Book Review

Neuromuscular Diseases: Expert Clinicians' Views

N Engl J Med 2002; 346:386January 31, 2002

Article

Neuromuscular Diseases: Expert Clinicians' Views
Edited by Rahman Pourmand. 655 pp., illustrated. Boston, Butterworth–Heinemann, 2001. $125. ISBN: 0-7506-7019-3

There have been important advances in our understanding of neuromuscular disorders during the past decade. Molecular genetics has had a profound effect on the way we investigate these disorders in our patients. Further delineation of inflammatory syndromes of muscle and nerve has allowed improved classification and treatment. It is in this context that Pourmand and colleagues have published this book.

Pourmand clearly aimed to provide a predominantly clinical book that will be of value not only to neurologists but also to other physicians and health care professionals who look after patients with these conditions. The book succeeds at this level. On the whole, there is a uniform standard throughout the book. Wearing my clinical neurologist's hat, I enjoyed all the chapters, and I can certainly see the value this book will have for my colleagues. It is accessible and presents excellent clinical clues. Many young neurologists and even those who are experienced will learn from this book.

The best chapters and comments in the book are those in which an author expresses a personal view as to the best way to investigate or manage certain disorders. In these days of so-called evidence-based medicine, there still are many areas of neurology in which no such evidence is available. Under these circumstances, there is nothing better than the views of clinicians who have extensive experience in the field. Many of the comments in this book are based on years of experience, and these comments, in the absence of data from clinical trials, really made me think about the care of my own patients. It is also refreshing to find comments on topics for which there is a lack of evidence or indeed any scientific information to help our investigations or to improve our understanding of these diseases. Nowhere is this truer than in the evaluation of muscle pain and fatigue. These common symptoms can have multiple causes, many of which are not neuromuscular in nature, and in these circumstances we must rely on the “art of medicine.”

Are there problems? As a neurologist who does not work in the United States, I find that some chapters do not quite fit in with the general approach of the book. The chapter on genetics explains molecular genetic techniques at length; however, it then focuses on the American way of organizing an investigation. Some of the chapters are uneven. For example, one chapter gives a detailed description of the congenital myopathies, a rare group of disorders that are rarely seen by physicians other than pediatric neurologists, and another on back pain and neck pain. From my perspective, back and neck pain seem out of place in this book. Some of the comments in this particular chapter are directed at primary care physicians, whereas the rest of the book is directed at specialists.

I recommend this book to young neurologists and physicians who want to learn more about neuromuscular diseases. These fascinating disorders remain a challenge to clinicians. Although clinical acumen, in terms of history and examination, is still the key to their diagnosis, the recent advances in this field and in molecular techniques have made us think again about these disorders. This book is a timely addition to the literature.

Doug Turnbull, M.D.
University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, United Kingdom