Scolding proposes with tongue in cheek that it should be renamed the `Moersch–Woltperson syndrome', so as not to exclude women from the diagnosis.
Overall, this is a valuable reference book for clinicians and experimental immunologists involved in the diagnosis and treatment of neuroimmunological disorders. The illustrations are, in general, well chosen, although the reproduction of some figures (Histology, MRI) suffers somewhat from the paper quality and the absence of colour. All chapters are well referenced with key articles, generally published between 1997 and 1998.
A few suggestions for the next edition: the index should be extended, and the headings or subheadings could be arranged more clearly to facilitate quick searching, a prerequisite for the stressed clinician. A chapter on the immunological aspects of epilepsy (e.g. on Rasmussen's encephalitis) would also be worthwhile considering.
Despite such minor points of criticism, the authors are to be congratulated on their admirable achievement. This well-structured and balanced account of our current knowledge of the clinical and basic scientific aspects of inflammatory and immunological CNS disorders will appeal to clinicians, students and researchers alike.
Notes
Edited by N. Scolding. 1999. Oxford: Butterworth-Heinemann. Price £45.00. Pp. 264. ISBN 0-7506-2357-8.
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