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Multiple Sclerosis. Clinical and pathogenetic basis.

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    Multiple Sclerosis. Clinical and pathogenetic basis. Edited by cedric s raine, henry f mcfarland and wallace w tourtellotte. (Pp 426 £125.00). London: Chapman and Hall, 1997. ISBN: 412308908.

    The modern day neurologist attempting to maintain a semblance of current knowledge on multiple sclerosis has an awesome task ahead of him. A brief perusal of Medline will give him some idea of the size of the task ahead, as one of the most written about subjects in the neurological periodicals, articles number in their thousands every year and seem to be rising at an exponential rate. I offer my respects to anyone attempting to produce a comprehensive text book to provide a synopsis of current theories on the disease particularly since they seem to become out of date with alarming alacrity, however this is certainly one of the best around. These days that is no idle statement since the number of textbooks like the number of published articles has increased substantially and the resultant competition is intense.

    This books aims to provide a comprehensive text for contemporary theories on the aetiology of multiple sclerosis and current management. In a huge subject with a huge amount of raw material it has been appropriately selective with a high standard of editing and manages to deliver the essence of clinical practice in a single volume. It is divided into four parts covering clinical parameters, neuropathology and aetiology and symptomatic and disease modifying treatments. It has an international board of well respected contributors who provide a good balance of science and general practice and is well illustrated and referenced.

    Affective disorders, which seem to result in one of the major sources of morbidity to patients and their families in my experience receives appropriate attention with an incisive look into neuropsychological aspects by Stephen Rao. This is characteristic of this book whose editors have clearly thought hard about every aspect of the disease, offering advice on counselling, interpreting trial data and many other subjects that are often omitted. For those who think that magnetic resonance is the only imaging medium for multiple sclerosis, David Miller explores the relevance of positron emission tomography and CT as well as exploring the relevance of imaging abnormalities in monosymptomatic disease and application as a surrogate marker of disease activity in treatment trials underlining the fact that the relationship between short term MRI activity and disability remains uncertain. I also liked Weinshenkers chapter on the natural history of multiple sclerosis. The chapter on the relevance and role of cerebrospinal fluid in the disease seems to be a little impenetrable, the section on the epidemiology of epidemics seems to hardly have changed in 20 years despite alternative published analysis and the slant on disease modifying treatments is unsurprisingly North American. However, overall this is a book which I would recommend any interested physician to have on their shelves and it can do little else but enhance their clinical practice.

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