Book Review

Clinical Neuroimmunology

N Engl J Med 1998; 339:485-486August 13, 1998

Article

Clinical Neuroimmunology
Edited by Jack Antel, Gary Birnbaum, and Hans-Peter Hartung. 423 pp., illustrated. Boston, Blackwell Science, 1998. $75. ISBN: 0-86542-411-X

Neuroimmunology, a well-recognized subspecialty of neurology, deals with disorders with an immune-mediated component. This field has expanded tremendously in recent years. Unexpected immunologic features are being discovered in conditions as varied as Alzheimer's disease, epilepsy, and childhood movement disorders. Moreover, the explosion of new information in immunology and molecular biology has led to the development of novel immunomodulatory therapies. These are being refined to treat neurologic diseases and have become important components of modern therapeutics. Unfortunately, there have been no literate, up-to-date, and easily readable textbooks that explain this rapidly advancing field. At least, not until now.

Clinical Neuroimmunology is the best textbook available on this topic. The three editors, from the United States, Canada, and Europe, have assembled 48 international authors. The book has 26 chapters, loosely organized into four sections. Almost every chapter is 20 pages or less, making it easy to read a chapter in one sitting. There are 10 overview chapters on broad or introductory topics such as basic immunology, autoimmunity, and the way in which viruses and the immune system interact. Six chapters cover central nervous system conditions such as multiple sclerosis, brain tumors, and vasculitis. Another six deal with disorders of the peripheral nervous system that affect the nerves, neuromuscular junctions, or muscles. Four chapters cover systemic processes (paraneoplastic syndromes) and a limited number of topical infections.

The first chapter, “Introduction to Immunology,” is superb. In a few brief pages it presents sophisticated and recent information on the immune system in a succinct and understandable manner. At first I found it a little disconcerting that certain topics, such as transendothelial migration, were covered in several of the chapters. However, each chapter had a slightly different take on the subject, and the repetition actually helped reinforce the immunologic concept and make it clearer. There are interesting discussions of topics that are not usually covered in discussions of neuroimmunology, such as brain tumors, Alzheimer's disease, and tissue grafts. There is a helpful dictionary of immunologic terms at the end of the book.

The book has some weaknesses. Illustrations, which often convey certain immunologic concepts far better than words, are not as numerous as one would like. Certain topics, such as chemokines, a family of small chemotactic cytokines whose receptors are implicated in human immunodeficiency virus infection, are not well covered. The book is certainly not all inclusive. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and antibody-related epilepsies are not mentioned. A general review of cerebrospinal fluid immunology and a discussion of immune-mediated damage in bacterial meningitis would have been nice. The brief chapter on multiple sclerosis is a disappointment, particularly in the light of the fact that this is an area in which all three editors have great expertise. The chapter “Principles of Immunotherapy” might have included a more comprehensive discussion of drug mechanisms and side effects. Instead, this area is better covered in the chapter on myopathy. Incorrect or unjustified statements are scattered throughout the book, but they are rare. These minor weaknesses certainly do not detract from the overall quality and value of this textbook. It is first-rate. Neuroimmunology is such a rapidly moving field that it is hard to produce a textbook that is truly up to date. The editors and authors have done so and should be commended for their work.

P.K. Coyle, M.D.
State University of New York at Stony Brook, Stony Brook, NY 11794