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McAlpine's Multiple Sclerosis 4th Edition

by: Alastair Compston, Ian R. McDonald, John Noseworthy, Hans Lassmann, David H. Miller, Kenneth J. Smith, Hartmut Wekerle, Christian Confavreux
en

044307271X  9780443072710 

McAlpine's Multiple Sclerosis 4th Edition
By Alastair Compston, Ian R. McDonald, John Noseworthy, Hans Lassmann, David H. Miller, Kenneth J. Smith, Hartmut Wekerle, Christian Confavreux




Product Description:

Since 1955, this landmark masterwork has been revered for its authoritative presentation of the entire state of scientific and clinical knowledge about multiple sclerosis. The state-of-the-art 4th Edition presents the most recent information on the genetics and epidemiology, clinical neurology, pathogenesis, and management of this common neurological disease. Amply illustrated and referenced and beautifully written, McAlpine's Multiple Sclerosis has been described as "A standard reference for multiple sclerosis researchers, embryonic 'MS-ologists' and hard-ed clinical neurologists alike" (Brain, review of the last edition).






Summary: McAlpine's Multiple Sclerosis
Rating: 5

As I am very much interested scientifically in this field, I can very much recommend this book as it represents an enormous collection of information according to this disease and is written in fluent and entertaining style.



Summary: Review of McAlpine's Multiple Sclerosis, Fourth Edition (2005)
Rating: 5

If you are interested in buying this book, examine it first at your local medical library to make sure it is what you are looking for.

This six-pound reference work is updated about every 7 years and serves as a repository for the latest world-wide MS information. It attempts to organize thousands of research study conclusions and to pre the reader with a coherent status report on many different aspects of MS, both clinical and scientific.

Physically, the text is a work of art. Pages are large, thick and opaque with a solid binding and cover. One finds many photos, tables, charts and other color graphic elements. There are 810 pages of text (in a well-chosen font) followed by about 6,600 references (135 pages!).

The writing is excellent, sometimes just a bit formal with a penchant for lengthy sentences. A non-MD reader will need wiki and dictionary.com at the ready. The book is not designed as a primary teaching tool -- the reader is assumed to already know a lot about MS and related scientific subjects (eg, neurobiology). Each of the 19 chapters is written by a declared subset of the eight expert authors.

Here is the structure they chose for this edition, along with a brief outline of the contents of the book: (the full contents appears on the Elsevier site).

Section 1: One chapter (1) reviewing the history of MS up to the start of the modern era, circa 1980. Well-due homage is paid to many workers of the past, from Galen to Charcot to Marburg to Kurtzke to McAlpine.

Section 2: Four chapters covering these topics: (2) the mysterious geographical and racial distribution of MS prevalence throughout the world; (3) results of classical genetics research using linkage and association studies (multiple genes are implicated); (4) details of the (highly variable) course of the disease (the natural history of MS); and (5) a concisely-stated likely theory of how MS arose as mankind spread itself over the earth. The identical twin concordance rate for MS is about 30%, suggesting a definite mix of genetic and environmental factors which conspire to cause MS.

Section 3: Four chapters on clinical aspects of MS: (6) its symptoms of which there are, unfortunately, many; (7) how to diagnose MS, using clinical and paraclinical evidence such as MRI and evoked potentials, with a review of recent McDonald diagnostic criteria; (8) how to differentiate MS from diseases with similar symptoms; (9) a summary giving advice to the neurologist.

Section 4: We leave the clinic and enter the MS research labs. Five chapters cover the following huge subjects: (10) the cell biology of MS: T-cells, B-cells, macrophages, astrocytes, dendritics, microglia, oligodendrocytes and all their precursors, and inter-cell signaling. Topics include demyelination, axon degeneration, and the encouraging remyelination process. (11) MS from the viewpoint of autoimmunity: innate and adaptive components, EAE animal models, penetration of the BBB, antibodies in the CSF, biomarkers. (12) MS pathology: lesions/plaques, inflammation, demyelination, lots of histology here. (13) details of the physical damage done by MS to neurons, methods used to study same, blockage of signal conduction, the scary role of nitric oxide. This is the physiology of the pathology of MS. (14) This short chapter summarizes the way MS is thought to work: T cells are activated possibly by a myelin mimic molecule in the periphery, they cross the BBB and instigate a horrendous CNS battle involving just about all the players and their various weapons. Inflammation, demyelination and axon damage occur, the battle ends, and the result is a lesion which shows up on MRI and results in a clinical deficit if in an "eloquent" location. Progressive disease is thought to be a slow-burning widespread version of the same or a similar battle resulting in gradual loss of brain volume accompanied by increased clinical deficit.

Section 5: The closing five chapters concern the clinical treatment of MS patients. The first chapter (15) reviews issues which characterize the phases of MS, early middle and late. Early diagnosis is desired because early drug application might prevent neural damage. One chapter (16) deals specifically with how to treat the traditional MS acute relapse (steroids). Another (17) discusses the methods, usually drugs, for treating the many symptoms of MS. The authors emphasize disease management and rehab using family, nurses and other specialists and MS centers, in addition to the prescription of drugs. Then a long chapter (18) discusses the disease-modifying drugs discovered relatively recently: the beta interferons, glatiramer acetate, various monoclonal antibodies such as Campath-1H, etc. The final chapter (19) comments on issues involving Big Pharma influence on trials and drug-approving agencies, and foresees the future of MS treatment which will hopefully soon pre neuroprotection and repair.

Certain sections of the book can be rough sailing for the reader, as the authors painstakingly review a long series of research studies on a particular topic, giving a long one-sentence review of the conclusions of each study ( remember those 6600 references). Many study results are actively challenged and critiqued by the authors, who are not averse to stating their own opinions on many issues. Their message concerning trials is loud and clear: studies should be unbiased by drug companies' profit motives, fully randomized, placebo-controlled, fully double-blinded with crossover if possible, not terminated early unless futile or dangerous, and with sufficient statistical power to generate definite conclusions. The era of anecdotal MS trials is over.

Overall, this is an absolutely stunning and excellent book. It must have put a huge time burden on all eight of the authors. One hopes that only a few more editions will ever have to be published.