development of medical imaging of the body’s inner organs have won the
2003 Nobel Prize for..."From the New England Journal of Medicine, May
26, 2005
Stephen Waxman is the epitome of a molecular scientist who heads a
clinical department. His research interests focus on membrane channels
in health and disease, especially in spinal cord injury and multiple
sclerosis. Waxman deplores the bad old days (i.e., as recently as the
1950s), when the inimitable Labe Scheinberg said the best we could do
for multiple sclerosis was "diagnose and adios." Richard Masland, a
former director of the National Institute of Neurological Disorders
and Stroke, said something like "for all the good we do for multiple
sclerosis, neurologists could be replaced by sympathetic nuns."
(Figure) That world is thankfully gone. Imaging has improved diagnosis
immeasurably. New drugs and biologic agents are available for
Parkinson’s disease, multiple sclerosis, migraine, viral infections,
and even Alzheimer’s disease. For autoimmune peripheral neuropathies,
myasthenia, and myopathies, new immunosuppressive drugs, plasma
exchange, and intravenous immune globulins enhance treatment.
Botulinum toxin has taken on a life of its own -- in the treatment of
disorders ranging from dystonic torticollis and spasticity to facial
wrinkles. Endovascular catheters can be snaked into the far reaches of
the brain to bust clots and occlude aneurysms. Neurosurgery has
advanced to minimally invasive procedures for almost anything,
including epilepsy and Parkinson’s disease. Molecular genetics has
elucidated the inherited diseases, and gene therapy is coming.
Molecular biology has guided the development of new drugs for specific
disorders. Stem cells have captured the imagination of clinicians and
patients. The art of therapeutic trials has matured. Waxman had a good
idea. If he could assemble experts to write about these advances, it
might be possible to explain how they came about and how we might
learn from the experience to plan research for coming decades. He did
just that; chapters in this book cover all the neurologic advances
listed above and, conforming to another current theme, include both
depression and anxiety, because neurologic and psychiatric research
methods overlap. Looking to the future are chapters on genomics and
proteomics, neuroprotection, gene therapy, channelopathies, stem
cells, and functional imaging. All of that is to the good, but there
are limitations. Many chapters are such thorough reviews that they
seem to be addressed to peers, not to general neurologists and
certainly not to practitioners in other fields. Waxman does not
identify his intended audience, and it is not likely that anyone will
read this textbook from cover to cover. A minor problem is technical.
Illustrations are profuse but appear only in black and white. Colored
figures appear in an inconveniently separate fascicle at the end of
the book. There are other considerations. The great therapeutic
revolution was not restricted to neurology; all of medicine has
advanced. And neurology is still faced with the giant challenges of
age-related neurodegenerative diseases, which means that more than 4
million people now have Alzheimer-type or other dementia, and more
than 1 million have been diagnosed with parkinsonism or with the less
common but horrific amyotrophic lateral sclerosis. We can celebrate
when we make real progress against these conditions. Genetic and
developmental diseases and epilepsy are still targets for prevention
or control. Stroke is still a leading cause of death, but even the
formidable intracerebral hemorrhage may now be treatable. We know that
progress is coming, even if we cannot plan for it. What we need most
is a continued federal commitment to support the National Institutes
of Health so that medical research is a reasonable career. Molecular
research and clinical investigation are wondrous. Young investigators
are the readers who will most appreciate this book; they will keep the
advances coming if there is tangible encouragement. Lewis P. Rowland, M.D.
Product Details
Hardcover: 552 pages
Publisher: Academic Press (October 18, 2004)
Format:PDF
Size:10.72 MB
ISBN: 0127389032
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