Book Review

Principles of Neuroepidemiology

N Engl J Med 2001; 345:381August 2, 2001

Article

Principles of Neuroepidemiology
Edited by Tracy Batchelor and Merit E. Cudkowicz. 374 pp., illustrated. Boston, Butterworth–Heinemann, 2001. $95. ISBN: 0-7506-7042-8

Principles of Neuroepidemiology is an excellent book, despite its misleading title. The principles are covered in the section on methods, which occupies only 4 of the 16 chapters and certainly does not represent the most interesting part of the book. This work can be regarded as a series of brief, focused reviews in clinical neurology — reviews constructed by sophisticated, critical, and analytic observers. Each chapter or review covers the basic facts about the occurrence of a disorder, followed by a discussion of the associated risk factors, and concludes with an analysis of major treatment trials.

Would you like to know which of your patients are at highest risk for Alzheimer's disease? Are you somewhat confused by the various studies of estrogen therapy or of antiinflammatory agents for the prevention of Alzheimer's disease? If so, you will appreciate the excellent analytic review of the epidemiologic data by Irizary and Hyman in chapter 5. For even more insight into why studies sometimes reach contradictory conclusions, read the discussion earlier in the same chapter about how the choice of study instruments can alter the reported prevalence rates of dementia. Depending on the classification system used, the proportion of subjects considered to have dementia can vary from 3 percent to 29 percent in the same group of persons.

The textbook discusses the descriptive and analytic epidemiology for a wide group of neurologic disorders in adults, including common medical problems of interest to most physicians. As long as they avoid chapter 2 on statistical methods, math-phobic readers should find this a friendly book. Throughout the volume, the authors do a nice job of analyzing complicated and technical epidemiologic literature in straightforward prose with a minimum of jargon. More figures and tables might have been helpful, but the book contains a sufficient number of appropriate graphics to allow the average reader to understand the authors' primary points.

Chapter 3 on the methodology of clinical trials is particularly well done. Though it is primarily concerned with the problems of designing treatment trials for neurologic disorders, the principles are widely applicable. Stanley and Andersen make good use of graphics to highlight important points. Most readers will find this chapter easy to read and rewarding; it will enable them to better understand and analyze future treatment trials involving both neurologic and nonneurologic disorders. The first two chapters, which cover methods and statistics, will be appreciated only by epidemiologists (who already know the material) and by students (who expect to be tested on it); everyone else will skip them.

Sections of the book that will appeal to the general reader include chapter 12, which covers traumatic brain injury and contains a discussion of brain trauma from firearms, automobile accidents, falls, and sports injuries. For physicians who wonder why their earnestly delivered advice is not sufficient to protect their younger patients from harm, there is a discussion of “risk budgeting” (or “risk homeostasis”) plus a table of strategies for injury control adapted to traumatic head injury. Also of interest is the review of ethical and other special considerations in designing randomized clinical trials in this field.

Drislane introduces his chapter on seizures and epilepsy with a guide to the problems of classification and diagnosis of seizures. The problems of misdiagnosis in this field, which is without a gold standard, worry all clinicians. Although his emphasis is on epidemiologic studies, Drislane provides useful clinical guidelines for both primary care physicians and neurologists in the evaluation of the patient who appears to have epilepsy. Chapter 11 on back pain, by Lewis and Tucker, should appeal to doctors who see many persons with back problems, as it helps to consolidate the vast and seemingly contradictory literature. In addition, the chapter reviews randomized clinical trials and includes a discussion of the well-known Journal article that compared an educational booklet, physical therapy, and chiropractic manipulation for the treatment of back pain. The authors offer suggestions as to why such a well-designed and carefully executed study may not be relevant to many clinical practices.

Multiple sclerosis is the crown jewel of neuroepidemiology. To any physician interested in following the medical detective story about the search for the causes of multiple sclerosis, chapter 7 by Bar-Or and Smith will be satisfying. Those unacquainted with these intriguing data will find the chapter well written and fascinating.

Principles of Neuroepidemiology is a well-bound, nicely produced book printed on glossy paper. Its major limitation is common to all textbooks — it took too long to publish. The most recent references are from 1998, with a smattering of 1999 papers cited in the chapter on multiple sclerosis. This limitation, however, does not reduce the value of the book.

Robert J. Baumann, M.D.
University of Kentucky, Lexington, KY 40536-0284
baumann@pop.uky.edu