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Am Fam Physician. 1998;57(11):2899-2900

Practical Neurology

Edited by Jose Biller. Pp. 725. Price, $59.95. Lippincott-Raven, 227 E. Washington Sq., Philadelphia, PA 19106-3780, 1997.

Practical Neurology is a comprehensive paperbound textbook that undertakes the arduous task of reviewing anatomic, physiologic and clinically relevant information in a format meant to be informative and useful to primary care physicians, practicing neurologists and residents in training. This portable, conveniently sized textbook covers most neurologic disorders encountered in clinical practice. The authors provide a concise and pertinent review of the information necessary to diagnose and treat neurologic disorders. The review is largely successful, as a broad variety of subjects are covered in a succinct but thorough manner. By necessity, however, many areas are covered in a style that assumes a basic knowledge of neuroanatomy, neurophysiology and neuroterminology. Because this problem is unavoidable, the authors try to review these subjects where appropriate. Primary care physicians may, however, find it necessary to do further basic neurologic review when studying chapters such as hypokinetic and hyperkinetic disorders and gait disturbances.

The textbook is divided into two sections, the first of which primarily concerns diagnosis. These chapters are organized by symptom complex, making the textbook extremely useful to primary care physicians who have limited evaluation times in their busy patient schedules. By organizing the chapters in this fashion (e.g., “Approach to the Patient with Acute Sensory Loss”), the primary care physician will find an outlined review to help guide evaluation.

In the first section, most of the chapters are similarly organized. There are brief reviews of anatomy, pathophysiology, diagnostic criteria, evaluation plans and description of tests, as well as discussion of appropriateness of tests and their interpretation. Necessity and timing of referral to specialists are discussed, especially if delay of specialized treatment poses a risk to the patient.

The second section of the textbook covers the treatment of a variety of neurologic disorders. These chapters are comprehensive, largely up to date and provide good rationales for most treatment regimes. Study of this section makes the reader aware of the expanding armamentarium of therapeutic modalities available for the treatment of neurologic disorders. The use of thrombolytics in acute stroke is covered in overview fashion in the section on experimental therapies , not reflecting recent U.S. Food and Drug Administration approval of recombinant tissue plasminogen activator (rt-PA) for use in acute ischemic stroke. The use of intramuscular beta-interferon for the treatment of multiple sclerosis, which is a currently available therapy, is referred to as a study in progress, again probably reflecting developments that have occurred since these chapters were originally written. Overall, the chapters on therapy are well-written and organized in a useful fashion.

Both sections have abundant tables, figures, and diagnostic and treatment algorithms. These are useful for both review and reference.

The references listed at the end of each section provide a good literature overview of each subject covered, but would be of greater interest to neurologists than to primary care physicians.

Practical Neurology is a comprehensive review textbook dealing with the diagnosis and treatment of a broad spectrum of neurologic disorders. It is well-organized and has a user-friendly outline format, but it will probably be most useful to neurologists in training and as a handy reference source to practicing clinical neurologists. It can also serve as an excellent guide and reference to the primary care physician who has more than a passing interest in both diagnosing and treating neurologic disorders. In addition, it is valuable as an easy to use primary care reference source to formulate evaluation plans for patients using the symptom-oriented approach.

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