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Neurologic Disorders in Women

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    Neurologic Disorders in Women. Edited bymerit e cudkowicz and michael c irizarry. (Pp 162.) Published by Butterworth-Heinemann, Oxford. 1997. ISBN 0-–7506–9745–8.

    I was a little bemused when first presented with this book,Neurologic Disorders in Women. Like many things in life, I suppose I had always accepted that it was more hazardous to be male. After all, are we not always telling men with vascular disease that whereas they can reduce some of their risk factors they can’t change being male, or being aware of possible x linked adrenoleukodystrophies in young men with what has been labelled aggressive multiple sclerosis and then there are the x linked muscular dystrophies. So where is the neurological problem in being female? Migraines and epilepsy fluctuate with the menstrual cycle, pregnancy alters the course of multiple sclerosis and the connective tissue diseases, and then there are the potential complications of hormone treatment be it in the shape of the oral contraceptive pill or hormone replacement therapy. And maybe we do have more headaches. But is that really enough on which to base a book? So with these preconceptions I opened the book with curiosity.

    Cudkowicz and Irizarry (one woman, one man: an important balance in having such a book accepted) and colleagues from the Massachusetts General Hospital, have divided neurology into nine broad categories including, epilepsy, stroke, headache, and multiple sclerosis. In each chapter a brief overview is provided with particular reference to the incidence and prevalence in females and noting any sex specific features of the disease. Emphasis is then placed on the interaction of the disease with the female functions of menarche, menstruation, menopause, and reproduction including both the hormonal and other aspects of pregnancy, oral contraception and hormone replacement. Much of what is discussed is small print that would be omitted from larger textbooks—for example, that whereas issues surrounding a young woman with multiple sclerosis or a connective tissue related vasculitis who wishes to get pregnant are generally known, what if she had Parkinson’s disease or chronic inflammatory demyelinating polyneuropathy or if that same woman wished to breast feed? Such issues are considered. Important pharmacological areas are discussed in detail; the interaction of antiepileptic drugs with other medications, in particular the oral contraceptive pill, the teratogenicity of certain medications, and the role of the oral contraceptive pill and hormone replacement therapy in cerebrovascular disease. The neurological complications, both direct and paraneoplastic, of predominantly female malignancies are also described; a female presenting with a Lambert-Eaton myasthenic syndrome might well have a small cell carcinoma of the lung but could also have a similar carcinoma of the uterus or breast carcinoma and then there is the rare stiff “man” syndrome described in women with breast carcinoma.

    So, despite my starting position that there was not such a specific gap in the neurological literature, I have been converted. Perhaps the book should have been named The Hazards of being a Female with a Neurological Disease as the strengths of this book lie in describing the role that the menstrual cycle, reproductive functions,and associated factors have in altering the course of a disease or how they alter the therapeutic options. The other great strength of this book is its thorough and up to date referencing. Small and concise, this book will provide an excellent reference source for all physicians treating neurological disorders in women.