Media watch Clinical Evaluation and Diagnostic Tests for Neuromuscular Disorders Edited by Tulio Bertorini Butterworth Heinemann, 2002 £110, 400 pp ISBN 0 7506 7290 0
This book aims to present clinicians and trainees with overviews of the clinical approaches to neuromuscular disease as well as the application of different diagnostic tests for these conditions. Topics covered include neuromuscular electrophysiology, autonomic function and autoantibody testing, quantitative assessment of sensory and motor function, magnetic resonance spectroscopy of muscle, and other neuroimaging techniques in the investigation of neuromuscular disease. The appendices include a collection of the rating scales and protocols for the assessment of neuromuscular disease as well as important diagnostic criteria. The chapter on the clinical assessment of the patient with neuromuscular disease is superbly presented. It includes a wonderful collection of photographs that illustrate important features of the physical examination as well as a series of tables that summarise the differential diagnoses of numerous neuromuscular symptoms and signs. This chapter offers something for all readers, from the trainee to the expert. Another chapter that stands out as particularly helpful is the one on the histology and histochemistry of muscles and nerves, which includes numerous figures among which there are 50 colour plates that illustrate features of the neuropathology of nerve and muscle tissue. This chapter has been written in such a way that it provides a manageable overview when read from beginning to end, but the layout is
such that it is also possible for the reader to quickly access the neuropathological findings of specific diseases. Notably absent from this book is adequate attention to genetic testing in neuromuscular disease. The chapter entitled “Basic medical genetics and molecular diagnosis” covers basic principles of molecular genetics as well as a brief discussion of selected hereditary neuromuscular disorders. It would have been more helpful, however, if the genetic information had been presented in a clinically relevant manner. For example, the clinical neurologist would like to know more than simply that mutations in the skeletal muscle chloride channel underlie myotonia congenita. More helpful would be to know whether there is a single or a select few mutations that are present in all patients and whether the available genetic tests screen for all known mutations; if an initial screening test is negative, are there more sophisticated (even if less readily available) tests that might be useful under conditions of high clinical suspicion? Finally, the index does not do justice to the content of the book. For example, the histology chapter includes a very nice description of the neuropathology of chronic inflammatory demyelinating polyneuropathy, but the index contains no entry for this disorder. This is a pity as it means that those who have not read the book from cover to cover are less likely to know where to find the information they seek. The reader would do well to page through the relevant chapter in search of information about a particular subject even in the absence of an index entry. This is a book that I am pleased to have read and to have on my bookshelf even though there were parts of it that I found disappointing. Michael Benatar This book is an imprint of Elsevier, of which The Lancet Neurology is part.
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