Brain, Vol. 125, No. 8, 1923-1924,
August 2002
© 2002 Guarantors of Brain
Book Review |
MULTIPLE SCLEROSIS: CURRENT STATUS AND STRATEGIES FOR THE FUTURE
Department of Neurology,Atkinson Morley’s Hospital, London, UK
MULTIPLE SCLEROSIS: CURRENT STATUS AND STRATEGIES FOR THE FUTURE
Edited by J. E. Joy and R. B. Johnston Jr
2001. Landover: National Academy Press
Price £54.95. ISBN 0309072859.
This book, 412 pages in all, is the result of a collaborative effort from the Institute of Medicine in response to a request from the US National Multiple Sclerosis Society to review current knowledge of multiple sclerosis and to identify ways forward with regard to future research into multiple sclerosis. It is difficult to classify and characterize this offering in terms of who might buy it, and who might benefit from it. There is no doubt about the ambition and enthusiasm of the editors with regard to the future of multiple sclerosis research.
The book begins with an Executive Summary, which does not shirk from stating the obvious; for example, ‘The power of neuro-imaging as a tool for basic research and for clinical assessment should be taken advantage of more extensively’, the somewhat arbitrary ‘Symptom management should be pursued, including those directed at neuropathic pain and sensory disturbances’ or the ambitious ‘The discovery of an MS pathogen would likely provide the single most important clue’. Nevertheless the 18 recommendations of the Executive Summary do cover all the important aspects in the effort to ‘end the devastating effects of multiple sclerosis’, the original mission statement of the National Multiple Sclerosis Society.
The introductory chapter leads us into the meat of the work with a slightly arbitrary list of recent research advances with far flung implications ranging from ‘discovery of the therapeutic potential of stem cell transplantation’ to, alongside it in the list, ‘development of standardised methods for conducting clinical trials’. This somewhat random presentation is the theme for much of the book. Beta-interferon appears not as a therapy, but buried within the ‘Clinical and Biological Features’ chapter and the use of steroids in multiple sclerosis is discussed under the ‘Management of Optic Neuritis’, itself rather strangely placed in the centre of the section on ‘Management of Major Symptoms’. This lack of rational organization rather destroys any story that an optimistic reader might hope to find within the pages of this book. If it is not particularly readable, then could it be considered a useful source of reference? Here again one has to be slightly fortunate to succeed. If your concern is the management of depression associated with multiple sclerosis then you have eight pages of information, whereas if you are worried about your ability to manage bladder function in your multiple sclerosis patients then you will need to make do with six lines of advice. In general, however, the presentation of symptom management is helpful and informative. Each section contains a suggestion for further research at its end.
The chapter on ‘Disease Management and Measurement’ is an odd mix of the overall management of patients with multiple sclerosis and how to assess the effects of the disease. I will be forever grateful to the book for providing a comprehensible definition of a Qaly. As a stimulus for research however this chapter is not helpful and in terms of planning research studies, particularly of new treatments, the location within this chapter of outcome assessments apparently in isolation is somewhat confusing.
The chapter on ‘Strategies for Future Research on Disease Mechanisms’ contains, as throughout the book, a series of rather basic cartoon-like diagrams which perhaps reflect a limitation on the funds available to provide the illustrations or a desire to keep the cost of publication to a minimum. There is a much more scientific feel to this part of the book as evidenced by the observation that ‘The classic experiment to reproduce the disease by transferring auto-reactive T-cells from affected to unaffected individuals is not ethically permissible in humans’. What follows is a fairly comprehensive summary of immunopathology in multiple sclerosis and important questions are raised with regard to pathogenetic mechanisms and their triggers, as well as a reasonable review of correlation between pathology and neurological dysfunction and also, briefly, imaging. Any reader seeking valuable insights into how MRI may be used as a surrogate marker of disease activity in multiple sclerosis is likely to be disappointed by this book. There are, however, some interesting insights into new techniques such as toggled contrast agents which may be switched on and off in certain circumstances.
The final academic chapter considers future strategies for multiple sclerosis therapies though contains a reprise on MRI as do several other chapters which is a reflection on the piecemeal nature of this offering, perhaps a necessity given the way it was constructed.
A summary of this book would reasonably point out that, in a publication of this type, flowing narrative and cohesiveness is almost impossible to attain. It is nevertheless frustrating when using it as a reference to find, as like as not, so many different points within the book where one’s focus of interest appears, or conversely to find that something one considered to be important is almost ignored. It is as though the book was produced as an afterthought to the main object of the exercise to brainstorm the future of multiple sclerosis research in the US. There are however some extremely interesting conclusions which reflect the sheer quality and expertise of the various authors. Conversely other offerings appear to have been included as mandatory but of no interest.
The original questions of who would buy, and who would benefit from this book remain difficult to answer. I would not describe it as a textbook on the management of multiple sclerosis nor even as an overview of the subject. It is best seen as what it is, namely a published version of the Institute of Medicine’s current thinking on the future of multiple sclerosis research. To this end it should be on the bookshelf of any committed multiple sclerosis researcher, whether they be at the head of large research units or starting out in a career of multiple sclerosis research, if only because of the list of references is comprehensive and up-to-date. There is also a gratifying conclusion with regard to the prominence of the management of patients with multiple sclerosis overall rather than dedicated concentration on individual aspects of patient care.
By its nature this book cannot compete with proper multiple sclerosis textbooks nor immunological reviews nor manuals on multiple sclerosis treatment but a small academic faction of studies of this enigmatic disease will find it to be exactly what they seek. In other words it achieves exactly what it sets out to do.
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