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Clinical aspects of neuroimmunology by Edward A. Neuwelt and W. Kemp Clark The Williams and Wilkins Company Baltimore 1978 277 pp illustrated $35

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BOOKS
Reviews
Clinical Neuroimmunology, by Peter 0. Behan and Simon
Currie, W . B. Saunders Company, Philadelphia and London,
1978, 213 pp, illustrated, $20.00
Clinical Aspects of Neuroimmunology, by Edward A.
Neuwelt and W . Kemp Clark, The Williams and Wilkins
Company, Baltimore, 1978, 277 pp, illustrated, $35.00
Reviewed by Richard T .Johnson, M D
In recent years immune responses have been implicated in
the pathogenesis of a number of neurological diseases.
During this time, several symposia related to immunovirology have been published, such as the Proceedings
of the Association for Nervous and Mental Diseases of
1971. However, until quite recently no authors have attempted to offer comprehensive coverage of the immunological aspects of neurology. Two books have now been
published that attempt to rectify this situation, but with
mixed success.
The books are quite different in their content, clearly
reflecting the orientation of the authors. Behan and Currie
present a chapter on general immunological principles and
a brief one on infectious diseases, followed by five chapters
on demyelinating diseases of the central and peripheral
nervous systems that constitute 40% of the volume. These
include a 15-page chapter on acute hemorrhagic leukoencephalopathy, a seemingly excessive amount of emphasis to place on a very rare disease (which nonetheless is
one of the best clinical and pathological reviews available
on the subject). In the second book the subiect is covered
in one-third of a page. Neuwelt and Clark, who are
neurosurgeons, follow their introductory chapters o n general immunology with a 46-page discussion of C N S tumor
immunology, a topic not even addressed in the former
book. They also provide a fairly comprehensive 15-page
chapter on ataxia telangiectasia, a subject covered by Behan
and Currie in a single page.
Both books are very clinical. In fact, the majority of
Behan and C u r i e ’ s book deals with clinical features, laboratory findings, pathological findings, and treatment, with
only a minority of the text aimed at immunological aspects.
Consequently, immunology is at times dealt with rather
superficially, though in an articulate manner. Neuwelt and
Clark highlight clinical relevance with case histories, some
of which are needlessly long, complete with roentgenograms, C T scans, and similar diagnostic aids. They do deal
with the immunological aspects in more detail, but the presentation of primary data from articles is not balanced and
issues of controversy are often not summarized or clarified.
Furthermore, they use a curious citation system. In the
preface they explain: “Since all the references in the text
give the author’s name and year in which the work was
published those references not given in the bibliography
can be found in Index Medicus. If this proves inconvenient
to some readers o r undesireable (sic) to some authors we
apologize.” They should. N o t only is this a clumsy means of
citation, but some authors’ names are misspelled, which
makes certain references difficult to retrieve.
N o first edition can be expected to be free of proofreading o r factual errors. Both books contain them. Behan
and Currie refer to papovaviruses as R N A viruses and include BK virus as a cause of progressive multifocal
leukoencephalopathy. However, Neuwelt and Clark’s errors are not only factual but conceptual; for example, they
confuse resistance with clearance and speak of increased
viral titers in referring to a graph that shows virus persistence but not increase in titer. I n general, the former
monograph is more accurate and more readable, as exemplified in the descriptions of K cells. Behan and Currie correctly and clearly describe them as follows: “Recently a
further distinct subpopulation of lymphocytes has been
identified, namely, K or killer cells. These lymphocytes are
cytotoxic for target cells sensitized with IgG. They have
been shown to be neither T nor B cells, although like B
cells they carry membrane receptors for the Fc fragment of
IgG on the target cell.” Neuwelt and Clark err in both fact
and syntax, stating: “The K cell is merely a non-sensitized B
cell or monocyte with receptors for antibodies. When
these mononuclear cells are armed with specific antibody,
antigen-specific cytotoxicity results. . . . The K cell should
not be confused with killer lymphocytes (which are T cells)
o r with the N K cell which is not necessarily either a T cell
o r a B cell, but often is a null cell (i.e., a cell which does not
have the properties of either T or B cells).”
Behan and Currie have authored the better book, and
Saunders has published it attractively at a reasonable price.
Although Neuwelt and Clark have attempted to include
more immunology, the book fails to provide accurate or
clear overviews. Furthermore, the book is overpriced, and
this is not justified by the larger number of illustrations
since many are of poor quality. Both books are properly
titled; neither is an introduction to immunology for the
neurologist. For the neurologist interested in a clinical text
with a discussion of immunological studies of the diseases,
the book by Behan and Currie will suit admirably. For
neurologists wanting a background in immunology
sufficient to understand the current neurological literature,
I would recommend a very readable paperback by Ivan
Roitt titled Essentials of Immunology. published by Blackwell for only $9.95!
Baltimore, M D
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neuroimmunology, edward, neuwelt, aspects, 1978, illustrated, company, wilkins, clarke, 277, william, clinical, kemp, baltimore
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