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McAlpine's Multiple Sclerosis. Third Edition.

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    McAlpine's Multiple Sclerosis. Third Edition. By alastair compston et al. (Pp 592, £105.00). Published By Churchill Livingstone, London, 1999. ISBN 0-443-05008-2.

    For those not versed in the history of this text, Douglas McAlpine, Nigel Compston, and Charles Lumsden, in 1955, authored its forerunner Multiple Sclerosis. This was then succeeded by two editions of Multiple Sclerosis: a Reappraisal with the addition of E D Acheson to the authorship. The first edition of its offspring McAlpine's Multiple Sclerosis appeared in 1985. This current edition is inextricably linked to its past; its principal author, Alastair Compston, being the son of Nigel to whom the book is dedicated. Bryan Matthews, a current contributor, was the main author of the first edition.

    Enough of the history, what of the book? As internationally recognised experts in their specific areas of multiple sclerosis, the present group of authors requires no introduction. The book contents have changed considerably since I first acquired the 1965 edition that concentrated on epidemiology (including a fold away map), clinical studies, and chemical pathology. The present text, lavishly illustrated, contains a balance of genetics, neurobiology, and pathophysiology as well as maintaining, for the generalist, authoritative sections on epidemiology, clinical presentation, diagnostic methods, treatment, and management.

    Alastair Compston's initial chapter, itself a literary gem, elegantly sets the scene, outlining the early clinical and pathological descriptions of disease as well as the experiences of sufferers from the worlds of medicine and the arts. He goes on, in subsequent chapters, to discuss epidemiology, pathogenesis, and treatment. In relation to treatment he comprehensively reviews the evidence for disease modifying therapies and, with the aid of a particularly memorable figure (14.8), addresses the symptomatic treatments available for both early and late disease. Bryan Matthews reviews the symptoms and signs of multiple sclerosis and its differential diagnosis. As would be expected, from his vast experience and clarity of writing, these sections are of great practical value—for example, the description of the warning signs (red flags) that should lead to diagnostic caution. Ian McDonald addresses imaging and other diagnostic techniques as well as pathophysiology of disease. These chapters reflect his own career at the forefront of electrophysiological investigations and thereafter the recognition and development of the potential of MRI, both diagnostically and in the understanding of disease mechanisms. George Ebers writes on the natural history, drawing on the literature and his own seminal work with Brian Weinshenker. Finally, and perhaps for the clinician most imposingly, Hans Lassman and Hartmut Wekerle describe the immunology and current state of experimental models with great clarity.

    I am reminded, when praising a book so fully, of the dangers of sycophancy. Indeed, as Groucho Marx once wrote to an author pleased with his review “I am delighted that you are delighted that I am delighted”. Of course there are omissions, the authors accept that while trying to be comprehensive they have delved into their specific areas of interest. With increasing specialisation in multiple sclerosis care within the United Kingdom, there is disappointingly nothing on how to develop a service and only a page on rehabilitation and the role of therapists (although evidence based medicine possibly justifies no more). There is also no mention of the economic burden of disease or the cost benefit and cost utility of available treatments and multiple sclerosis services.

    These are, however, minor criticisms and the authors must be warmly congratulated on producing an outstanding reference text that Nigel Compston and his original coauthors would be immensely proud of, their intention at the outset being that of simulating interest “in the ever widening field of demyelinating disease”. This book clearly fulfils that legacy and definitively presents the current state of knowledge. In their preface, the authors state that the final solution to the problems of multiple sclerosis, in particular more effective treatments, must await another edition (or more). Indeed, Dan Quayle might well have been referring to multiple sclerosis when he famously once said, “there are a lot of uncharted waters still out there in space”.

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