Book Review

Emerging Strategies in Neuroprotection

N Engl J Med 1993; 329:215July 15, 1993

Article

Emerging Strategies in Neuroprotection
Edited by Paul J. Marangos and Harbans Lal. 359 pp., illustrated. Boston, Birkhauser, 1992. $99. ISBN: 0-8176-3544-0

Emerging Strategies in Neuroprotection has as its goal the summarizing of the new field of neuroprotection after neural injury. It comprises 17 chapters written by 42 authors and contains approximately 1450 references, many from 1991. The editors have succeeded in their goal. The field of neuroprotection research arose from the realization that although the primary neurologic damage incurred at the time of trauma or stroke is irreversible, an evolving, complex pathophysiologic process starts from this central core of initial damage and causes secondary damage. Such secondary damage can potentially be prevented or diminished by intervention. The methods of neuroprotection are clearly closer to clinical application than neuroregenerative or neurotransplantation techniques. Moreover, it seems inevitable that even after the newer techniques are developed, it will be desirable to preserve the greatest possible amount of original nervous tissue. Thus, the field of neuroprotection will become a staple of clinical neurology and neurosurgery for the foreseeable future and will probably be in widespread clinical use before the end of the decade.

The book is divided into three parts. The first covers the preclinical ischemia model systems of primary neuronal culture, hippocampal-slice models, animal models of stroke, animal models of ischemia, and animal models of head trauma. Historical review, description of the techniques, and discussion of their limitations are provided in compact, well-referenced chapters. The second part, the majority of the book, covers a variety of neuroprotective agents and methods, including N-methyl-D-aspartate-receptor antagonists, calcium-channel blockers, self-protection of the brain, gangliosides, lazaroids, membrane-derived lipid second messengers, free-radical scavengers, insulin, and hypothermia. Each of these agents and methods is covered briefly in a good review, and a generous number of references is provided for readers with an interest in a particular topic. The third and shortest part of the book covers clinical end points in the study of neuroprotective drugs and discusses clinical trials focusing on stroke, excitotoxicity, and neurodegenerative disorders. This section of the book does not cover the second National Acute Spinal Cord Injury Study (M.B. Bracken et al. New England Journal of Medicine 1990;322:1405-11) or the GM-1 ganglioside study of spinal cord injury (F.H. Geisler et al. New England Journal of Medicine 1991;324:1829-38), the two randomized, placebo-controlled, clinical trials that have reported positive results of neuroprotective agents. A discussion of the planning and inherent difficulties of these clinical studies would have been a useful addition to the excellent section on planning a clinical study of stroke.

This is a concise, well-edited review of the state of neuroprotective research through 1991. It belongs on the bookshelves of neurologists, neurosurgeons, and basic-neuroscience researchers. The reference list alone easily justifies the addition of this book to one's library. The book has been edited to provide a uniform style; it presents a concise, enjoyable review of well-known topics and a good introduction to techniques with which the reader may be unfamiliar.

Fred H. Geisler, M.D., Ph.D.
Chicago Institute of Neurosurgery and Neural Research, Chicago, IL 60614