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Parkinson's Disease: The Treatment Options
  1. ROGER BARKER

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    Parkinson's Disease: The Treatment Options. Edited by peter lewittand wolfgang oertel. (Pp 272, £65.00). Published by Martin Dunitz, London. ISBN 1-85317-379-7.

    This book is one of many that are emerging on the market which consider the issues of the best approaches to the evaluation and treatment of patients with Parkinson's disease. This is a complex area that is constantly changing—the move away from levodopa to dopamine agonists and deep brain stimulation as opposed to pallidotomy being two modern examples. However, this book tries to present a balanced account of the various options and to my mind gives a clear account of the issues and the advantages and disadvantages of these various options.

    The book is divided into 16 chapters, of which half deal with the therapeutic options and the others concentrate on aetiology, pathology, differential diagnosis, and evaluation of patients with parkinsonism. Each chapter is typically only 10 pages long and uses an attractive combination of tables and bullet points, which actually means that each chapter can be read in full without losing the plot, point, or interest. Sadly the photographs are a bit disappointing, for example figure 3.2 demonstrating 18F-dopa uptake in a grafted patient with Parkinson's disease loses a lot for being small and in back and white. This is especially a shame given the cost of the book.

    The book, though, is up to date and there are good accounts on the newer dopamine agonists ropinirole and pramipexole, as well as the relative merits of stimulators over lesions. However the account on neural transplantation for Parkinson's disease was disappointing, especially given all the recent controversy with this approach as a result of the double blind placebo controlled trial of embryonic nigral grafts for Parkinson's disease in the United States. Indeed a more critical and extensive discussion on this subject would have been useful in a book of this sort, as whereas this approach is experimental, it is nevertheless a common area of misconception and very much in the public domain with patients not uncommonly asking about this type of therapy. Furthermore, it is the only approach that attempts to cure the patient rather than ameliorate their symptoms and ultimately the efficacy of stimulators and lesions will have to be compared with transplants.

    There are occasional omissions in this book—for example, the chapter on neuropathology fails to discuss α-synuclein. However, other chapters are excellent and such an example is that on the genetic epidemiology by Golbe. This chapter does not just rehash old reviews on this topic; it actually presents the information for the likely audience for a book of this sort, so that after presenting the rudimentary concepts of epidemiology it goes on to discuss such things as “The utility of anecdote"; an approach which is refreshing and engaging and one which I found exceptionally helpful and useful.

    Obviously there are areas which one may disagree with and the value of the schematic figures of the basal ganglia explaining the pathophysiology and therapeutic options in Parkinson's disease are often presented as definitive, even though a large number of connections are omitted.

    Overall though the book is a useful and manageable addition to the burgeoning literature on Parkinson's disease, although it is rather expensive which will limit its appeal. I thoroughly enjoyed it and found it helpful and easy to use and apart from the photographs, well presented. I think it is especially helpful to those just entering the clinical arena of Parkinson's disease and its management, but even for those who are familiar with the literature there is a lot to be gained by reading this book.

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