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Sleep Disorders and Neurological Disease.

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    Sleep Disorders and Neurological Disease. Edited by antonio culebras. (Pp 422). Published by Marcel Dekker, New York, 2000. ISBN 0-8247-7605-4.

    This is the best handbook of sleep disorders in neurology that I know. It gives clear as well as comprehensive information about the many and common sleep problems that accompany neurological illness. The text is well organised with chapters on sleep symptoms such as insomnia as well as sleep disorders in conditions such as multiple sclerosis and migraine. The forward spells it out - “the British never seem to get bored of discussions about the weather, whilst Americans are equally prepared to discourse about their own sleep patterns”. This is fair comment on the cottage industry state of United Kingdom sleep medicine versus the GB (Giga-buck) values of the United States. Indeed, we owe much of what we know about sleep to the American pioneers, who are well represented in this book.

    It may reflect the parlous state of British sleep medicine to complain that there is too much of the neurosomnologist who will do a “sophisticated neurological assessment of the type best coordinated by a clinical neuroscientists” in this book. Surely there is still the foremost need to make a definite diagnosis by clinical history rather than sleep laboratory. I still think that a good psychiatrist is of greater value in steep medicine than an EEG machine. Here the opportunity to discuss psychological factors is sadly missed. Still, the science presented is state of the art, although surprisingly there is little emphasis on molecular biology, which is an expanding field of sleep research in 2000. HLA systems get attention, but not clock genes or the many gene determined neurological disorders such as the Prader-Willi syndrome, which have important implications for sleep medicine. The book unfortunately went to the printers before the important discovery of the hypothalamic orexin system involvement in sleep and atonia.

    There are a few minor criticisms. The index is unhelpful (no Epworth, no modafinil). The references are very comprehensive but not selective (a near universal book fault); the illustrations, which are mainly EEGs and actimetry recordings, are adequate but boring. Meaningless sentences are no more common than in most medical writing, but we could do without “the diagnostic criteria for multiple sclerosis served to identify patients with this condition”, as well as “sleep is an active and integral component of the central nervous system (CNS) and may be one of its most important functions”. Treatment information can be inadequate. There are four lines on modafinil in a book of 422 pages. Physicians who want to know how antiepileptic drugs impinge on sleep are referred to “the many excellent texts available”. What about sleep problems with new dopamine agonists, or after stereotactic surgery? Does melatonin deficiency insomnia in elderly people really exist? How does the idea that “chronopharmacological considerations will prove to be of importance in TBI” turn into an exact timetable for giving drugs after head injury?

    Despite these problems it is most useful to have authoritative writing about conditions as diverse as fatal familial insomnia and narcolepsy collected into one volume. Special mention must be made of an excellent chapter on insomnia by Lugaresi and his colleagues, discussion about dissociated states of brain and mind by Mahowald and Schenck, as well as Zhadanova's critical review of the role of melatonin in sleep disorders. There is a quite outstanding historical review by Thorpy, and the editor, Antonio Culebras, gives a good description of the biology and neuroanatomy of sleep as well as outstanding chapters on neuromuscular disorders, headache, and multiple sclerosis.

    Sleep disorders are important in all areas of neurology. Unless you already have one of the many comprehensive texts on sleep medicine, money spent on this book is well worth it. Your practice will improve.

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