BOOK REVIEWS

Neurological Complications of HIV & AIDS: is no longer true for PML, in which control of plasma HIV
Major Problems in Neurology, Vol. 34 viral burden is associated with markedly increased survival.
by G. Said, A.G. Saimot, M. Tardieu, and C. Lacroix, 224 In spite of these few limitations, this text accomplishes its
pp., Philadelphia, W.B. Saunders, 1997, $89.00 stated goal, and provides a practical overview of this criti-
cally important field. Medical students, residents and cli-
Neurological disorders are estimated to occur in 50–70% nicians managing HIV-infected patients at the level of pri-
of patients infected with human immunodeficiency virus mary care, infectious diseases, or neurology would be
(HIV). Unfortunately, relatively few neurologists have well-served to have this book on their shelves, supple-
taken a keen interest in the management of this disease, mented by more recent literature. It is only with dissemi-
leaving it to primary care clinicians and infectious disease nation of this information from a relatively small cadre of
specialists to treat these complex neurological disorders. It investigators to a wider medical community that these un-
is not surprising that this often results in incorrect or de- fortunate patients will benefit from a greater quantity and
layed diagnoses. Thus, a comprehensive text reviewing the quality of life.
neurological complications of acquired immunodeficiency
syndrome (AIDS) by Said and colleagues is welcome. This David M. Simpson, MD
concise book benefits from a limited number of authors
with a history of collaboration, and with expertise in adult
and pediatric neurology, infectious disease, and neuropa-
thology. The text provides a clear and systematic overview
of the range of HIV-associated neurological disorders, in- Comprehensive Neurology, 2nd edition
cluding those primarily related to the virus (e.g., demen- edited by R.N. Rosenberg and D.E. Pleasure, 948 pp., ill., New
tia, myelopathy, distal polyneuropathy), and secondary York, Wiley-Liss, 1998, $239.50
complications of immunodeficiency (e.g., toxoplasmosis,
This handsome volume contains 31 chapters on different
lymphoma).
aspects of neurological disorders, written in many in-
As might be expected in a limited authorship book,
stances by senior, internationally recognized authorities in
some areas are extensively reviewed, while others are cov-
the field. The book is well-illustrated, and includes some
ered only to a limited extent. For example, the section on
color plates. References are cited in the text by author and
the pathogenesis of adult HIV dementia is comprehensive,
date rather than numerically, and this has permitted the
whereas only one short paragraph is devoted to the treat-
inclusion of references published as recently as 1997. A
ment of this disorder. This partly results from a lack of
significant portion of the text relates to disorders of nerve
references after 1995, common but unfortunate in books
and muscle, providing convenient reviews that will be use-
covering such a rapidly moving field as AIDS research.
ful to busy practitioners. They would have been helped
Similarly, whereas the clinical and pathological findings of
even more, however, by the provision of greater guidance
peripheral neuropathy are amply covered, including ex-
concerning the management of patients, for example by a
cellent photomicrographs, the treatment section fails to
greater use of algorithms or summary statements to focus
mention recent findings including the failure of amitrip-
the text more clearly. In a book of this sort, some incon-
tyline in controlled studies, and recent trials of recombi-
sistency is to be expected in the depth to which different
nant human nerve growth factor. Other issues that are not
chapters provide coverage of the subject matter. One of
reviewed are the neurotoxicity of stavudine (d4T), a com-
the longest chapters in ths book, on genetic neurological
monly used antiretroviral agent, and utility of HIV viral
diseases, includes discussions on various disorders that are
load measurements in plasma and particularly cerebrospi-
also considered elsewhere, leading to unnecessary repeti-
nal fluid.
tion. I would have preferred to see greater coverage of
In general, the authors’ clinical recommendations are
certain topics, such as Lambert–Eaton myasthenic syn-
accurate and defensible. However, in a field in which only
drome or spinal vascular malformations, reflecting per-
a limited number of clinical trials guide management, it is
haps a personal bias.
not surprising that controversy exists in certain situations.
Despite these minor points, this book is an excellent
For example, the authors’ statement that the high risk of
resource that will be a welcome addition to the library of
cerebral hemorrhage from stereotactic brain biopsy has
most neurologists, and should be in constant demand in
led them to avoid the procedure would be questioned by
institutional and departmental libraries. It can be recom-
many investigators. They apply this reasoning to both pri-
mended with enthusiasm.
mary central nervous system lymphoma and progressive
multifocal leukoencephalopathy (PML), which they assert
has a life expectancy of only a few weeks or months. This Michael J. Aminoff, MD, FRCP

Book Reviews MUSCLE & NERVE February 1999 293

Prognosis in Neurology
edited by J.M. Gilchrist, 473 pp., ill., Boston,
Butterworth-Heinemann, 1998, $85.00
Neurologists have become progressively more captivated
with treatment. New therapeutic options have been intro-
duced for diseases that were previously palliated at best, as
the field has turned its focus to developing new treatment
strategies and modalities. This shift has taken us away from
our previous major role as diagnosticians and prognosti-
cators.
James Gilchrist’s book, Prognosis in Neurology, reminds
us of the importance of the roots of our profession. Re-
viewing data from natural history and treatment studies,
the book provides a concise source for information on
prognosis of neurological diseases. It is broken up into 81
short chapters, each 3 to 9 pages long, focused on a spe-
cific disease or group of diseases. There are 94 contribut-
ing authors, many very well known and a few still in train-
ing. There are no major gaps in the book’s coverage,
though some disease areas, such as ischemic stroke, could
have been covered in greater detail. Chapter length is
quite variable, depending more on an author’s precision
of focus rather than available data or disease frequency.
Writing style is also variable but generally succinct and
cogent. Variability in the chapters seems unavoidable
given the large number and diverse backgrounds of con-
tributing authors, but careful editing and standardized
subheadings have helped to reduce it and provide cohe-
sion to the book as a whole.
294 Book Reviews
The book will clearly have utility as a quick reference
between patient visits when an issue of disease prognosis
arises. It also will be useful to the practitioner looking for
a brief readable review of the clinical presentation, natural
history, and prognosis of a disease. Even reading it from
cover to cover, as I did for this review, is rewarding. In this
way the importance and limitations of an understanding of
disease course become more apparent. Though the au-
thors generally have made wholehearted attempts to re-
view all the data, in many instances we are left with vague
predictors of disease outcome. This can be attributed in
part to the inherent unpredictability of disease processes
that involve many contributing factors, some of which are
completely unknown. However, some of this incomplete
knowledge is due to lack of adequate clinical investigation.
The book makes clear the vast opportunities for further
clinical studies of prognosis.
As pointed out by the editor in the preface, a better
understanding of prognosis facilitates evaluation of treat-
ments by providing a backdrop upon which therapeutic
effects can be assessed. In addition, understanding the
prognosis of a disease may comfort our patients even more
than our treatments. Therefore, it is important to have a
resource on prognosis in neurology, and Dr. Gilchrist’s
book provides such a resource in a comprehensive, con-
venient, and readable format.
S. Claiborne Johnston, MD, MPH
MUSCLE & NERVE February 1999