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Book review palliative care in neurology
  1. C E Urch

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    Edited by Raymond Voltz, James L Bernat, Gian Domenico Borasio, Ian Maddiocks, David Oliver and Russell Portenoy. Published by Oxford University Press, Oxford, 2004, pp 435. £79.50 (hardback), ISBN 0-19-850843-3

    This book is very opportune, with the increasing recognition of the need for specialist palliative care in fields outside oncology. It is densely written and presented; however, it is very readable and would be of great use to those in specialist palliative care, who are developing an interest in neurology, as well as those who are specialist neurologists. The interface between neurology and palliative care is explored from several directions. The first section briefly surveys common neurological conditions such as stroke, motor neurone disease, dementia, Parkinsons’ disease, and human immunodeficiency virus/Creutzfeldt Jakob disease (HIV/CJD), giving a useful summary of the course and possible interventions in the disease process, and highlighting significant points and symptoms where specialist palliative care may be off assistance. The focus is always on integrated collaboration between the whole multi-disciplinary teams within the hospital and community, and between medical specialities. Areas of particular difficulty are handled well, such as the need for family support and ongoing bereavement work in families with muscular dystrophies, or involving relatives in decision processes for patients with limited capacity.

    The second part of the book discusses the interface between neurological outcomes such as persistent vegetative state, locked in syndrome or quadriplegia, and palliative care. The chapters throughout the book commence with a case history, which neatly sets the scene and allows several points to be discussed, whilst keeping the focus patient centred. The third section explores the subject from the symptom rather than disease point of view. The pathphysiology and treatment of specific symptoms such as pain, nausea, fatigue, spasticity, and dyspagia are detailed and offer a good review of these areas. The sections avoid repetition with the first section, due to the tight focus and allows for a more detailed examination of both sides of the coin—disease process and symptom control. The next two sections revolve around the difficult areas of ethics, informed consent, advanced directives, and care of the dying patient. These chapters offer logic and clarity to often ignored and demanding areas, and are a good basis for further exploration. The contributors are all eminent in their fields, which is clear from the depth and clarity of the writing. Although the focus of the book is neurology/palliative care interface, many of the discussions and reviews are valid in any area of medicine. It should be required reading for all doctors in both disciplines.

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