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Multiple sclerosis. Diagnosis, Medical Management and Rehabilitation
  1. JOHN ZAJICEK

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    Multiple sclerosis. Diagnosis, Medical Management and Rehabilitation. Edited by jack s burks and kenneth p johnson. (Pp 624, US$210.00). Published by Demos Medical Publishing, New York, 2000. ISBN 1 888799 35 8.

    The past few years have seen a plethora of books on multiple sclerosis. Many of these books simply decorate my bookshelf and are rarely consulted by any member of the team.

    Some cynics have correlated a high number of recent publications with pharmaceutical investment in new drugs; there is no doubt that many of these books are purchased by the pharmaceutical companies and are often used as marketing tools.

    Each new volume, therefore, needs to justify its existence in some way. In most cases the battle is between McAlpine'sMultiple Sclerosis and each newcomer. Most young pretenders are unable to match McAlpine in most areas. This is certainly true for the present volume in the context of the history, epidemiology, pathology, diagnosis, and aetiology sections. Where this book is particularly strong and justly deserves its place on the multiple sclerosis bookshelf is in the clinical sections, most of which are very helpful.

    The book is divided into eight sections, including most of the ones mentioned. Section 6 deals with symptom management and rehabilitation, including specific chapters on weakness, mobility, fatigue, spastic paresis, vertigo and incoordination, neuro-ophthalmology, paroxysmal disorders, cognitive and emotional problems, pain and dysaesthesia, bladder dysfunction, bowel disturbance, sexual dysfunction, autonomic disorders, dysarthria, and dysphagia. These chapters are generally informative and well written by specialists in their field. I would particularly pick out excellent chapters on neuro-ophthalmic signs and symptoms, by Elliot Frohman and colleagues, a very useful chapter on dysarthria, and an excellent section on clinical and rehabilitation outcome measures by Linda Coulthard-Morris, which contains analysis of most of the commonly used measures together with examples of the forms.

    The later chapters are involved with “societal issues” and are more specific to the American care system than European health care models.

    This book is much weaker in the earlier sections and it is here that I would reach for my trusty McAlpine.

    A volume such as this is an opportunity not only to review evidence, but also to interpret in a particular fashion. During this interpretation, authors may be tempted into controversial areas, occasionally using logic which can at best be described as woolly. Often these ideas are promulgated at commercially sponsored satellite symposia where the promise of a free lunch and more books draws a large audience. It is much more difficult to get some of these theories into scientific peer review publication than it is to express them at satellite symposia and in book form. For example, the concept of “asymptomatic disease” and “symptomatic disease” has been around for a while and is again exposed by Pat Coyle in this book. The logic goes something like: early inflammation causes early axonal damage, therefore we must treat early and aggressively. Jack Simon in his MRI chapter provides a good deal of common sense information, including the fact that completely unsuspected multiple sclerosis may be detected at necropsy. At present, we have no hard information to inform us that any of the immunotherapies make a difference to secondary progression in the long term, and the implication that we should be treating MRI rather than a patient may cause dysphagia to some neurologists on this side of the Atlantic.

    It is important to maintain a balanced viewpoint in life. Overall, the many good chapters in this book outweigh the mediocre ones, and the quality of the paper is wonderful!

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