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This is a timely moment to publish a book which takes an analytical look at outcomes in the common neurological and neurosurgical procedures’ obsessed as we seem to be at present with evidence based medicine. In addition we are rapidly moving towards and era when therapies are becoming available for many neurological diseases, hitherto deemed more suitable for pastoral care, and our understanding of treatment trials and the importance of comparative treatment groups is essential for local and regional health planning. It places the work of neurosciences effectively in context with the rest of medicine and provides a multitude of informative lessons on patient management and our interpretation of medical dogma and established practice.
Before embarking on the more traditional interpretation of current neurological and neurosurgical therapy there are four invaluable chapters in the introduction section. These take a practical view on the aims of studies designed to evaluate and measure outcome as well as their financial impact on the health services in a cost-benefit analysis. Although these subjects may seem a little stodgy to pure clinicians they provided important background within which to understand the aims of the book and to set up a pattern of interpretation for the clinical sections which followed. By and large the authors keep to the task set out to them in the introduction and the range of subjects covered is broad and includes the traditional subjects of vascular disease, trauma, tumours, degenerative diseases, infections, epilepsy, and coma. In addition the contemporary issues of surgery in movement disorders and rehabilitation were addressed well. However, the quality of a few of the sections was variable and some of the authors appeared to stray from their brief preferring to provide a tired and rather automated version of therapy for a given group of diseases occasionally providing the reader with a deja vu phenomenon.
I cannot pretend that this is an essential book for neuroscience libraries, but it does provide important insights for those planning treatment or outcome studies and may also be of value for medicolegal work.
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