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Multiple Sclerosis in Clinical Practice

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    Multiple Sclerosis in Clinical Practice. By stanley van den noortand nancy j holland. (Pp 192, $34.95). Published by Demos Medical Publishing, New York, 1999. ISBN 1-888799-25-0.

    There is no shortage of books on multiple sclerosis and increasingly it has to be asked what justifies each new publication. With this offering, the Chief Medical Officer and the Vice President of the Clinical Programs Department of the United States National Multiple Sclerosis Society enter the fray. When on home territory (such as the National Multiple Sclerosis Society studies on the emotional effects of multiple sclerosis on patients and families) the material is original and helpful. Also the list of community resources available to patients with multiple sclerosis will be useful for United States neurologists. No less than 70 pages of the book are given over to a detailed catalogue of commonly used medications in multiple sclerosis, which could perhaps be photocopied for patients.

    However, where readers might expect a critical review of controversial management issues in multiple sclerosis, these authors are found wanting. Nowhere is this clearer than in the description of the use of β-interferon. There are pages on the way the drugs should be administered and the problems that might be encountered, but the only comments on their efficacy are that they “reduce attack rates and severity.... may be helpful in preventing progression in secondary progressive disease... and have positive effects that are highly significant statistically and clinically”. Surely doctors managing patients with multiple sclerosis, to whom this 234 page book is apparently addressed, need a more penetrating analysis. Similarly, the authors recommend that all patients with optic neuritis be treated with intravenous steroids to reduce the 2 year risk of multiple sclerosis. They do not say that this advice is based on a controversial interpretation of the Optic Neuritis Treatment Trial and that the 5 year risk of developing multiple sclerosis (in the same study) was unaffected by treatment. Perhaps the next edition will be better.