Book Review

Tropical Neurology

N Engl J Med 1996; 335:1075-1076October 3, 1996

Article

Tropical Neurology
Edited by Raad A. Shakir, Peter K. Newman, and Charles M. Poser. 485 pp. Philadelphia, W.B. Saunders, 1996. $75. ISBN: 0-7020-1922-4

Few people would dispute the need for an updated review of tropical neurology, a subject that has languished without a textbook since Spillane's classic treatise, published almost 25 years ago (Tropical Neurology. London: Oxford University Press, 1973). Tropical neurology focuses on neurologic disorders, mostly infectious, that are endemic in developing countries but are being recognized more frequently in developed countries as a result of foreign travel and migration.

This multiauthored book has 38 contributors, half of whom work in the tropics or subtropics. The book is divided into four sections according to the causes of neurologic disorders: viral, bacterial and fungal, parasitic, and environmental. A fifth section reviews selected neurologic conditions, including the global epidemiology and causes of epilepsy and multiple sclerosis.

This is an excellent review of an important and often neglected subject. Most of the chapters are well written, comprehensive, and generously referenced. It is clear from the writing that most of the authors have an intimate knowledge of their subjects from both a basic-science perspective and a clinical point of view. Where possible, the authors emphasize low-technology approaches to patient care for readers practicing in areas of the world where more sophisticated and expensive investigations and therapies may not be available. The chapters on viral and parasitic diseases are the highlight of the book, especially the chapters on rabies, cerebral malaria, neurocysticercosis, and schistosomiasis. As with any multiauthored work, however, the book is a bit uneven. The chapters on tuberculosis and leprosy, in particular, are disappointingly mundane and somewhat superficial, with fewer than 20 references each for subjects of such global importance.

The book has a disease-oriented approach, which is fine if one knows the diagnosis but is less helpful when one is faced with a patient presenting with a particular sign, symptom, or radiologic finding. However, two chapters move beyond this classic approach and describe conditions in a global context. These are the well-written chapters on epilepsy, by Sandmann and de Bittencourt from Brazil, and multiple sclerosis, by Poser from the United States. In the next edition, the authors might consider a section that outlines the approach to various diseases according to geographic area.

Overall, Tropical Neurology can be highly recommended for neurologists, tropical-medicine specialists, and infectious-disease consultants in both developed and developing countries. The cover of the book, showing four patients with konzo (epidemic spastic paraparesis) in an African village, is colorful and unconventional, yet appealing. It draws appropriate attention to an excellent reference textbook, which should find its way into medical libraries and offices of specialists providing care to those living in or coming from the tropics. You won't have trouble finding it on your bookshelf.

J.S. Keystone, M.D.
Toronto Hospital, Toronto, ON M5G 2C4, Canada