Book Review

McAlpine's Multiple Sclerosis

N Engl J Med 2007; 356:534-535February 1, 2007

Article

McAlpine's Multiple Sclerosis
Fourth edition. Edited by Alastair Compston, Christian Confavreux, and Hans Lassmann, with five others. 982 pp., illustrated. Philadelphia, Churchill Livingstone, 2006. $199. ISBN: 978-0-4430-7271-0

Multiple sclerosis is the most common inflammatory disorder of the central nervous system and a leading cause of disability in young adults. It usually begins with a relapsing and remitting course but eventually evolves into a chronic, progressive disease with an accumulation of neurologic dysfunction, permanent deficits, and increasing disability. Life expectancy is shortened. For these reasons, multiple sclerosis is a heavy burden on patients, their families and caregivers, the health system, and society.

McAlpine's Multiple Sclerosis has been the leading single-book source of information on this disease since it was first published in 1985, based on works from as early as 1955 by Douglas McAlpine, Nigel Compston (the father of the current edition's editor-in-chief, Alastair Compston), and Charles Lumsden. For this edition, Alastair Compston enlisted leading experts in multiple sclerosis research. Over a period of 3 years, these authors — world-renowned specialists in neurobiology, neuroimmunology, neuropathology, neuroimaging, genetics, neurophysiology, and neurology — produced an encyclopedic reference work on multiple sclerosis. What sets this book apart from others with several authors is the coherence in the approach, style, and layout of the chapters. The book's 19 chapters are organized into five sections, discussing the history of multiple sclerosis, its cause and course, its clinical features and diagnosis, its pathogenesis, and its treatment.

The first section provides an excellent account of the history of the disease. The second includes well-written, comprehensive, analytical commentaries on epidemiology, geographic distribution, natural history, and prognostic factors. In the third section, readers will find extremely valuable descriptions of the clinical features, the diagnostic approach, the invaluable contribution of magnetic resonance imaging, and the broad differential diagnosis of a bewildering array of disorders that mimic multiple sclerosis. The chapters in the fourth section discuss the cause, pathology, and pathogenesis of the disease; the final section discusses the ever-increasing therapeutic armamentarium. Included in this section is a relevant and extremely useful critical appraisal of trial methodology. Management of multiple sclerosis obviously mandates a multidisciplinary approach and encompasses neurorehabilitation at its core, apart from the use of drugs to modify the disease and alleviate its symptoms.

The introduction of disease-modifying drugs in the 1990s stimulated and intensified research into the causes of multiple sclerosis, which has in turn generated a wealth of information challenging old dogmas and changed paradigms. Among the areas subject to these changing points of view are the growing acknowledgment of the pathologic heterogeneity of the disease, the role of axonal damage (in addition to the cardinal feature of demyelination), and the involvement of the cortex and gray matter. Gratifying to note are the designer drugs currently in the pipeline that hold promise for further improvement in the treatment of this disabling disease.

All this knowledge has been admirably captured in this excellent book. The factual contents are greatly enhanced by the inclusion of highly instructive, aesthetically pleasing, almost artistic illustrations. The scientific literature incorporated into the text is current almost up to the book's date of publication. I congratulate the authors and editors and in particular their spiritus rector, Alastair Compston, on their achievements. I can enthusiastically recommend this latest edition of McAlpine's Multiple Sclerosis.

Hans-Peter Hartung, M.D.
Heinrich-Heine University, D-40225 Düsseldorf, Germany
hans-peter.hartung@uni-duesseldorf.de