ACE inhibitors. Central actions.

BOOK REVIEWS

235

should be read by pediatricians and residents who have forgotten or never been taught that the E E G still provides unique information during the course of acute neurological illness that is not provided by radiological studies.

clinicians working in different fields, especially neurologists, pediatricians, infectiologists and general practioners. Hilmar Prange

Neurologische Unil'ersitiitsklinik, G6ttingen (Germany) Jane F. Donat

Department of Pediatrics, Children ~ ftospital, Columbus, OH (USA)

Infections diseases of the central nervous system. - K.L. Tyler and J.B. Martin (Eds.) (Davis, Philadelphia, PA, 1993, 379 p., Price: US $85.00)

This m o n o g r a p h focuses on the current state of knowledge of infectious diseases of the CNS and has been written by 21 reputed specialists of the field with special emphasis being placed on immunopathology, molecular biology and therapy research. The book begins with 6 chapters devoted to viral infections of the CNS (part I). The first chapter represents a general view of the diagnostic procedure and clinical m a n a g e m e n t of acute viral encephalitis. Chapter 2 discusses immunological implications. Chapters 3, 4 and 5 deal with those classes of viruses that most frequently cause acute viral ('NS diseases, focusing on herpes viruses, HIV and enteroviruses. Chapter 6 describes chronic viral infections including the prionoses, better known as "slow virus" diseases. It also includes a brief review of the current data and thoughts on prion proteins, an area of particular interest since the bovine spongiform encephalopathy outbreak in Britain. The prion theory may serve as a bridge fl)r pathogenetic distinctions between infectious, neurodegenerative and genetically disposed CNS diseases. Part II (chapters 7-13) deals with infections of the CNS caused by bacteria, fungi and parasites. Acute bacterial diseases, generalized and focal suppurative processes as well as chronic non-viral CNS inflammations are the subject of chapters 7-9. These sections contain more practical considerations, as does chapter 13 as well. The following 3 chapters comprise syndromes produced by spirochaetaceae (Lymc disease, syphilis), parasites as well as some richettsial infections. The final chapter of the book is a detailed compilation of antimicrobial drugs commonly used in the treatment of bacterial and fungal CNS processes. In this excellent synopsis, the authors provide a wealth of information on the antimicrobial spectra, pharmacologic properties, dosage regimens and side effects of the drugs available. This chapter preferentially addresses clinicians. The book consists of individual contributions which almost represent review articles. It therefore benefits from the respective authors' individual experiences and investigative results. One shortcoming of this concept is a certain lack of homogeneity which could be disadvantageous to readers looking for quick information on a special point. A n o t h e r disadvantage seems to be the thematic overlap in some chapters (e.g., neurosyphilis in chapters 9 and 11, toxoplasmosis in chapters 3, 9 and 12, herpes simplex encephalitis in chapters 1 and 4, etc.). On the other hand, some infrequent conditions such as CNS diseases induced by mycoplasma, chlamydia, legionella, etc., were omitted. Other more common encephalitides such as LCM and rabies were dealt with only briefly. In summary, the book of Tyler and Martin represents an excellent state-of-the-art, even though the CSF diagnostics could have covered more current aspects. The few minor shortcomings which are probably unavoidable in monographs made up by many contributors do not impair the overall impression that this book is a valuable source of information for the years to come. It directly addresses

Practical handbook of pharmacology - a clinician's guide. - E.A. W o r k m a n and F.F. Tellian (CRC Press, Boca Raton, FL, 1993, 128 p., Price: US $34.95).

In Practical Handbook of Pharmacology, the authors set out to present a "pocket-sized, quick reference to basic data which will be of immediate practical value to the busy clinician." To this end, the authors have accomplished their goal, though fail in other areas. This small volume is replete with excellent tables presenting pharmacologic agents grouped by indication (delirium, dementia and geriatrics, psychosis, depression, mania, panic and anxiety, aggression, pain pediatrics, and personality disorders), along with tables of usual doses, dose forms, pharmacokinetic profiles, side-effects, dose equivalencies, and drug interactions. By organizing the handbook around syndromes and diagnoses, rather than by drug category, the book becomes more clinically useful. The handbook, however, deviates into two other areas in which it fares less successfully. The first area is the text portions of the handbook, presented in table format, which are too vague to be of much value. For example, in the chapter on aggression, the authors write "Patients may become agitated and strike out at others around them for various reasons," but do not go on to describe any of the reasons. -['he second area is the suggestions for the practice of psychopharmacolgy. I was surprised that the authors ventured into this territory as they stated in the preface that the handbook "does not tell the physician how to prescribe." The cookbook approach presented is misleading to the novice and perhaps unnecessary for the more experienced clinician. In addition, there are a handful of errors and omisskms in the handbook. An example includes the authors' r e c o m m e n d a t k m that high-potency neuroleptics be used for agitated demented patients, although the literature shows that thioridazine, a low-potency neuroleptic, is equally safe and effective in this population (Tune et al. 1991). Additional examples include the omission of benzodiazepines as a treatment for akathisia, as well as an overly conservative dose range for prozac in the treatment of OCD, which should be extended to at least 80 rag/day. The emphasis on following the patient's progress with objective rating scales is enthusiastically welcomed, although the failure to include a cognitive rating scale, such as the Mini-Mental State examination (Folstein et al. 1975) is an important omission. I can r e c o m m e n d the handbook for its clearly presented tables of basic psychopharmacologic data, as long as the reader is able to critique the remaining portions of the handbook from a position of prior experience in the field of psychopharmacology. Neal Ranen

Department of Psychiatry, Johns Hopkins Unil:ersity and [fospital, Baltimore, MD (USA)

ACE inhibitors. Central actions. - J.M. Starr and L.J. Whalley (Raven Press, New York, 1993, 300 p., Price: US $75.00)

There has been a recent surge in our understanding of the importance of central angiotensinergic mechanisms both with respect to the regulation of neurotransmission and also control of the

236

B()OK REVIEWS

cerebral circulation. Such mechanisms are likely to be important in clarifying hoth the way in which angiotensin c(mverting enzyme (ACE) inhibitors produce their effects on blood pressure, and in identifying the cause of their adverse effects. Consequently, the time is right for a comprehensive review of the subject. Starr and Whalley are certainly comprehensive: they discuss the central mechanisms of blood pressure control and how ACE inhibitors may act within the central nervous system to produce their effects: the trophic actions of angiotensin I1 and related molecules are also discussed in a separate chapter. The influence of ACE inhibitors on the various components of cerebral autoregulation are outlined, and finally there is a chapter on the effect of ACE inhibitors on cognitive function, ttowever, a detailed reading of the book conjures up the image of a large individual trying to get to sleep in a cold room under a light blanket: the area to be covered is immense, but the means are inadequate. The aulhols are on the whole quite uncritical of the papers they include. For example, much of the evidence they cite in support of the central actions of angiotensin comes from studies using intracerebroventricular injectkms (ICV). Whereas they argue that many central sites involved in blood pressure control are situated around the ventricles and often are devoid of a blood-brain barrier, this in no way means that these sites are the sole location of the actions of ICV injected agents. Many cells have processes which abut onto the ventricular surface, whence retrograde uptake may occur and produce actions in cell groups quite remote from lhe periventricular area. Most neurophysiok)gists thus tend to prefer the effects of local injection into a defined nucleus usually in more physiologically meaningful doses than achieved by ICV injection in studying the effects of a moleculc. In addition, their evident hick of first hand experience m many areas into which their discussion has taken them leads them to make ex cathedra statements which arc often irritating even when they are not completely' wrong. This is particularly apparent m their discussion of the control of cerebral blood flow. Statements such as: " P a O , effects are central to understanding the observation that women tend to have higher CBFs than their male counterparts; this is due to the fact that women have lower hematocrits and (TBF is inversely proportional to oxygen transport capacity." are erroneously simplistic and mislead the reader. Most would agree that other, mort important factors are involved. Many of the sections are rambling and add nothing to the topic suggested by the title of the book. Thc final chapter on ACE inhibitors and cognitive function is a case in point. It is 17 pages long and, apart for the conclusion, contains only 3 sentences relating directly to ACE inhibitors. The conclusion itself merely implies thai the effects of these agents on cognitive fimction is unclear. Lack of editorial oversight also is apparent in the figures which are often unnecessary or badly labeled (Fig. 6). The authors should also be informed that the EDRF-related agent is nitric oxide and not nitrous oxide as repeatedly mentioned. On the whole, a not very satisfactols efforl.

Stephen Oppenhcimer

Department of Neuroh~,W, .lohns Hopkins ~)ziversiO' and Hospital, Bahimorc, MD (USA)

Die Epilepsien. - W. Fr6scher and F. Vassella (Eds.! (Walter de Gruyter, Berlin, 1994, 813 p., Price: DM 448.00)

English has become the lingua franca in thc world ol science and medicine. It is therefore most unustl~ll, tr,/ use this international jourmd fl)r the review of a book written in a hmgnagc othcl than English. The reason for making such an exception lic~, in the onl standing qualities found in this w~)rk. One has to refrain in this exceptional situation lrom a detailed review. Let it be said that this is a comprehensive t~ook: edited by an adult (WF) and pediatric (FV) epileplologist so that both important sections ol cpileptology are equally represented. A special highlight is lhe enormous chapter 7 (vdth countless ~,ubsections) (m the clinical aspects of epileptic seizures and epilepsy syndromes. Fhc cast of conlributors includes numerous authors from outside lhc Gcrmanspeaking regions. The EEG is widclv represented in lracings of finc quality; a special EE(} chapter was contributed h~,, lhc late I11. (L Dumermuth. All forms ol modern diagnostic mclhods arc aplly presented. Thc chapters dealing wifll pharmacolhcrapy are excellent and include the most recent generations ol antiepileptics. As to lhc inevitable shortcomings of such a monumental work: (a) more space could be allotted to neurosurgical Ircatment and presnrgical EE(i evaluation, and (h) the presentation of the neurophysiological hasis of epileptogenesis would benefit from a more international flavor. The editors of this v,ork have phmned and orchestrated Ihis multifaceted book in a superb scholarly nmnner. The result is an impressi,,e blend of modern international orientation and historical national tradition. E. Niedermcyer

l,k7Jarlmenl ~t Netlrolt~£,y, .lotm~ tlol)hins Unit'ersily and ttospital, Baltimore, MD (U£41

Clinical neuropsychology of attention. - A.tl. van Zomeren and W.N. Brouwer (Oxford University Press, Oxford, 1994, 2611 p., Price: £35.00)

There has been a recent plethora of monographs dealing with topics such as attention and consciousness. Such subjects used to bc non-entities under the powerful influence of behaviorism and its strongest proponents, John B. Watson and B.F. Skinner. A few decades have sufficed to convince the scientific world that these terms are not anathema any longer. This is an eminently clinically oriented hook. Following a discus sion of theories of attention (with a delightful photograph of the revered Donald Broadbent on his motorcycle), there are very well written chapters on anatomophysiology of attention, hcad injury. Alzheimer-type dementia, Parkinson disease and epilepsy (with two EEG figures, one of them barely readable). The assessment of attention, behavioral/social consequences of attenliemal deficits and their rehabilitation comprise the final chaptcrs. This excellent book is most warmly recommended lor clinical neurophysiologists and neurologists. It should be kept in mimJ that the neurocognitive functions will be one ol our grca! challenges in the years and decades to come. [:. Niedermeyer

[)eparlmenl o/' "~eltroh~q% Johns ffopkins Uni¢'ers'ity and tlospila/, Baltimore. ;~fD ( (L~/t )