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Clinical Neurology-Parkinsonism.
  1. ROGER BARKER

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    Clinical Neurology-Parkinsonism.Edited by N P Quinn. (Pp 225, £30.00). Published by Harcourt Brace and Co, Sidcup, Kent, 1997. ISBN 0-7020-2309-4.

    Currently the most exciting new developments in Parkinson’s disease relate to the genetics and role of α-synuclein in the pathogenesis of this disorder, and the resurgence of neurosurgery that dominates new management strategies. These areas are therefore well covered in this book which (like others in this series) is a well structured and topical review of, in this case, Parkinsonism. However, unlike previous volumes, abstracts are now provided along with a reference list in which the key articles are highlighted. This is a useful addition as it not only lays out the structure of the chapter, but allows the interested reader to supplement their understanding by the acquisition of a few essential source articles.

    The book opens with a chapter on the clinical features of Parkinson’s disease (Quinn) which is supplemented later on by chapters on other parkinsonian syndromes, including multiple system atrophy (Quinn and Wenning), progressive supranuclear palsy and corticobasal degeneration (Litvan), as well as other causes of parkinsonism (Tison). These chapters are helpful in defining the characteristic features of these diseases and by so doing the differences between them which should allow for a more accurate clinical diagnosis in life. However, the fact that all these conditions ultimately rely on pathology for diagnosis can create significant discordance between clinical features and disease state, and this is exacerbated by the desire to try and fit an atypical patient into one of these categories. In this respect the discussion on Lewy body dementia is timely, given its increasing recognition as a cause of dementia. The relation of this condition to Parkinson’s disease is still far from clear and this is acknowledged by Lennox and Lowe in their chapter on dementia and Lewy bodies.

    The book, however, does not stay purely within the realm of clinical phenotypes. Schapira provides a familiar chapter on the pathogenesis of Parkinson’s disease and Wood reviews the genetic literature and Ben-Shlomo the epidemiology. These are comprehensive chapters and again highlight the difficulties of conducting such work given our inability to make a definite diagnosis of Parkinson’s disease in life. There is limited discussion on α-synuclein and the recent identification that this forms the major filamentous component of Lewy bodies and Lewy neurites is obviously not mentioned, although it may prove to be the gold standard for diagnosis in the future. Furthermore, the recent identification of a second gene (parkin), this time in autosomal recessive juvenile parkinsonism, is also not covered in this book, which highlights the speed with which these books can become out of date.

    The chapters on management are useful if not inspiring. Oertel and Quinn discuss the issue of drug therapy well, both in terms of overall aims and specific advice, and LeWitt discusses rather turgidly newer pharmacological therapies. The controversy as to the treatment of young onset Parkinson’s disease is touched on in both chapters, although no clear scientifically proved answers are provided. The surgical management is then discussed by Obeso and colleagues, who present data on the newer techniques of pallidotomy, deep brain stimulation, and transplantation. This is a burgeoning area of interest although the basic wiring diagram of the basal ganglia, that regularly turns up in chapters of this sort, is a gross simplification, which may explain some of the limited effects of these surgical manipulations. Since this book came out there is now much more information on the cognitive consequences of pallidotomy, as well as early studies addressing pallidal versus subthalamic stimulation in the treatment of Parkinson’s disease. Furthermore the discussion on transplantation in this chapter is not especially critical both in terms of the failure of some centres to follow scientifically proved methods of tissue preparation and implantation as well as adherence to the CAPIT-PD guidelines. This has meant that comparisons between centres with this experimental procedure cannot be done easily, if at all.

    Overall the book is very rewarding and is probably more of interest to those not directly working in the field of movement disorders and Parkinson’s disease. It is generally clear and concise and combines scientific data with practical advice. It is a shame that there is no discussion of the cognitive and affective aspects of Parkinson’s disease, outside the context of Lewy body dementia, but there again one can’t have everything!

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