Brain, Vol. 125, No. 12, 2785-2786,
December 2002
© 2002 Oxford University Press
Book Review |
BRAIN DAMAGE, BRAIN REPAIR
Section for Neuronal Survival, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
BRAIN DAMAGE, BRAIN REPAIR
Edited by James W. Fawcett, Anne E. Rosser and Stephen B. Dunnett
2001. Oxford: Oxford University Press
Price £60. pp. 482. ISBN 0198523386.
Bridging the gap
This multi-author book has a total of 17 experts contributing to the 26 different chapters. It is both easy and very stimulating to read, and it contains a vast amount of information. In many of the chapters, the reader is introduced to the field from a historical perspective, sometimes starting at the beginning of the last century, and is then presented with the field’s development through to the most recent findings. There is an excellent list of over 1700 cited references covering more than just the basic papers in most of the areas.
The book is divided into six sections, each comprising two to six chapters, dealing with the following areas: mechanisms of brain damage, damage limitation, intrinsic mechanisms of recovery, clinical assessment of brain damage, pharmacology and rehabilitation, and structural repair.
In addition, there are nine appendices that each consist of a one to two-page description of clinical disorders (e.g. Parkinson’s disease, Huntington’s disease, Alzheimer’s disease, stroke, ALS, etc.). Obviously the editors have chosen to make these into appendices to emphasize that they do not constitute comprehensive chapters that describe the diseases properly. To write chapters that describe each disease in detail would obviously have required a book of its own. Some of the appendices even contain a brief history of the disease in question. These historical overviews are very short and seem to reflect the personal interests of the editors. For example, the original proposal that L-dopa could effectively treat Parkinson’s disease, which won Arvid Carlsson the Nobel prize in 2000, is not mentioned. In general, we feel that the appendices would have benefited from being more homogeneous in structure and would have needed more detail to be really useful.
The core chapters cover the present scientific knowledge from the laboratory bench to clinical application and evaluation. There are six chapters specifically devoted to clinical assessment of brain damage and clinical pharmacological/neuropsychological approaches to treatment. They make this book superior to other similar books in the area and will be particularly stimulating to the basic science readers.
There is definitely a need for greater communication between basic and clinical science in the areas of brain damage and repair. Undoubtedly, laboratory research into brain damage and repair has undergone a dramatic transformation during the past two decades. However, relatively little has been translated into clinical therapy. The reasons for this can be manifold. First, it is easier to study and treat sick cell cultures and laboratory animals than patients. Secondly, a limited understanding of basic research among neurologists and neurosurgeons, coupled with a lack of clinical perspective among many basic scientists, hamper the transition. This book may help to bridge this gap and thereby make an important educational contribution that will promote communication between these two communities.
The title, however, implies that the book covers most types of brain damage. We feel that some important areas are missing: congenital brain damage resulting from developmental defects is not dealt with in depth. Furthermore, why are, for example, brain damage due to recreational drugs, alcohol-abuse and malnutrition not featured? After all, these are important areas, and they can also provide some insight into mechanisms causing neuronal dysfunction and death. It would have been refreshing to have a chapter reviewing evidence of brain damage in psychiatric disorders. Currently, psychiatry is really only included briefly in a chapter describing psychiatric assessment of brain disease, and then only in the context of psychiatric symptoms in cerebrovascular disorders, traumatic brain damage and Huntington’s disease. A chapter describing animal models of, for example, schizophrenia, and relating them to current treatment strategies may have attracted psychiatrists to the book. Without question, clinical psychiatry would benefit greatly from more interaction with basic science and it would have been excellent if the book had covered this dimension too.
Regarding the structure of the book, it is missing a foreword from the editors. This would have been useful to introduce the reader to the philosophy of the book. The reviewers would also have enjoyed an introduction to the authors and their respective areas of expertise. The table of contents should include the names of the authors of each chapter. In the present edition, it is not clear who has contributed to the different chapters, which sometimes seem to be authored by the guest writers alone and sometimes in collaboration with the editors.
The book would have benefited from the chapters being written in a more homogenous style. Some chapters have adopted a historical perspective and describe the developments in a field chronologically. Authors of other chapters have chosen a more mechanistic or conceptual approach, paying less attention to who discovered what, and when. While some chapters are written in a story-telling, easy-to-read textbook style mentioning only a few key experiments in detail, others have employed a more scientific approach and mention multiple experiments to illustrate each principle. Despite the index being well structured, the heterogeneity in style between chapters makes it difficult to find information when trying to use the book as an encyclopaedia. Rather, the book should be read from beginning to end, or section by section, and then the reader will enjoy exciting voyages from the laboratory bench to the hospital bed.
There are at least a couple of major problems with writing books of this kind today. First, neuroscience research is advancing so fast that information quickly becomes outdated. For example, the book was released about the time of the currently ongoing surge of interest in neurogenesis in the adult brain. Today there is a great deal of interest in the potential for new neurones to functionally integrate into the brain. As research in this field was limited when the chapters were produced, it is dealt with only very briefly in the book. Secondly, the past 2–3 years have seen several new journals emerge on the market that focus on general reviews—more like textbook chapters. These have a short production time and the time from leaving the hard disk of the author’s computer until being made available worldwide via the journal web sites can be a matter of a few weeks.
Nonetheless, we think this is an excellent book for those who prefer to have information gathered in one place. Some still prefer reading an ‘old fashioned’ book. For Brain Damage, Brain Repair, we envisage primarily two target groups. First, clinical neurologists and neurosurgeons who want insight into experimental research of relevance to damage and repair in the brain and spinal cord. Secondly, we think this book is excellent reading for graduate students entering this area of investigation. Today many neuroscience students become too specialized right from the beginning. With molecular biology being such an important sub-speciality in neuroscience research, some students may see the function of the brain primarily as an organ that can produce DNA and RNA for analysis by various blots! In conclusion, we think that the book should be available in neurosurgery and neurology clinics with academic research programmes, and in every laboratory where young scientists are studying brain damage and repair.
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