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Neurology Practice Guidelines.
  1. MARK MANFORD

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    Neurology Practice Guidelines.Edited by richard lechtenberg, henry s schutta. (Pp 544; US$150). New York: Marcel Dekker, 1998. ISBN 0-8247-0104-6.

    With an ever increasing number of neurology texts concentrating on diagnosis and medical science, a book with an emphasis on therapeutics is a welcome addition. The key problem is that whereas older treatments may change little, up to date ones change in the time it takes such a book to come to fruition. Nevertheless this text does cover a broad range of therapeutic issues with access to key publications in a way that would be difficult to find in another single volume.

    It is divided into sections, for example headache, degenerative diseases, and seizure disorders. Each starts with a brief overview and goes on to chapters dedicated to specific topics. Common diseases are given substantial coverage but the choice of more minor topics is curious. Whole chapters are devoted to botulism, diphtheritic neuropathy, and organophosphate poisoning and a few lines only to tuberculosis or AIDS and its complications. The emphasis varies throughout the book. A very valuable chapter on Parkinson’s disease devotes three pages to diagnosis and 40 pages to topical issues in therapeutics, whereas the chapter on myasthenia gravis devotes 14 pages to diagnosis and eight to treatment. In some chapters the discussion of treatment is little more than a list of drugs and their side effects. The more successful chapters give an analysis of relevant publications and try to give up to date treatment options for specific clinical situations. Others are more didactic, drawing on the authors’ personal experiences. The authors are American and some familiar treatments are omitted—for example pizotifen for migraine prophylaxis. Others may sound strange to British ears, for example intravenous dihydroergotamine features prominently in treatment of chronic daily headache. Key references are cited only at the end of each chapter, which gives a free flowing text but makes it difficult to identify sources of specific information. There are many tables but no illustrations and no colour to break 500 pages of print, and although the text is readable, this is a missed opportunity.

    The book is expensive at $150, but it does stand apart from most neurological texts, going some way to being a manual of current therapeutics. l should have liked to see a more consistent emphasis on treatment in all the chapters.

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