Brain, Vol. 123, No. 3, 652,
March 2000
© 2000 Oxford University Press
Book reviews |
AN ATLAS OF MULTIPLE SCLEROSIS.
.
Department of Neurology, Derriford Hospital, Plymouth, UK
In much the same way as one may sit enjoying a glass of claret musing with one's friends over the composition of the world's greatest international soccer team, Charles Poser would probably figure in most Neurologists' forward line-up when considering contributions to multiple sclerosis over the last 30 years. The late Dale McFarlin and the recently retired Ian McDonald would be wearing jerseys on the same team. Charles Poser has contributed significantly in a number of areas and is justly renowned not only for establishing definitive criteria for diagnosing multiple sclerosis, but also for his work on epidemiology and his thoughts on the pathogenesis of multiple sclerosis. He is to be further congratulated on assembling a magnificent collection of illustrations in his current Atlas of Multiple Sclerosis, which admirably convey reflections of the history of multiple sclerosis as well as clinical aspects, pathology and imaging.
The book is divided into two sections. There are 20 pages providing a concise overview of most aspects of multiple sclerosis, followed by a short bibliography and then 117 figures, in both black-and-white and colour, covering most aspects of the disease. The quality of the reproductions is very high throughout. The illustrations start with some rare pictures relating to the early history of multiple sclerosis, including a portrait of Augustus d'Esté, the first documented case of multiple sclerosis, which was reported by Douglas Firth in 1948. There are also portraits of Sir Robert Carswell and Jean Cruveilhier, as well as more easily recognized figures such as Jean Charcot and James Dawson. The quality of the reproductions is superior to those in the most recent edition of McAlpine's Multiple Sclerosis, although Alastair Compston's chapter in the latter volume is one of the best accounts of the early history of the disease.
One of the strengths in the book is the number of pathological illustrations that help to describe the various clinical forms of multiple sclerosis as well as the cellular components of each phase of the disease. There are also examples of cerebrospinal fluid electrophoresis, visual field mapping, visual and auditory evoked potentials and funduscopy.
The 50 or so imaging figures are both historical (including early CT scans and 32P scans taken in 1954) and also clinically useful in illustrating misdiagnoses. Whilst the correct degree of emphasis is placed on magnetic resonance scanning, I am not sure how much we gain from early generation CT scans. There is no mention of newer MRI techniques such as magnetization transfer or spectroscopy.
Having said these things, it is clear that Charles Poser emanates from the old school of Neurologists, who prefer to use clinical weighting information rather than magnetic T2-weighting. He states clearly in the text that `too often the diagnosis of multiple sclerosis has been based exclusively on the presence of "lesions" visualised in the white matter on T2-weighted MRI scans.' It is interesting to consider the variation in emphasis placed upon the MRI on the two sides of the Atlantic Ocean. A recent eminent Chair of Neurology from the US remarked at a clinical meeting that the Food and Drug Administration in the United States would license treatments for multiple sclerosis based solely on MRI data, whereas in the United Kingdom these data are rarely even considered in deciding on the appropriateness of such treatment. It is therefore refreshing to read Charles Poser's personal views on the importance of clinical aspects of multiple sclerosis. His fount of personal experience is clearly described and concisely laid out. While on this tack, it is also worth mentioning that Dr Poser is very condemnatory about the concept of `burden of disease'; I am not sure how representative he is of North American opinion in stating this.
The book does not provide a great amount of detail in the text, and the bibliography is limited to 72 references. Furthermore, there is no mention of treatments for multiple sclerosis. The book does provide an excellent introductory text to the condition and is a source of useful illustrations for lecturing and teaching. Although there have been several recent publications in the field of multiple sclerosis providing more definitive accounts of the condition (such as McAlpine's Multiple Sclerosis edited by Alastair Compston, and Multiple Sclerosis by Don Paty and George Ebers), none of these provides quite such a personal view or is able to surpass the quality of illustration. For these reasons, Charles Poser's Atlas of Multiple Sclerosis is a useful addition to the departmental bookshelf.
Notes
1998. Pp. 134. Carnforth: Parthenon Publishing.
Price £48.00. ISBN 1-85070-946-7.
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