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Ethical issues in neurology. By James L

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BOOKS
Reviews
Evaluation and Treatment of Myopathies
By R. C. GriggJ. M D . J . R. Mettdell. M D .
and R. G. Miller. M D
Philade(phia. PA. F . A. Datis Co.. 1995
$ I35 .OO
This compact book, authored by experts in the field, presents
a valuable and up-to-date guide to the diagnosis and treatment of myopathies. Part I conta.ins chapters on the structure
and function of normal muscle a.nd on evaluation of patients
with myopathies. Part I1 considers the major categories of
muscle disease, and Part I1 deals with general strategies of
clinical management. The book is easy to read, the chapters
are elegantly illustrated with high-quality micrographs, many
in color, and the references provide good entry points into
the larger literature. The recent remarkable advances in myopathies are faithfully recorded. One cannot help but notice,
however, that these advances have not yet increased the ther;
apeutic repertoire for many categories of muscle disease. The
book will be appreciated by anyone in clinical practice, seeing
patients with muscle diseases.
Andreu, G. Engel>M D
Rochester. M N
chapters cover generalized and focal dystonic disorders and
discuss disorders of different etiologies. Unfortunately, however. the balance is often uneven. Of the eight chapters concerned especially with therapy, for example, five are focused
solely on botulinum toxin, the remaining three providing
some discussion of medical, surgical, and supportive aspects
of treatment. Again, dystonia caused by drugs is covered in
only 14 pages, whereas that caused by toxins receives almost
double this coverage even though it is encountered much
less often by the clinicians for whom this book is intended.
There are also some disappointing omissions that would
have enhanced the utility of the volume. For example, the
excellent chapter on secondary dystonias would be of even
more use to the busy clinician if complemented by a succinct
algorithm for the evaluation of dystonic patients of different
ages to identify any underlying primary pathology. Moreover, given its medicolegal implications, a critical analysis of
the possible relation of dystonia to preceding trauma should
surely have merited a chapter of its own in a work of this
sort. A more comprehensive account of the indications, role,
and morbidity of surgery using modern imaging and recording techniques would also have been helpful.
Despite these limitations, this book provides in-depth multifaceted coverage of an important topic by many recognized
authorities in the field, and a convenient summary from a
clinical perspective of recent advances in knowledge of dystonia. It will be a valuable reference source for anyone concerned with the diagnosis and management of patients with
dystonic disorders.
Companion to Clinical Neurology
By Wrlhani Pose-Phillips
Borton. Little. Rroum. 1995
1024 pp, illustrated, $99.95
Michael J . Amino#. M D . FRCP
San Francisco. C A
This extraordinary new work is a compendium of neurological information including definitions, terminology, eponyms,
classifications, and many clinical scales and tables. Dr PrysePhillips single-handedly (and with the aid of WordPerfect
and Reference Manager programs) has provided over 15,000
entries and 5,000 references! Both the common and obscure
topics of neurology are covered encompassing “some science,
some art, some history, some practical experience!” This
unique book serves as a ready and readable reference that
will be a great help to its readers. It has earned well a place
on the neurologist’s reference shelf. Moreover, it is both
interesting and fun to browse. Thank you Dr Pryse-Phillips!
Ethical Issues in Neurology
By James L. Bernat
Stoneham. MA, Butte~uorth-HeineTnann, 1995
364 p p
Robert A. Fishman, M D
San Francisco. CA
Handbook of Dystonia. Neurological Disease
and Therapy Series, No 39
Edited bj J . K . C . Tsui and D. B. Cahe
Neu’ I’ork. Marcel Dekker. 1995
469 p p , ilIustraIed. d 165 .OO
This volume, which consists of 25 chapters by 39 authors,
provides a review of all aspects of dystonia. The individual
Modern intensive care management of critically ill patients
has produced a unique set of ethical dilemmas. Frequently,
the question of if and when to withdraw medical treatment
is framed with a perceived lack of significant neurologic outcome. These questions fall squarely on the neurologist who
must provide quantitative or qualitative prognostic data to
help guide future delivery of patient care. More and more
the decision to withdraw support is based on medical futility,
a concept that is difficult to define and is often misused.
James Bernat provides the first comprehensive text of ethical concepts germane and specific to the practicing neurologist. This single-authored text achieves an excellent balance
by discussing and defining ethical concepts, by reviewing important case law, and by providing specific examples of ethical dilemmas. Dr Bernat draws upon his own clinical experience and contributes his own opinion on controversial areas.
Neurologists will find this book an important reference.
For example, the text includes concise definitions of brain
death and its determination, and the persistent vegetative
state. It reviews relevant ethical concepts pertaining to the
withdrawal of nutrition, hydration, and foregoing resuscita-
484 Copyright 0 1995 by the American Neurological Association
tion. Throughout the book Dr Bernat cites pert:ment common law (e.g., Quinlan, Cruzan, and Brophy) and provides
a readable account of the issues addressed in such rulings.
Neurointensivists and neurosurgeons will find this text comprehensive and directly relevant to the specialty of neurocritical care. Ethical concepts surrounding the procurement of
organs from brain-dead patients is discussed in detail. He
discusses “slippery slope” arguments against the proposal to
expand the definition of brain death to include “higher brain
death” and anencephaly. Pediatric neurologists and neonatologists will find excellent discussions regarding the withdrawal
of medical treatments from neurologically devastared neonates. Physicians without advanced training in neurology may
especially benefit from this text because of the clear and
precise definitions of certain neurologic diagnoses.
Dr Bernat’s command of ethics theory and clinical experience allows him to provide concrete examples of moral issues
that arise in clinical practice ( e g , rationing the use of computed tomographic scans for headache evaluation). He discusses the ethics of limiting care for the retarded child,
demented patients, and patients with acquired immunodeficiency syndrome or Huntington’s disease. A chapter on ethics and law defines medical malpractice, discusses who may
provide substituted judgment, and suggests how physicians
should behave when their ethics collide with current case
law. This text is an important contribution to the practice of
clinicai neurology and to the field of medical ethics in general.
Wade S. Smith, M D , PhD
San Francisco. C A
Immunology of Neuromuscular Disease: Immunology
and Medicine, Vol 24
Edited by R. Hohlfeld
Dordrecht, Kluwer Academic Publishers, 1994
297 pp, illustrated, $105.50
Handbook of Neuro-Urology: Neurological Disease and
Therapy Series128
Edited by David N . Rushton
New York, Marcel Dekker, 1994
404 pp, illustrated, $150.00
Handbook of Tremor Disorders: Neurological Disease
& Therapy Series130
Edited by Leslie J . Findley and William C. Koller
New York, Marcel Dekker, 1994
576 pp, illustrated. $195.00
International Workshop on Eye Movements: Ottorino
Rossi Award Conference
Fondazione IRCCS Casimiro Mondino
Pavia, Italy, Fondazione IRCCS, 1994
33 7 pp, illustrated
Pediatric Neuropathology
Edited by Serge Duckett
Baltimore, Williams & Wilkirzsj 1995
954 pp, illustrated, $169.00
Merritt’s Textbook of Neurology, ed 9
Edited by Lewis P. Rowland
Baltimore, Williams 6 Wilkins, 1995
1058 pp, illustrated, $79.50
Books Received
Human Brain Anatomy in Computerized Images
By Hanna Damasio
New York, Oxford University Press, 1995
303 pp, illustrated
Neurological Rehabilitation, ed 2
Edited by L. S. Illis
London, Blackwell Scientific Publication, I994
581 pp, illustrated, $125.00
Histology of the Nervous Systems, Vols 1 and 2
Santiago Ramon y Cajal. Translatedfrom the French by Neely
Swanson and Larvy W . Swanson
New York, Oxford University Press, 1995
161 1 pp, illustrated, $195.00
Childhood Seizures: Pediatric and Adolescent Medicine,
Vol 6
Shlomo Shinnar, Naomi Amir, and David Branski
Basel, Karger, 1995
200 pp, illustrated, $1 87.25
Memory in the Cerebral Cortex: An Empirical
Approach to Neural Networks in the Human and
Nonhuman Primate
By Joaquin M . Fuster
Cambridge, M A , MIT Press, I995
358 pp, illustrated, $50.00
Orofacial Pain and Temporomandibular Disorders:
Advances in Pain Research and Therapy, Vol 21
Edited by James R. Friction and Ronald Dubner
New York, Raven Press, 1994
538 pp, illustrated, $1 15.00
Touch, Temperature and Pain in Health and Disease:
Mechanisms and Assessments: Progress in Pain Research
and Management, Vol 3
Edited by Jorgen Boivie, Per Hansson, and Vlf Lindblom
Seattle, WA, IASP Press, 1994
533 pp, illustrated, $69.00 (IASP)
Ethical Issues in Neurology
By James L. Bernat
Boston, Butterworth-Heinemann, 1994
364 pp, $49.95
Psychopharmacology: The Fourth Generation of
Progress
Edied by Floyd E. Bloom and David J . Kupjir
New York, Raven Press, 1994
2002 pp, illustrated, $1 75 .00
Annals of Neurology Vol 38 No 3 September 1995 485
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