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Parkinson's Disease and Movement Disorders. Diagnosis and Treatment Guidelines for the Practicing Physician
  1. C E CLARKE

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    Parkinson's Disease and Movement Disorders. Diagnosis and Treatment Guidelines for the Practicing Physician. Edited by charles h adkerand j eric ahlskog (Pp 480, US$ 125.00). Published by Humana Press, New Jersey, 2000. ISBN 0 896 03607 3.

    The authors state that this book is aimed at the primary care physician or perhaps the “general” neurologist who is not an expert in the movement disorders field. As such, they have emphasised the clinical aspects of each condition including differential diagnosis with only an outline of the various treatment options.

    It is divided into five sections. The first covers basic principles taking us back to the basic phenomenology of movement disorders and also basic neuroanatomy. There then follows an inappropriately complex chapter on motor speech disorders which is out of place in such a volume. Section two covers all aspects of idiopathic Parkinson's disease. As is common with multiauthor texts there is a great deal of repetition between the different chapters on the epidemiology, aetiology, pathophysiology, and clinical features of the condition. The chapters on neuroprotection and symptomatic therapy for the condition are more balanced and divided into sections specifically aimed at the less experienced clinician. However, they only cover North American practice where tolcapone remains available, whereas madopar, apomorphine and cabergoline are not. The chapters on associated problems such as sleep disorders, autonomic dysfunction, psychiatric problems, and surgery for Parkinson's disease are shorter and thus more suitable for the busy general practitioner. The third section covers Parkinson's plus syndromes including progressive supranuclear palsy and multiple system atrophy. These chapters are more balanced but then spinocerebellar degenerations suddenly appear and in considerable detail instead of being placed in a separate section on ataxic disorders. Whether chapters on corticobasal degeneration and primary degenerative dementia should be included in a book for general practitioners is a mute point. Section four covers hyperkinetic movement disorders with separate paragraphs on tremor disorders, essential tremor, dystonia, hemifacial spasm, Huntington's disease, and tardive dyskinesias. The detailed explanations of myoclonus and the stiff person syndrome are inappropriate in such text. The final miscellaneous section comprises Wilson's disease, gait disturbance, and post-traumatic and psychogenic movement disorders. Much of this is also too specialised.

    As a text for the general practitioner to either read or use as a reference source, this book is far too long. This stems from the repetition in the earlier sections and the excess detail throughout. This, combined with the strongly North American orientation of the book, particularly in terms of epidemiology and medication, means it will be of little value to the European primary care physician.

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