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Clinical geriatric neurology. Edited by Laurie Barclay Malvern Lea & Febiger 1993 513 pp illustrated $98

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temporary neurologists, however, will probably remain on
the fringes of the CFS scene, documenting normal neurological function (or signs of conversion disorder) in patients with
multiple somatic symptoms who lack objective signs of somatic illness. None of the three books reviewed here is likely
to attract neurologists into active participation in CFS research or treatment.
experimental therapy or a procedure to turn to in extremis.
It should be seriously considered in all cases of partial epilepsy after aggressive treatmenc fails with two appropriate
anticonvulsancs in monotherapy. This definitive text on the
subject is essential reading for all physicians who treat patients with epilepsy.
Robert B . L p e r , hlD
Suri Francijco, CA
New York, N Y
RderenceJ
Clinical Geriatric Neurology
Edited by L u k e Barclay
Malvern. Lea d Febiger, 199.3
5 13 pp, illustrated. $98.00
Thuddeuj Wulnak. M D
1. Sigurdsson B, Sigurjonsson J, Sigurdsson JHJ, et al. A disease
epidemic in Iceland simulating poliomyelitis. Am J Hyg 1950;
52:222-238
2. Butler S , Chalder T, Ron M, Wessely S. Cognitive behaviour
therapy in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry 1991;%:193-158
3. Hill RCJ, Chetham RWS, Wallace HL. Epidemic myalgic enccphalomyelopathy. The Durban outbreak. Iancet 1959;1:689-693
4. Thomas PK. Postviral fatigue syndrome. Lancet 1987;1:218-219
5 . Shorter E. From paralysis to fatigue: a history of psychosomatic
illness in the modern era. New York: Free Press, 1992
6. Wessely S. “Old wine in new bottles”: neurasthenia and “ME.”
Psycho1 Med 1990;20:35-53
Surgical Treatment of the Epilepsies, Ed 2
Edited b.; Jerome Engel. Jr
New York, Raoen Press, 1993
786 pp. illustrated, $135.00
This excellent book results from the Second Palm Desert
International Conference on the Surgical Treatment of Epilepsy. The second edition follows the first Palm Desert Conference and the resulting first edition by more than six years.
These years have seen an explosion in the number of centers
offering epilepsy surgery and in information regarding the
indications, evaluation, and results of epilepsy surgery. These
changes are ably reflected in the new edition, which bears
only passing resemblance to the first.
The book far surpasses publications resulting from most
conferences for several reasons. First, D r Engel insisted that
preliminary versions of chapters be written well before the
conference. Authors were to develop consensus on various
topics relating to epilepsy surgery. Participants were given
copies and encouraged to read these before the conference.
The resulting focused discussions were usually incorporated
into the final versions of the chapters. Second, participants
were asked to complete extensive surveys regarding important issues in epilepsy surgery and generally did so. The resulting data, while not epidemiologically rigorous, provide
the most extensive information currently available on approaches to evaluation and results of epilepsy surgery. Finally, virtually all contributors describe how consensus has
evolved and provide concise summaries.
The result is the definitive textbook on the subject. The
book is logically organized, illustrations are of good quality,
and tables are used frequently and appropriately. There is
detailed discussion of when to refer patients and of results
of epilepsy surgery. Concise chapter summaries allow quick
review for the busy practitioner. Epilepsy surgery is no longer
252
Annals of Neurology
Vol 35 No 2
February 1994
Here comes Laurie Barclay and her 57 contributors with
a new book of geriatric neurology. What makes this text
outstanding? The book is divided into 12 sections with several chapters in each. It opens with an overview section with
chapters on normal agmg and an exposition of geriatric neurology itself. The trend that separates this book from most
neurology texts begins in the first section in which a chapter
describes the effects of aging on the organ systems other
than the nervous system. This emphasis on extracranial dysfunction underscores one of the lessons of geriatrics: the
body works as a unity and even the brain needs support from
its neighbors. The direct effect of extracranial illness on the
nervous system comes in a separate chapter. The two complementary chapters provide a broader exposition than seen in
neurology books. The section describing changes in consciousness also stresses the relationship between general illness and neurological illness. A clinically savvy chapter discusses the neurology of coma but less expected is the
nonneurological discussion of syncope. A third chapter supplies the neurological lowdown on seizure disorders. Together, the chapters illustrate the dichotomous approach
needed to evaluate a patient who passes out.
The section on cognitive disorders adds a chapter on ageassociated memory impairment and one on the ethics of caring for Alzheimer’s patients, to the expected discussions of
dementia found in neurology books. An excellent chapter,
later in the book, describes specific methods for taking care
of demented patients.
Other chapters deliver neurological information about
movement disorders, stroke, tumor, trauma, and other intracranial disorders. The chapters that stray out of the neurological perimeter will attract a neurologist most to this book. The
chapter on medical complications of neurological disorders
discusses decubitus ulcers, gastric motility, and other issues
that plague neurological patients, especially those with
chronic diseases. Depression, sleep disorders, pain management, and urinary incontinence find a place in the section on
management of symptoms. The section on treatment strategies in geriatrics finishes the book by covering broad areas of
surgical, pharmacological, rehabilitation, and long-term care.
The several chapters that discuss the geriatric approach to
patient care will inform and irritate traditional neurologists.
The chapter on multidisciplinary team practice emphasizes
consensus diagnosis and treatment among providers with different skills but does not acknowledge that every kitchen
needs a chef no matter how many sous chefs there may be.
Hierarchy aside, the point is clear that the complexity of
trying to provide comprehensive care to sick, old patients is
beyond the single provider. The next chapter, a preachy
piece, coaches the physician on history-taking and teaches
how to communicate with another human being. The author
asserts that “the first criterion for the provider is a genuine
liking for the older age group.” Liking a patient is a handy
aid in making the job easier but treating only patients one
likes would deprive a large number of patients from care.
This chapter gives valuable pointers on how to produce an
optimal doctor-patient interaction even if “liking” is not always possible. The errant provider, and it’s clear that the
most refractory ones are male physicians, needs to develop
empathy, respect, warmth, and genuineness toward the patient. Although this is an annoying chapter (because everyone
believes himself or herself to be warm, genuine, and empathetic), it reveals the book’s approach.
The simplistic diagram of the cervical root localization will
irritate the neurologists but might be acceptable to others.
T h e otiose drawing of the myasthenic snarl looks like a Warhol print. A bigger nit at which to pick is the inclusion of a
chapter on quantitative electroencephalography, with expensive color pictures. The technique is sometimes helpful but
is generally trumped by other methods. Giving such a specialized test a chapter rather than a footnote may mislead as to
its importance in clinical practice.
Clinical Geriatric Neumlogy is successful because it explains
neurological problems with geriatric emphasis and it also provides geriatric information not found in the usual neurological sources. The book also contains chapters that address the
borderland between neurology and medicine, a place where
oldsters abound.
Thorrm M. Waljshe. M D
Boston, M A
Principles and Practice of Neuropathology
Edited by J. S.Nelson,J . E. Parisi, and S. S. Schothet. Jr
St. Louis,Mosby-Year Rook, 1993
62j pp, i h t r a t e d , $1 19.00
This multiauthored text is an outgrowth of the highly successful annual “short course” in neuropathology given by the
Armed Forces Institute of Pathology. The text, as with the
course, is not intended for the seasoned neuropathologist or
meant to be a reference book. Rather, it is aimed at students
or residents in training. When residents rotate on neuropathology, it is often difficult to recommend a text that can
be read and digested in some weeks without eirher being
encyclopedic, too brief, or having too many pictures.
This book contains 20 chapters covering all the major disease areas. The generally concise description is accompanied
by well-chosen photographs. There are only a few minor
complaints. Some photomicrographs can be improved. The
reference list is current to about 1991, which is somewhat
out-of-date for some areas in which there have been tremendous advances: Alzheimer’s disease, acquired immunodeficiency syndrome, and Creutzfeldt-Jakob disease. Finally, presenting primitive neuroectodermal tumors as a separate
chapter is unfortunate. This concept of an expanded classification to cover the undifferentiated tumors is not widely
embraced by many practicing neuropathologists such that introducing this difficult problem of nosology in a basic text
may be more confusing than educational. Being a concise
introduction to the principles of neuropathology is agoal this
book accomplishes admirably. This textbook should find a
wide audience among students and trainees; a reasonable
price adds to its attractiveness. Indeed, even before this review could be completed, a number of our residents had
already bought the book.
Edward H. Koo
Boston. MA
Neurological Aspects of Substance Abuse
By John C. M. Brust
Boston, Butteruiorth-Heinemann. 1993
289 pp. illustruted, $75.00
This excellent monograph provides a Comprehensive review
of the experimental and clinical literature concerning substance abuse. The book is up-to-date, well written, attractively produced, and extensively referenced. It is divided into
12 chapters, 11 of which discuss major classes of drugs of
abuse. Each chapter begins with a review of experimental
results concerning the behavioral effects and pharmacology
of individual drugs. Fascinating sections summarize the history and epidemiology of substance abuse. Descriptions of
clinical effects of the drugs arc followed by derailed and practical discussions of therapy for overdoses. Other topics, including drug effects during pregnancy, long-term neurological complications (for example, stroke associated with cocaine
use), withdrawal syndromes, and complications of chronic
alcoholism are included.
This book is an impressive display of scholarship. Although
the main focus of the book is neurological and neurobiological, its scope is broader than its title suggests, as it also deals
with general medical, psychiatric, and sociological aspects of
substance abuse. I t is an excellent source for all physicians
who deal with medical complications of substance abuse. It
will be of particular value to house staff and emergency room
physicians, who are on the front lines in big city hospital
emergency wards, and to neuroscientists interested in problems related to addiction, neurotoxicology, and substance
abuse.
Stephen M.Sagar, M D
San Francisco, C A
Neuro-oncology. Primary Tumors and Neurological
Complications of Cancer
Edited by A. Twijnstra. A. Keyser,
and B. W. Ongerboer de Vzssar
Amsterdam, Elsevier. 1993
496 pj?, ilhtrated, $277.25
The field of neuro-oncology has suffered from the lack of a
comprehensive textbook. This multiauthored book is the first
attempt to fill that gap. It is a mixed success. The heart of
Annals of Neurology
Vol 35 No 2
February 1994 253
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malvern, barclay, lea, laurie, 1993, clinical, illustrated, geriatrics, neurology, edited, 513, febiger
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