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Diseases of the nervous system: clinical neuroscience and therapeutic principles
  1. M Donaghy

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    Edited by A K Asbury, G M McKhann, W I McDonald, et al. Cambridge University Press, Cambridge 2002, £250.00, II volumes. ISBN 0-521-79351-3

    The third edition of this well known book is subtitled Clinical neuroscience and therapeutic principles. This signifies that it is not a textbook of clinical practice, but a reference book founded in pathophysiology. So how well does it succeed? With 221 authors writing 129 chapters some unevenness is inevitable. It is a tribute to the editors’ tight grip that the overall coverage of neurological disease is suitably comprehensive.

    I particularly liked the introductory section which highlights contemporary trends in understanding neurological disease processes, the principles of restoring function after damage, and “windows on a working brain”. This is the section of the book that I chose to read for pleasure, simply for a succinct and thoughtful view as to where neurology is going outside my own subspecialty. And throughout the book, there is excellent coverage of background issues ranging from the chemical bases of addiction and alcoholism, to host responses to infection, to pathophysiology of cerebral circulation, to the cellular basis of epilepsy, and to repeat trinucleotide expansions.

    Inevitably one can take issue with aspects of subject matter coverage, particularly in one’s own subspecialty. For instance, within the neuromuscular disease section, the scientifically interesting and clinically important multifocal motor, CIDP, paraproteinaemic, and vasculitic neuropathies, lie buried incognito in a chapter entitled “Guillain-Barré syndrome”. I imagine that the lack of coverage of mononeuropathies deliberately reflects the lack of sexy science underlying this topic, despite its commonness as a clinical encounter. Most welcome, is the coverage of how channelopathies and metabolic derangements affect muscle function.

    Although extending to two hefty volumes, totalling over 2000 pages, this text has a refreshingly light and accessible feel. The index is reasonably good. Many of the illustrations are line drawings, and are beautifully clear. This enhances the notion of scientific principles which imbues the text. A superb book to have at hand in one’s office alongside a textbook of clinical practice. It is pretty expensive, but probably worth it if you need a succinct summary of the myriad bases for neurological disease.

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