Book Review

Clinical Autonomic Disorders: Evaluation and Management

N Engl J Med 1994; 330:73-74January 6, 1994

Article

Clinical Autonomic Disorders: Evaluation and Management
Edited by Phillip A. Low. 800 pp., illustrated. Boston, Little, Brown, 1993. $165. ISBN: 0-316-53390-4

This book, whose editor has developed one of the best-known laboratories of autonomic function in the world, provides a complete overview of disorders of the autonomic nervous system. It covers the anatomy and physiology of the autonomic nervous system, clinical evaluation of autonomic function, and autonomic disorders. The section on anatomy and physiology benefits immensely from numerous large and detailed illustrations. The book in general is quite user-friendly. Each chapter is preceded by a full-page summary of the important points covered.

The section on the evaluation of autonomic function is superb. It contains an enormous amount of information on noninvasive testing, including equipment specifications, cost, and availability. Clinical autonomic testing has historically been an area that has attracted an unusual number of dilettantes. A lot has been written about autonomic testing, but little has previously been done to organize information on the subject in a comprehensive, quantitative manner. I believe this is the most important contribution of the book and what makes it superior to other textbooks on the autonomic nervous system. The chapters on the development of an autonomic laboratory and the pitfalls in autonomic testing are particularly important in this regard, since this information is generally unavailable elsewhere.

The section on clinical disorders benefits from the quantitative approach to peripheral neuropathies developed by Peter Dyck and Phillip Low at the Mayo Clinic. This is particularly evident in the chapter on nerve biopsy. The chapter on the management of orthostatic hypotension is also particularly welcome, since it consolidates detailed treatment information from a variety of sources for the first time in a textbook.

This book should become a general reference source for neurologists and clinical neurophysiologists. Cardiologists and specialists in diabetes should also be interested in the book.

Allan Rubenstein, M.D.
Mt. Sinai School of Medicine, New York, NY 10029