Brain, Vol. 122, No. 7, 1393-1394,
July 1999
© 1999 Oxford University Press
Book Reviews |
IMMUNOLOGICAL AND INFECTIOUS DISEASES OF THE PERIPHERAL NERVES.
By N. Latov, John H. J. Wokke and John J. Kelly, Jr.1998. Cambridge: Cambridge University Press.Price £95. ISBN 0-521-46265-7..
Section of Neurology, University of Wales, college of Medicine, Cardiff, UK
Just over 40 years ago, the connection between immunology and peripheral neuropathy was proposed by Waksman and Adams with the discovery of experimental allergic neuritis. Byron Waksman's introduction to this textbook provides a fascinating account of the science behind the development of experimental allergic encephalomyelitis and, subsequently, experimental allergic neuritis, and the link made between these models and multiple sclerosis and Guillain–Barré syndrome, respectively. The subsequent advances in our understanding of basic immune mechanisms and the development of therapies for immune-mediated neuropathies are outlined in this excellent textbook.
The book is divided into 5 sections with chapters of uniformly high standard, presentation and clarity. There are detailed and clear introductory chapters on the biological and epidemiological aspects of autoimmune neuropathies and on patient assessment and investigations including neuro-physiology and nerve biopsy techniques. The only minor criticism here is that the histological photographs have not been reproduced to the standard of the original prints.
A further section is devoted to immune related neuropathies such as Guillain–Barré syndrome, chronic inflammatory demyelinating polyneuropathy and the less common neuronopathies and autonomic neuropathies. The role of antibodies to ganglioside, sulphatide and glycoconjugates associated with neuropathies is discussed. Peripheral nerve disorders extend as far as the neuromuscular junction, with an outline of neuromyotonia and the Lambert–Eaton syndrome. Whilst an immune pathogenesis has clearly been demonstrated for the Lambert–Eaton syndrome, evidence is less clear for paraneoplastic neuropathies other than the sensory neuropathy associated with anti-Hu antibodies.
The section on neuropathies caused by infections begins at the anterior horn cell level with the post-polio syndrome, and other chapters deal with HIV-related, Lyme and lepromatous neuropathies. Also in this section there is an interesting outline of the range of neuropathies related to herpes virus infection.
The final section deals with immunomodulatory treatment, although therapies for specific conditions are dealt with in the relevant chapters. There is a comprehensive review of the principles of immunosuppression covering the wide range of drugs used, in addition to the use of plasma exchange and intravenous immunoglobulin.
The problems of neuropathy developing in the intensive care unit (critical illness neuropathy) and the difficult management of neuropathic pain are dealt with in a very helpful practical manner. Although the chapter on rehabilitation is not specifically related to immune or infectious neuropathies, it covers important general principles in the overall care of these patients.
This book will serve as a useful practical clinical text for every neurologist or clinician involved in the management of patients with these immune and infectious neuropathies, but it also carries up-to-date reviews and references for those who may have a more research orientated interest in this field, where significant advances continue to be made in diagnosis and development of treatment.
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