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There are two parallel strands to the development of our understanding of immune mediated disorders of peripheral nerve. The first grew from the demonstration in the 1950s, by Waksman and Adams, that rabbits immunised with homologous sciatic nerve and adjuvant developed an inflammatory demyelinating neuropathy. In this model, experimental allergic neuritis, the CSF characteristically shows a raised protein concentration and a paucity of cells. These findings replicated those of Guillain-Barré and Strohl on the CSF abnormalities of Landry’s disease and so spawned the notion that Guillain-Barré syndrome was immunologically mediated. Accordingly, over the past 20 years patients with Guillain-Barré syndrome and chronic inflammatory demyelinating peripheral neuropathy have been exposed to immunosuppressive regimes borrowed from other inflammatory disorders.
The second important development has been the growing understanding of the relation between plasma cell dyscrasias and peripheral neuropathies. The association of peripheral neuropathy and myeloma was noted in the 1930s and that with an IgM monoclonal gammopathy was reported in the 1960s. Twenty years later IgM antibodies were found that were directed against myelin associated glycoprotein. This work has gathered pace and over the past 10 years, peripheral neuropathies have been described in association with specific antiganglioside and antisulphatide antibodies.
Alongside this expansion of interest in the immunology of peripheral nerve disorders, new infective neuropathies have emerged such as those due to HIV and Lyme disease, first recognised in 1993. It is an appropriate time then for this authoritative text on immune mediated neuropathies. The scope of the book is wide, including scientific overviews of immune interactions in the peripheral nervous system as well as pragmatic accounts of the use of immunosuppressant drugs and the management of neuropathic pain. The inflammatory demyelinating neuropathies and antibody associated neuropathies are comprehensively surveyed, as well as more difficult entities such as the post-polio syndrome and the rare toxic inflammatory neuropathies. The dry review of silicone neurotoxicity by Rosenberg is a special treat. British readers may be surprised to find only one United Kingdom contributor to this American-Dutch edited text, whereas 18 authors are American, 11 are from The Netherlands, two each from Italy, Japan, and Israel, and one each from Canada, Nepal, and Switzerland. It is not cheap, but it has no equal as a comprehensive, accessible, and useful resource for the practising neurologist.
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