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Lecture Notes: Neurology, 8th edition
  1. A J Larner

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    Edited by Lionel Ginsberg. Oxford: Oxford University Press, 2005, pp 184, £17.95 (softcover). ISBN 1405114371

    What constitutes the “core knowledge” of neurology that all medical students should reasonably be expected to learn? This is a question that Lecture Notes: Neurology (LNN) and Essential Neurology (EN)—two stalwarts of the medical student library—continue to grapple with in their latest editions.

    EN, longer but with fewer chapters than LNN, tackles subjects in greater depth (and hence claims to be a review text for MRCP), whilst LNN has greater breadth, with suggestions for extra reading and key points summarising each chapter. Both texts incorporate case histories, somewhat more successfully in EN if only because the answers are physically separate, encouraging readers to pause and think about each presentation. Illustrations seem more integral to the text in EN, but this volume does have some surprising typographical gaffes—for example, Brown-Séqard, L’Hermitte; Argyll Robertson with a hyphen. I enjoyed reading about “messy breakfast syndrome” and “Kellogg’s epilepsy” which, like “flying saucer syndrome”, are variant names for juvenile myoclonic epilepsy. Considering my experience of general neurological clinics, I would have valued more discussion in EN on “neurologically unexplained symptoms”, which seem so frequent, and a specific section on neurofibromatosis, the commonest monogenic disorder that I see, albeit rarely.

    How should the undergraduate neurology text develop, assuming that it is not wholly superseded by internet browsing? Should there be more emphasis on expert consensus diagnostic criteria and management guidelines, rather than succinct qualitative descriptions of neurological conditions, facilitating pattern recognition, and their treatment? Should there be greater reference to the evidence base (and its inadequacies)—for example, citing of systematic reviews? These are issues to be addressed by the authors in future editions, but for now one has no hesitation in recommending either of these volumes to medical students, or both, since it would be invidious to choose one as “better”.