Brain, Vol. 126, No. 3, 748-749,
March 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg048
Book Review |
THE YEAR IN NEUROLOGY 2001
Frenchay Hospital, Bristol, UK
THE YEAR IN NEUROLOGY 2001
By M. Feliciani, T. Warner, N. Quinn, A. Schrag, M. Walker, S. Lovestone and J. Zajicek
2001. Oxford: Clinical Publishing Services Ltd
Price £49.50. pp. 400. ISBN 0-9537339-4-7.
As suggested by the title, this relatively small hard-backed book is neither a reference textbook nor is it a book dedicated to a particular field of interest or subject within neurology. Rather, the book attempts to cover the significant new developments over the preceding year in a number of fields within neurology. The scope is therefore deliberately limited and the book does not attempt to be a comprehensive review of all of the advances in neurology. The format is rather unfamiliar and initially the volume does seem rather inaccessible. Persevere however and there is something for most neurologists within the covers of this volume.
The topics covered include cervical dystonia, Parkinson’s disease, epilepsy, Alzheimer’s disease and multiple sclerosis. Clinicians with expertise and interest in the field write each section. The approach attempts to cover clinical aspects, developments in the investigation and scientific understanding and also a helpful review of current treatment.
The book can be tackled in a number of ways. I suspect that most readers will not approach this as a cover-to-cover read and will wish to dip in and out. For most of us the maximum gain will come from the sections covering topics in which we do not have a sub-specialist insight. Others may approach the book reading small sections as time allows and the book lends itself to the part-time reader as there are well-demarcated sections and subjects that can be read in a satisfying way. The casual browser will also be able to get a broad-brush overview by simply reading the introduction and the conclusion of each subject section. The sections are well referenced for the readers wanting to look in more depth and to refer to the original research sources.
The five subjects covered each constitute a section of the book and each section has a number of chapters. The chapters begin with an introduction by the author covering the basic elements of the subject. This is then followed by a number of papers that are presented with title, reference and an abstract. After each abstract or group of abstracts there is a section of editorial interpretation and then comment on the paper and the published findings. I found the sections on treatment perhaps the most interesting and useful. Although the understanding of mechanisms and processes is of importance, the most crucial area in patient management is often in making reasoned decisions about treatment. Hopefully we all strive to base our treatment decisions on clinical evidence, and guidance on the evidence and the strength of evidence is most welcome.
In the section on cervical dystonia, aspects of Botulinum toxin treatment are reviewed and topics covered include antibodies to the toxin, the use of type B toxin, cervical surgery and deep brain stimulation covering the full spectrum of our treatment options.
In the Parkinson’s disease section, drug treatments are discussed with particular focus on dopamine agonist therapy. The increasing use of surgical techniques is also covered. A valuable section covers the complications relating to Parkinson’s disease and its medication. Dyskinesia is one of the most difficult areas of management in Parkinson’s disease and drug treatments as well as surgical approaches are considered.
In the section on epilepsy there are of course contributions relating to drug and surgical treatments. There are also helpful contributions on status epilepticus together with a section on epilepsy in women, both of which could easily merit a whole chapter on their own. It would perhaps have been helpful to have the section of epilepsy include more about both of these topics and also about the area of sudden death in epilepsy, which has raised much concern.
The section on Alzheimer’s disease addresses some of the problems we face with the new drugs and the limitations of our knowledge about Alzheimer’s disease and the relative efficacy of the newer drugs.
The section on multiple sclerosis covers some of the new information from imaging studies and the clinical trials in early multiple sclerosis. This has become of increasing interest in view of the discussions concerning the cost-effectiveness of disease-modifying interventions.
As busy clinicians, many of us will have an area or areas of particular interest and perhaps expertise, but still have a significant commitment to general neurological practice. We are flooded by an increasing amount of information presented to us in lectures, meetings, in paper format and electronically. Although we feel we can interpret a scientific paper this is often an illusion of command and understanding and increasingly we rely on specialists in particular fields of neurology to help us to sift this information and rank the importance and validity in some way to help us make a reasoned approach to any change in practice. The call from us all to be more evidence-based often comes unstuck when faced with a real clinical problem in an individual patient. Books of this type, while sometimes less easy to read initially, may go some way to helping us with this interpretation of information and establishing our own hierarchy of importance. The book is certainly worth a read but I would not put it at the top of my wish list of ‘must-have’ volumes for my personal library.
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