Book Review

Neurological Disorders: Course and treatment

N Engl J Med 1997; 336:813-814March 13, 1997

Article

Neurological Disorders: Course and treatment
Edited by Thomas Brandt, Louis R. Caplan, Johannes Dichgans, H. Christoph Diener, and Christopher Kennard. 1150 pp., illustrated. San Diego, Calif., Academic Press, 1996. $139.95. ISBN: 0-12-125830-0

This book, the combined effort of 136 authors in 95 chapters, covers a broad spectrum of neurologic disorders. After I read it, the days seemed distant when neurology was considered a specialty with an intricate nosology, an abundance of clinical names, and a notorious lack of remedies. Neurological Disorders: Course and Treatment is a fine effort that brings together not only a wealth of treatments for neurologic disorders, but also data of enormous value for decision making. It even provides elements for discussion between the clinician and the patient on the important issue of cost and benefit.

The design of the chapters is astute. Most begin with a brief description of the clinical aspects, followed by an account of the natural course of the disease, including the prognosis, symptoms, and complications. This prepares the reader for a tour of the therapeutic possibilities and their limitations. The chapters end, when pertinent, with documented discussions of treatments no longer recommended. This last section is a useful contribution to neurology, because the relatively recent introduction of numerous approaches to complex disorders has led to confusing therapeutic claims that are soon abandoned or whose initial rates of success are largely tempered in subsequent studies.

An example is the chapter on multiple sclerosis. After a detailed description of most kinds of therapy and their applications to the different forms of the disease, the authors enumerate the limitations of the available treatments and give a clear, measured statement that all are far from ideal. For such disorders as malignant brain tumors, this book gives the pros and cons of conservative and aggressive therapeutic approaches and discusses their effect on the unfavorable course of the neoplasms.

This is an international book that portrays practices in Europe and North America. For neurologists in other parts of the world, it is certainly a welcome experience. Besides chapters on common neurologic entities, this book includes discussions of topics not usually covered in textbooks on therapeutics, such as the restless legs syndrome, cramps, and neural prostheses. Particularly useful is a section on intensive care in neurology, with chapters devoted to topics found mostly in neurosurgical textbooks.

A chapter on the neurologic side effects of most families of drugs is easy to consult. Appendixes explain the drugs and their proprietary names, as well as the applications of each in various neurologic disorders. Well-selected references give a balanced view of each disease, particularly those in which substantial controversies about therapeutics remain.

In the everyday practice of neurology, depression and psychosomatic symptoms constitute a considerable proportion of cases in outpatient clinics; headache, dizziness, sleep disturbances, back pain, and vague symptoms due to chronic depression are a very frequent challenge. I suggest that future editions include a chapter on depression in the section on cognitive and behavioral disorders. Also, malnutrition, which is prevalent in vast areas of the world, causes important brain dysfunction and neurologic sequelae; a chapter on this topic would improve the usefulness of the book in developing countries.

Julio Sotelo, M.D.
National Institute of Neurology and Neurosurgery, Mexico City 14269, Mexico