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Multiple sclerosis: tissue destruction and repair
  1. Katrina Dedman

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    Edited by L Kappos, K Johnson, J Kesselring, and E W Radu (Pp 350, £65.00). Published by Martin Dunitz Ltd, London, 2001. ISBN 1 85317 872 1

    The Martin Dunitz imprint produces high quality books with catchy titles often built around European congresses of neurology. Brain disease: therapeutic strategies and repair emerged from the European Neurology Society meeting in Jerusalem (2000). Multiple sclerosis: tissue destruction and repair is the proceedings of the joint meeting of ECTRIMS and ACTRIMS (European and American Committees for Treatment and Research in Multiple Sclerosis) held in Basel in 1999. Looked at critically, neither book is much about repair. Here, the 116 contributors to 37 chapters edited by a team from Switzerland and Baltimore write on central nervous system-tissue-immune interactions; in vivo assessment of tissue destruction and its consequences; multiple sclerosis fatigue; new immunological concepts and their therapeutic consequences; treatment of relapse; modern concepts of therapeutic immunosuppression; and an update on therapeutic trials. Many of the usual suspects are rounded up: magnetic resonance surrogates for various histological components of the disease process in multiple sclerosis; markers of demyelination in body fluids; treatment effects of interferon beta and its mechanisms of action; and strategies for transplantation in multiple sclerosis. Some authors rake up old matters: the use of steroids in acute episodes; and disease modifying effects of non-specific immunosuppressants. But there are also some new or emerging stories: inflammation and neuronal activity; interactions between inflammatory mediators and growth promoting molecules; fMRI evidence for plasticity in multiple sclerosis; T helper and T regulatory activity; bone marrow transplantation in multiple sclerosis; prophylactic treatment of puerperal disease activity with intravenous immunoglobulin; and a brace of preliminary clinical trials with hitherto unknown agents offering spaces to watch. Multiple sclerosis: tissue destruction and repair succeeds as a statement from experts on where selected aspects of research stood in 1999 and as testimony to the deserved and sustained success of ECTRIMS (and ACTRIMS) but as a lasting statement on limiting and repairing the damage in multiple sclerosis, perhaps less so.

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