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Experimental and Clinical Neurotoxicology, 2nd edition.

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    Experimental and Clinical Neurotoxicology, 2nd edition. Edited by peter s spencer, herbert h schaumburg and albert c ludolph. (Pp 1310, £145.00). Published by Oxford University Press, New York, 2000. ISBN 0-19-508477-2.

    The first edition of this text was published 20 years ago. The growing recognition of the importance of neurotoxicology and the development of molecular and cellular pathology and toxicology have resulted in a huge increase in knowledge since the publication. As a result the second edition of this very influential publication is much increased in content and mass. It is not a volume to be casually carried between library and home: it is now the definitive reference text on neurotoxicology.

    The book is in two sections. The first, comprising three chapters, provides informative and well written introductions to the biological principles of clinical neurotoxicology, and to the major aspects of human and veterinary neurotoxicology. The chapter on human neurotoxic disease describes disease processes by system rather than by class of compound; that on veterinary neurotoxic disease describes disease by class of toxic agent. I found the first a much more valuable approach. Despite that personal preference, these first three chapters should be required reading by any aspiring neurotoxicologist, neuropathologist, or neurologist whether scientist, clinician, or veterinarian.

    The second section, about 1000 pages in length, is a comprehensive listing of several hundred substances with neurotoxic potential. At its best, this section offers mini-reviews of major neurotoxic industrial chemicals—for example, acrylamide, n-hexane—and therapeutic agents—for example, chlorpromazine. At times, however, the choice of compounds for inclusion seems confused, and cross referencing is not particularly successful. For example, organophosphates and sarin and related organophosphate “nerve agents” are given separate sections, both dealt with in great detail but with no cross reference at all. More problematic is the handling of natural poisons and venoms and their respective toxic components (toxins). Venoms inoculated by biting and stinging animals and the poisons responsible for events such as paralytic shellfish poisoning and ciguatera are invariably complex. The clinical syndrome reflects the combined activities of numerous toxins. There is, therefore, the possibility of defining the neurotoxic potential of either the entire venom or poison or only that of the neurotoxic toxins. Each approach has its strengths and weaknesses but in this publication the editors have used both approaches without any clear strategy. This has resulted in some curious choices being made. The venom of the sea snakes is given an entry, although sea snake bites are now rather rare; the venom of the taipan is not given an entry although effective bites by this snake constitute a neurological emergency. The postsynaptically active toxins of cobra venoms are discussed but not the presynaptically active toxins of krait venoms. Saxitoxin, the toxin primarily responsible for paralytic shellfish poisoning, is a member of many related gonyautoxins, and interconversion is common. This is not mentioned in the entry on saxitoxins. Neither is the fact that gonyautoxins are often found in blue-green algae. These confusions could relatively easily be resolved in subsequent editions of this book by describing the neurotoxic potential of major groups of toxin, “postsynaptically active toxins of snake venoms” for example. This may seem a complaint based on the personal interests of the reviewer, but the editors clearly feel that “natural” neurotoxic agents are important.

    Experimental and Clinical Neurotoxicology is an unusual book in structure, organisation, and content. But it is not easily put down. I found myself constantly moving to new sections exploring its contents much as one handles a new dictionary. It is, quite simply, a good read. This new edition will become the definitive reference for the neurotoxicologist. It is an essential component of the library of any respectable toxicology or pathology laboratory and of every neuropathologist or neurotoxicologist. I doubt we shall wait 20 years for the third edition.