Brain, Vol. 125, No. 5, 1162-1163,
May 2002
© 2002 Guarantors of Brain
Book Review |
PROGNOSIS OF NEUROLOGICAL DISORDERS, 2ND EDN
Mayday University Hospital, London Road, Thornton Heath, UK
PROGNOSIS OF NEUROLOGICAL DISORDERS, 2ND EDITION
Edited by Randolph W. Evans, David S. Baskin and Frank M. Yatsu.
2000. Oxford: Oxford University Press.
Price £69.50. pp. 786. ISBN 0-19-511936-3.
How many textbooks does the average British neurologist buy per year? As I contemplated this book review I realised I had absolutely no idea. Does it depend on the age of the neurologist? Do older ones like me who were brought up when books and journals were the only source of reading material buy more than younger ones? Do the youngsters (and of course the computer literate older ones) perhaps rely more heavily on computer based systems? I tried a literature search on the book buying habits of consultants with singular lack of success. In desperation I turned to a straw poll of a dozen members of our department, six juniors and six seniors, to discover that half bought less than five per year and half more! Next I asked myself what makes me buy a textbook? For many of us I suspect there is the sheer pleasure of owning and using and reusing cherished books so beautifully captured in Helene Hanff’s ‘84 Charing Cross Road’. There are classic works, standard textbooks on particular diseases, books needed for teaching and those you dip into regularly when faced with some unexpected clinical question and they do not disappoint. Many of the books in this latter category cross strictly defined subject barriers.
After that lengthy preamble let me say immediately that I thoroughly enjoyed this book which falls neatly into the group you get used to turning to often. As the authors discuss in their introduction to the first edition, diagnosis and treatment are usually thoroughly aired in most textbooks. The natural history of diseases by comparison and the effect of treatment thereon is often glossed over not least because until recently at least we knew relatively few facts for so many neurological conditions. Prognosis is also something it is not so easy to ascertain quickly from a literature search. The mushrooming of neurological knowledge has made a second edition, after only 8 years, appropriate and timely.
Although the book is published by Oxford University Press, this is an all American effort with 79 US authors and one lone Canadian. Despite this the book represents a major contribution of practical, user-friendly scholarship principally for neurologists, but also perhaps for some psychiatrists and neurosurgeons and everyone with an eye on medicolegal matters. To have so much data generally well set out backed up with comprehensive references mostly as up-to-date as is feasible means that this is a book I believe others will also turn to often for concise summaries of a vast array of topics. As you might expect core neurological diseases are well covered with chapters on stroke, multiple sclerosis, motor neurone disease and headache. Parkinson’s disease alone among these major disorders is treated too lightly for my taste being buried in a chapter on movement disorders and being afforded the same two and half pages as that far less common but much loved rarity dystonia.
The outstanding feature of this book is the wide view the authors took of what might be covered under the title ‘neurological disorders’. There is a whole section on pain disorders and a second on trauma. Within these sections are the real jewels in the crown of the book, namely the chapters on whiplash injury and post-concussion syndrome with those on traumatic brain injury, spinal cord injury and peripheral nerve injury close runners up. These are non-core neurological subjects which are forever cropping up in everyday practice and on which my knowledge is deficient and for which I tend not to have good individual subject textbooks at home to dip into. So now no more excuses! 35% of patients will have persistent head and neck pain 3 months after whiplash injury, 25% at 6 months, 20% at 1 year and 15% at 2 years. Risk factors for persistence of symptoms are given, as are the chances of getting back to work and the effect of litigation on the persistence of symptoms. It’s all there.
There is a fair amount of neurosurgery as well as a pot pourri of short chapters on a wide variety of other topics such as neurofibromatosis, industrial toxins and metals to name just a few. Somewhat strangely right at the very end, coming in last but I am sure not least, in a politically totally incorrect fashion, is another useful chapter simply called ‘Pregnancy’.
The book starts with a section entitled ‘Issues in Prognosis’ giving an ethical, psychological and medicolegal perspective. I found the chapter entitled ‘Economic Prognosis: Evaluating Economic Outcomes of Health Care’ most useful. Much of the recent debate in England around the use of ß-interferon and the National Institute for Clinical Excellence (N.I.C.E.)—the Department of Health’s committee on new treatments—has hinged on QALYs (quality adjusted life years). It is all explained in easily understandable form here.
I have picked out a few subjects I found particularly interesting or helpful. The question of the outlook for brain tumour patients is always something we neurologists try to leave to our neurosurgical colleagues but perhaps this is something that is changing with a more active approach to all ‘cancers’. You will find well described the figures for survival not only for gliomas but for lymphomas, both HIV and non-HIV related and a host of other tumours. Perhaps it is time neurologists get more involved with neuro-oncology. Secondly, many years ago before the term clinical audit had become part of our everyday vocabulary I presented at a journal club a review of the benefits of ulnar nerve surgery. So I looked to see what the current view is. The topic is concisely discussed but perhaps somewhat uncritically. We are told that ulnar nerve transposition gives ‘excellent results with improvement in about 75% of patients’, but what improves and for how long is not made clear. But lest I become too critical the small section contains seven references specifically on the surgery including studies on outcome up to 1997. Thirdly, what does it mean when you find a patent foramen ovale as the only apparent risk factor in a young stroke patient? The evidence is well set out with clear clinically relevant advice. Finally there is a beautifully concise section on analgesic rebound headache quoting a success rate for treatment of 48–91% and an extremely helpful table giving the 14 main studies between 1975 and 1996.
Does the book have weaknesses or deficiencies? Perhaps in these days of appraisal and assessments we are not meant to use such negative images but instead to put them forward as potential learning opportunities for a hoped for 3rd edition in due course.
The chapters inevitably vary in quality. It made me smile to see that syphilitic labyrinthitis ‘remains an important cause of vertigo’ with discussion of congenital and acquired disease and its treatment in the chapter on neuro-otology. Now there’s something to look out for when you next see a dizzy patient in clinic. On a more serious note I felt the lack of any real discussion of the prognosis of benign intracranial hypertension was a major disappointment as was the almost total omission of intracranial venous thrombosis and the treatment options and outcomes. Far too much was written about reflex sympathetic dystrophy stages 1, 2 and 3, causalgia or complex regional pain syndrome types 1 and 2 (whatever you choose to call it). Amazingly, despite this over long chapter the vital question of prognosis seems to have been totally overlooked. This brings me to another observation, not a criticism, which is that, as a British reader, there seem strong medicolegal threads running throughout the book which may be a sign of things to come for us in Britain. Every time I read about attorneys I cannot help but recall American television courtroom dramas. But these are minor quibbles.
Finally, I come back to where I started wondering what makes neurologists actually go out and buy new textbooks. Well, if they are anything like me, price is one of the important factors and I feel this is a snip at £68.00. So buy it for Christmas or birthday or just to give yourself a well earned treat.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||