Book Review

Neuromuscular Disease: Evidence and Analysis in Clinical Neurology

N Engl J Med 2007; 356:2334-2335May 31, 2007

Article

Neuromuscular Disease: Evidence and Analysis in Clinical Neurology
By Michael Benatar. 483 pp. Totowa, NJ, Humana Press, 2006. $145. ISBN: 978-1-58829-627-6

The expression “Don't judge a book by its cover” can be paraphrased in the case of Benatar's book as “Don't judge a book by its preface.” The preface of Neuromuscular Disease does not do justice to the book's content. In the six-page introduction, Benatar reasons that those of us in the field of neuromuscular disorders are not practicing evidence-based medicine because we are not interpreting the literature correctly. He asserts that we “know less . . . than we perhaps realize” because of “the limitations of clinical investigators' knowledge of study design” and because “those who read the literature have limited ability to critically appraise publications.” These statements are disturbing, if not offensive, to my colleagues who made major breakthroughs in the field, successfully fought to establish diagnostic criteria, conducted controlled clinical trials, and taught young investigators how best to diagnose and treat neuromuscular disorders. I share Benatar's views that much more work is needed and that several published papers are not of the desired quality, but I also think that this is the case in all fields of medicine and is not specific to the field of neuromuscular diseases.

I must confess, however, that the bad taste I was left with after reading the preface started to dissipate as I made my way through the chapters. Benatar does not challenge any prevailing views; instead, he constructs a series of questions to address practical and controversial topics that generate debate or uncertainties in everyday practice. He provides unbiased, thoughtful, and succinct responses in most areas, based on his critical review of the literature. The information in his book, although dry and without clinical pearls, constitutes an easily accessible resource for the busy practitioner or the novice in the field, because the reader can select questions of interest without needing to read a whole review on the subject. The format is didactic and keeps the reader engaged. Unfortunately, however, the book lacks the depth in pathogenesis, morphology, and basic science that would attract scholars in the field of neuromuscular diseases.

The first section, which includes discussions about biostatistics, methods of randomization, sensitivity analysis, and regression analysis, is rather disconnected from the rest of the book. Although it will help the reader understand fundamental terms, it will not teach the reader how to design a clinical study or judge the quality of published data. The other sections cover common diseases of the spinal cord, the peripheral nerve, the neuromuscular junction, and muscle. The selection of topics seems arbitrary, and the depth of coverage ranges from good to excellent. For example, there is a chapter on statin myopathy but not on other toxic myopathies, and a chapter on fascioscapulohumeral muscular dystrophy but not on other common dystrophies. Among diseases of the spinal cord, the author covers amyotrophic lateral sclerosis and spondylosis but not spinal muscular atrophies or the common problem of back pain. The questions used as subheadings within the chapters are heavily biased toward electrophysiology. I appreciate that one cannot be all-inclusive, but more coverage in areas such as morphology, epidemiology, and therapeutics would have been useful.

In retrospect, the unusually harsh preface reflects the author's genuine desire to teach and engage in evidence-based medicine in the field of neuromuscular diseases. In spite of its shortcomings, this book can provide easy reading for the busy general neurologist and offers quick and succinct answers to questions raised in everyday practice regarding the diagnosis and management of common neuromuscular problems.

Marinos C. Dalakas, M.D.
National Institutes of Health, Bethesda, MD 20894
dalakasm@ninds.nih.gov