Fw: Diagnosis and Management of Peripheral Nerve Disorders

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Subject: Diagnosis and Management of Peripheral Nerve Disorders

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The challenge of peripheral neuropathies

Diagnosis and Management of Peripheral Nerve Disorders

Jerry R Mendell, T Kissel, R Cornblath. New York: Oxford University Press,

2001. Pp 720. $165.00. ISBN 0195133013.

Diagnosis and Management of Peripheral Nerve Disorders is the 59th volume in the Contemporary Neurology

Series of texts published by Oxford University Press. The three editors have written most of the chapters,

although there are 16 other authoritative contributors. What results is a fairly homogeneous treatment of

peripheral nerve disease. The book is easy to read and succinctly written, with plentiful tables and illustrations,

as well as case studies. Don't expect the exhaustive discussions found in larger texts on this topic, notably

Dyck's Peripheral Neuropathy (1992) but instead what the book offers is a very clinically oriented approach with

many quick reference features, such as summary tables of individual disorders, similarly formatted throughout the chapters.

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Part 1 of the text includes eight chapters on general aspects of the clinical approach to neuropathy. Included are chapters

on obtaining a history and examination, and biopsy of peripheral nerve and skin, with figures that depict the techniques and

beautiful photomicrographs of representative examples of histopathology. There are valuable chapters on autoantibody testing

and the general approach to painful peripheral neuropathies. Other chapters cover the neurophysiological assessment of neuropathy,

including quantitative sensory testing. Oddly, the chapter on autonomic testing is far more detailed and informative than the chapter

about nerve conduction studies and electromyography.

In part 2 there are 23 chapters devoted to specific disease entities. Among these, the "hot topics" in peripheral neurology are well

covered, including multifocal motor neuropathy, Guillain-Barré syndrome, and chronic inflammatory demyelinating polyneuropathy.

Our understanding of these disorders is evolving, and this text touches on the most recent developments in the specialty. However,

the discussion on Guillain-Barré syndrome fails to mention clinical masqueraders of that disorder. A chapter on vasculitic neuropathies

has a unique table that outlines the causes of multifocal neuropathy that mimic vasculitic neuropathy. I had hoped for more extensive

discussion of non-systemic vasculitic neuropathy, and a more disorder-specific approach to the treatment of this group of disorders

would have been helpful. The chapters on neuropathies associated with monoclonal gammopathies, porphyria, diabetes, and HIV are

very useful. A chapter on sarcoidosis includes a useful table on clinical findings and assessment that incorporates data from many

previous studies. The chapters on hereditary neuropathies are especially lucid, a subject notorious for obfuscation. Furthermore, these

chapters describe recent improvements in our understanding of the genetics underlying these disorders.

There were a few things I looked for but did not find. A more systematic approach to therapy and management of each disorder

would have been a useful thread linking all the chapters. A particularly valuable addition would have been the authors' personal

approaches to the management of patients who are difficult to treat--eg, those in whom first-line therapies have failed and those

with fulminant disease. The text does not discuss motor neuronopathies or disorders of the motor nerve terminal. I did not find a

discussion of radiculopathy or the differential diagnosis of polyradiculopathy.

Even with the synopsis-oriented format of the chapters, the authors succeed in providing current material, up-to-date advances

in pathophysiology, and voluminous references. As such, the book speaks to a wide audience, and should be a useful addition

to the libraries of neurologists in training, neurologists in practice, and any physician with special interest in neuromuscular diseases.

Kerry Levin