Archive for January, 2010

Therapy of Parkinson’s Disease

Therapy of Parkinson’s Disease

Edited by William C. Koller and George Paulson

New York, Marcel Dekker, Inc., 1990. 583 pp.

Therapy of Parkinson’s Disease represents volume five in a series written on neurologic disease and therapy. It focuses on the therapeutic approaches to Parkinson’s disease (the second in this series dealing with that disorder). In addition to treatment issues, other areas are covered, including clinical evaluation, imaging, pathophysiology, neurochemical systems, and behavioral aspects. A clear strength of this text is that it covers a range of very specific treatment approaches in depth, which in sum provide a broad review of the clinical and research aspects of Parkinson’s disease therapeutics.

The volume is divided into five parts, composed of chapters on specific topics. Part 1 is cfevoted to the assessment and measurement of symptoms and signs and provides a review of clinical assessment via rating scales, videotape analysis, measures of motor disability, neurochemical evaluations, and various neuroimaging techniques. Part 2, an extensive review of pharmacological interventions, addresses traditional agents, novel agents, various routes of administration, preventive therapy, and treatment of secondary disorders. Part 3 discusses surgical interventions such as stereotaxic thalamotomies and neurotransplantation. Part 4 is concerned with the dietary issues related to Parkinson’s disease treatment, and part 5 addresses the behavioral and psychiatric issues, along with physical therapy issues, in Parkinson’s disease.

As indicated, each chapter provides a condensed, in-depth account of a highly specific topic and cites numerous references. The reference list is both comprehensive and timely (through 1990) and provides a good base from which to search for further literature on a specific topic. Most chapters are succinct and well organized. Tables, graphs, photographs, diagrams, and photomicrographs are used extensively throughout the volume. The contributors to the text (numbering 69) represent the mainstream of basic and clinical research and practice in the area of Parkinson’s disease, from academic centers in the U.S. and abroad. Errors are present in the arrangement of some material (for example, a section on dopamine receptor blocking drugs describes both agonists and antagonists). The chapter on neuroimaging could be difficult to get through without knowledge of various imaging techniques. The chapter on the management of behavioral symptoms reviews depression, drug-induced psychosis, and cognitive impairment, but does not discuss other (less common) neuropsychiatric issues, such as non-iatrogenic psychosis, the therapy of which is a timely issue in the psychiatric literature.

Therapy of Parkinson’s Disease is an expensive book, and not appropriate for everyone. Those who are involved in the clinical or research aspects of Parkinson’s disease and the related neuroscience, or who have an interest in that area, will find this text a valuable resource.

Vision and the Brain

Vision and the Brain: Organization of the Central Nervous System

Edited by Bernard Cohen and Ivan Bodis-Wollner

New York, Raven Press, 1990. 364 pp.

While experimenting with retinal ganglion cells of cats in 1966, Enroth-Cugell and Robson made one of the major breakthroughs of the century in vision research. They showed that these cells, capable of firing action potentials, are organized in relation to simple receptive fields on the retina centralis. This work pioneered the ongoing effort to understand how light-induced signals are graded, distributed, and processed from the retina to the thalamus to the cortex (and within the cortex), making visual function possible. Vision and the Brain: Organization of the Central Nervous System, edited by Bernard Cohen and Ivan Bodis-Wollner, attempts to bring the reader up to date on the latest research in this fascinating and dynamic field.

Vision and the Brain is volume 67 in a series published by the Association for Research in Nervous and Mental Disease. The organization has been sponsoring a new volume about once a year since 1920. Vision and the Brain is the product of 37 authors, and contains 161 illustrations. It is drawn from the authors’ original works and compiled from eighteen papers, each complete with a set of references. The volume is supplemented with an extensive index.

Vision and the Brain reads more like a textbook than a collection of many authors’ writings. In general, each chapter provides a clear and concise overview of the topic under consideration that the non-expert can easily understand and appreciate. This overview is followed by descriptions of potential domains of research as well as a summary of the authors’ pioneering work in the field. The book begins with a thorough examination of the functional and pharmacological organization of retinal cells. Here, much attention is given to the horizontal cell and the role of dopamine as a modulator of lateral inhibition — a phenomenon that aids in the visual recognition of edges. Next, the authors discuss the different transmitters mediating systems within the lateral geniculate nucleus, thus summarizing the pre-cortical processing of visual input.

Most of the book is dedicated to describing the complex interpretation of images at the level of the cortex. A summary of the encoding of objects in their shapes, color, movement, and depth is provided in an enjoyable chapter which explains some of the rationale behind optical illusions. This material is followed by a detailed analysis of neural velocity field computation, recognition of facial expression, motion processing, and the coordination of eye movement. An interesting discussion of the use of positron emission tomography to help map visual cortex functioning is also included.

For the neurology student, this book can be an amusing and up-to-date summary of visual processing systems. For the clinician, it also sheds light on the visual disturbances associated with such conditions as Parkinson’s disease, Altzheimer’s disease, and multiple sclerosis. For the vision researcher, it serves as a convenient collection of some of the field’s pioneering work. In any case, it comes with a hefty price tag.

Neurologic Emergencies

Neurologic Emergencies. Recognition and Management. 2nd Edition

Edited by Michael Salcman

New York, Raven Press, 1990. 442 pp.

The second edition of Salcman’s Neurologic Emergencies. Recognition and Management is an excellent resource manual for non-specialists responsible for early management of neurologic emergencies. Its chapters are brief and consistently pertinent in guiding the evaluation and initial treatment of neurologic presentations ranging from headache and backache through major trauma and stroke.

The book is divided into five sections. The first chapter in section one, on “general considerations,” reviews the pathophysiology common to cerebral infarction, hemorrhage, and trauma. The second chapter provides a clear exposition on the approach to the unconscious patient — always a demanding diagnostic challenge; this chapter also sets the standard for most of the following chapters by including a simple and very valuable algorithm illustrating a logical approach to the presenting problem. Section one concludes with a chapter on cardio-respiratory management in neurologic emergencies.

Section two on stroke and tumor contains useful chapters on subarachnoid hemorrhage (including a differential diagnosis of headache), stroke, and neoplastic emergencies.

Neurologic trauma is reviewed in section three. The first chapter, head injury, provides an algorithm for evaluation and treatment, summarizes medical problems often associated with major head injury, and reproduces the University of Maryland neuroassessment flow sheet as a model for documenting the ongoing status and care of injured patients. The chapter on spine injury and acute paralysis is a brief, logical, and readable summary on evaluation and treatment. A half-page presentation on reading plain spine X-rays is in itself worth the price of the book. The chapter also contains useful algorithms on compressive traumatic lesions, disruptive lesions, pyogenic lesions, and vascular occlusive lesions. The chapter on acute nerve root compression and backache describes these common syndromes in a clear manner and also defines the circumstances under which emergency consultation is mandatory. Careful attention to this subject will save many patients — and doctors. The section on trauma concludes with evaluation of peripheral nerve injury.

There are six chapters in the section on medical neuro-emergencies: seizures, polyneuropathy, respiratory muscle failure, encephalitis, meningitis, and toxic-metabolic encephalopathy. All are concise and logical in presentation. The chapter on toxic-metabolic encephalopathy, including an excellent algorithm, provides in a mere 35 pages information sufficient to diagnose and treat the majority of presentations of altered mental status.

Salcman’s book concludes with a two-chapter section on pediatric neurologic and neurosurgical emergencies. Both chapters review the similarities and differences in early management of pediatric and adult patients; both provide a useful, albeit very brief, review of these fields.

Clearly, this is a book to be enthusiastic about, and I recommend it highly to all who deal with neuro-emergencies. One pet peeve about terminology, however: if my profession is to be named by the location of where I work, i.e., “emergency room doctor,” then Dr. Salcman is an “operating room doctor.” Furthermore, if the suite of rooms in which emergency care is practiced is an “emergency room,” then why not “critical care room” or “intensive care room”? I am disappointed to see these obsolete terms perpetuated in such an outstanding book.

Essentials of Clinical Neurology

Essentials of Clinical Neurology

Carl H. Gunderson

New York, Raven Press, 1990. 550 pp.

Essentials of Clinical Neurology is an intermediate-sized tome on neurological diagnosis and treatment. From the start, the author states that his goal is not to follow the examples of other “encyclopedic” volumes such as Merritt or Adams and Victor, but rather to provide a distilled body of facts.

The book is organized into four parts. Part one, “Introduction to Neurological Evaluation,” provides brief introductions to the currently available neurodiagnostic modalities, including the electroencephalogram (EEG), electromyogram (EMG), computerized axial tomogram (CAT), and magnetic resonance imaging (MRI). As is true of the remainder of the book, this part is well organized and quite easy to follow. In general, the reproductions of MRI and CT scans are of good quality. Part two, “Analysis of Common Neurological Complaints,” contains chapters on movement disorders, sensory disorders, neurology of vision, headache, dementia, and aphasia. Each chapter initially provides a review of the basic neuroanatomy and neurophysiology; these reviews are particularly well done in the chapters on movement disorders and the neurology of vision. Much of the emphasis is on diagnosis, and each chapter provides pertinent aspects of patient history, the neurological exam as well as a condensed differential diagnosis. Parts three and four discuss differential diagnoses and selected neurological diseases.

A strength of this book is its organization. First, it is written in outline format. In addition, the basic terminology is not assumed, and all terms (e.g., hypotonia, akathisia) are well defined; however, I did not really find the distinction between the major subheadings (parts two through four) to be very helpful. Another criticism is that certain areas, such as child neurology, are entirely lacking, although the author does mention this as a shortcoming in the introduction.

Despite these criticisms, this work is an exceptionally well-assembled volume. What distinguishes it from others is the author’s gift of distilling information. He intentionally avoids the encyclopedic approach, while, at the same time, avoiding the pitfalls of many of the smaller manuals which provide choppy, partially digested bits of information. The choice of facts leaves the reader with a true gestalt of neurological disease. The emphasis on basic physiology, diagnosis, and treatment makes the book particularly appropriate for neurology residents.

Neurochemical Pharmacology

Neurochemical Pharmacology — A Tribute to B.B. Brodie. Fidia Research Foundation Symposium Series. Volume 2

Edited by E. Costa

New York, Raven Press, 1989. 369 pp.

This book represents the proceedings of a Symposium held in April 1988 to honor Dr. Bernard Brodie, who died in February 1989 while the book was in press. The book consists of a series of articles in neuropharmacology by many of the world’s leading experts in the field and is a fitting tribute to Dr. Brodie and his remarkable career.

Dr. Brodie was for many years director of the Laboratory of Chemical Pharmacology at the National Heart Institute. Under his direction, the laboratory played an important role in establishing a new approach to pharmacology, termed by the editor of this book “Neurochemical Pharmacology.” This approach, elaborated in the 1950—60s, was based on the view that it would ultimately be possible to understand all of the brain’s functions, including mental functions, on the basis of the underlying biochemistry of the brain. The approach had an enormous influence on the biomedical sciences and provided the basis for a generation or two of research in biological psychiatry. An impressive number of investigators trained in the Brodie laboratory during this time, among whom were Julius Axelfrod, Jack Cooper, Erminio Costa, and Solomon Snyder. In fact, the extraordinary productivity of Dr. Brodie’s laboratory and its disciples was the subject of a recent book, Apprentice to Genius by Robert Kanigel.

The current volume is divided into four sections entitled: “Transmitters,” “Transmitter Function,” “Receptor Modulation,” and “Signal Transduction.” The following articles are particularly noteworthy: Arvid Carlsson presents a challenging overview of the role played by brain dopamine systems in motor and mental functions. Tomas Hokfelt and others offer a comprehensive and helpful review of the localization of peptide neurotransmitters in monoaminergic and cholinergic neurons. Of note in the second section are reviews of the role of monoaminergic systems in satiety (by S. Garattini and others) and stress (by Roger Maickel). An article by S. Roy and others in the third section describes attempts partially to purify opiate receptors and prepare monoclonal antibodies to the receptor. K. Fuxe and colleagues describe “receptor/ receptor interactions,” the critical idea that neurotransmitter systems interact with one another, making it likely that psychotropic drugs influence brain function through effects on multiple types of neurotransmitter and receptor systems. Goran Sedvall and others describe their experience in the use of positron emission tomography to image neurotransmitter receptors in living human subjects. In the fourth section. Fridolin Sulser and Elaine Sanders-Bush offer a very thoughtful and up-to-date analysis of the probable mechanisms involved in the clinical actions of antidepressant treatments and experimental approaches. Erminio Costa presents some of the data obtained over the years, much from his own laboratory, underscoring the importance of the role played by the regulation of gene expression in adaptive changes in brain function.

As would be expected, the quality and focus of the articles in this book are variable. Despite the considerable delay in publication of this volume, most of the articles remain up to date. The book would be useful to individuals in the field for its reviews and to individuals only peripherally associated with the field as a more general overview of current research in neuropharmacology.

Novel Antipsychotic Drugs

Novel Antipsychotic Drugs

Edited by Herbert Y. Meltzer

New York, Raven Press, 1992. 267 pp.

The field of schizophrenia research is rapidly changing. The advent of clozapine has led to the exploration of new pharmacotherapeutic strategies based on mechanisms other than dopamine-2 receptor blockade, the hallmark of typical neuroleptic treatment. As a result, investigators have explored many new approaches to antipsychotic treatment based on dopamine-1 receptor blockade, serotonin-2 receptor antagonism, serotonin-3 receptor blockade, enhancement of excitatory amino acid neurotransmission, and other novel approaches. As a result, people working within the field of schizophrenia and family members of individuals afflicted with schizophrenia frequently seek reference material that provides a snapshot progress report of novel pharmacotherapeutic approaches to schizophrenia. Novel Antipsychotic Drugs, edited by Herbert Meltzer, a leader in the psychopharmacology of schizophrenia, fulfills at least a part of this need by providing very brief introductions to treatment strategies based on a spectrum of neurobiological mechanisms.

Some of the 23 chapters in this book represent work in progress, bearing the strengths and weaknesses of this type of communication. Clinical investigators are hungry for information about drugs such as risperidone, amperozide, odansetron, remoxipride, and raclopride. This volume provides brief informative updates, but no definitive findings, regarding the use of these agents in treating schizophrenic patients. Chapters by investigators such as John Waddington, Philip Seeman, Carol Tamminga, and their colleagues manage to bridge approaches to the pathophysiol-ogy of schizophrenia and novel pharmacotherapeutic findings in short but informative chapters. Some of this material is unavailable in any other published source. An otherwise interesting chapter by John Olney, a leader in the field of excitatory amino acid neurotoxicity, draws parallels between neurotoxic and psychotomimetic effects of NMDA antagonists too closely. Olney suggests that anticholinergic agents would be antipsychotic, based on his data indicating that they protect against PCP-induced toxicity in the cingulate cortex. He ignores pre-clinical behavioral data and clinical studies suggesting that anticholinergic agents exacerbate and cholinergic agents alleviate the behavioral effects of PCP.

The key to this book is its timeliness. Priced at $90.00, this slim volume is unlikely to find its way into the personal library of many clinicians. At this price, this book would need to contain classic papers to be useful in the long run. Its snapshot reviews and introductions are likely to be out of date in a few years. Important contributions to the field of schizophrenia that emerge from its preliminary research presentations will eventually appear in the peer-reviewed literature. Advances that are blind alleys ultimately will be forgotten. In the long run, volumes such as these often gather dust on the back shelves of medical school libraries. During a critical period of time, however, there is an urgent need for the information contained in this book. I, and others interested in getting the latest update of a rapidly changing field, might do well to push our local libraries to obtain this handy and informative volume.

Comprehensive Neurology

Comprehensive Neurology

Edited by Roger N. Rosenberg

New York, Raven Press, 1991.920 pp.

Comprehensive Neurology proposes to review “all aspects of neurologic disease,” providing yet another addition to the ever-growing list of neurology references. Its editor, R.N. Rosenberg, claims substantial experience in neurology editorship with The Treatment of Neurological Diseases (1979), Neurology (1980), and the five-volume Clinical Neurosciences (1983); more recently, he has produced shorter studies, including Neurogenetics: Principles and Practice (1985) and Molecular Biology of Neurological Disease (1988). In contrast to other textbooks like Asbury, Mckhann, and McDonald’s Diseases of the Nervous System, which contain two cumbersome volumes of material, Rosenberg hopes with the present volume to produce a comprehensive neurological reference in a single volume, while providing a “detailed, scholarly account” of neurological diseases, synthesizing the basic and clinical neural sciences for clinicians and interested researchers.

Unfortunately, Rosenberg only partially accomplishes his goal, instead producing a book that conveys a fragmented view of neurology. Compared to other comprehensive textbooks, like Asbury et al.’s Diseases of the Nervous System, or even smaller works much as Rowland’s Merritt’s Textbook of Neurology, Rosenberg’s haphazard contribution simply pales. Comprehensive Neurology attempts to touch upon every aspect of neurological disease with chapters by various specialists, on topics from teratology to psychiatric disorders to coma; but the book fails to tackle an in-depth discussion of neurology. Indeed, most chapters do not consider all aspects of their respective topics, and the accounts tend to be either all-encompassing but superficial or else informative but specialized. For example, such chapters as “Diseases of the Autonomic Nervous System” or “Cerebellar Disorders” provide only brief descriptions of clinical phenomena, while “Headache Syndromes” and “The Comatose Patient” provide informative detail on pathogenesis, clinical presentation, and treatment, albeit limited to their specialized disease. The book treats more general topics rather lightly, though it offers excellent timely information on particular specialized subjects. The result is, by avoiding a thorough coverage of basic neurological concepts and disorders, its utility as a reference diminishes.

Comprehensive Neurology further suffers from a lack of focus or direction in editorship. The table of contents itself reflects a dense conglomeration of chapters without any obvious logical sequence. Many chapters overlap in coverage of several topics, including such conceptual issues as the principles of magnetic resonance imaging and computerized tomography, or such background issues as the neuroanatomy of the vestibular or ocular systems. As the most obvious example, even though Rosenberg generally devotes, at most, one chapter to individual sensory systems, the eighth nerve system alone receives two chapters of coverage, and the majority of their content reiterates information found in other chapters. Moreover, despite Rosenberg’s expressed desire to coordinate basic science with clinical disease and treatment, chapter formats vary tremendously, with some chapters presenting mostly background information, like G. Rosenberg and Wolfson’s chapter on brain fluid and electrolyte disorders, while other chapters present only clinical information, for example, Damasio and Tranel’s chapter on disorders of higher brain function. Some chapters even stray from their title topics: Hecox and Hogan’s chapter, “Diagnostic Principles in Neuro-otology,” for instance, scarcely even addresses diagnostics and instead focuses on neuroanatomy and physiology, while Richter and Corder’s “Neurotoxic Syndromes” chapter concentrates mostly on substance abuse, virtually skipping the role of biological toxins or metabolic toxicities. On the other hand, such chapters as Kase et al.’s on cardiovascular disease, Chad and Munsat’s on muscular disease, and Wray’s on neuro-ophthalmologic disorders clearly and concisely provide thorough, up-to-date information about their respective fields. Laudably, these chapters provide informative, thoughtful presentations. In my view, this volume contains a great diversity of writing quality and content, reflecting an editorship that allows the book’s contributors overmuch free rein to digress. The end product strays too far from the claim “comprehensive neurology.”

In light of other alternative neurology references, a clinician or any interested scientist might therefore find little of interest in Rosenberg’s Comprehensive Neurology, other than some specialized topics such as multiple sclerosis, metabolic encephalopathy, and the aforementioned cardiovascular, muscular, and ophthalmologic diseases. The book’s chapters generally offer unsatisfying whirlwind tours of neurological disorders, never providing a unique or novel presentation of the material. Other contemporary works provide identical information, presented in a more pragmatic, informative, and concise manner, such as Swash and Oxbury’s Clinical Neurology (1991) or, particularly, Asbury et al.’s thoughtfully organized and edited Diseases of the Nervous System (1992). Rosenberg’s present work fails to satisfy the requirements for a comprehensive neurological work in one volume because it rambles through neurological discourses. The editor and his contributors have unfortunately and disappointingly produced a weak overall contribution to the neurological library.

Stress: Neurobiology and Neuroendocrinology

Stress: Neurobiology and Neuroendocrinology

Edited by Marvin R. Brown, George F. Koob, and Catherine Rivier

New York, Marcel Dekker, Inc., 1991. 703 pp.

Stress: Neurobiology and Neuroendocrinology is an ambitious attempt to review the latest work in stress research to, state the editors, stimulate “… the development of innovative methods … for further studies in stress biology.” The work presents a great deal of data on stress biology, endocrinology, and physiology, and is for the most part a well-written and fully referenced contribution to the field of stress research.

The book, a collection of 29 reviews by biomedical faculty at American institutions, is organized into four main sections: (1) a general overview regarding issues defining and measuring stress; (2) basic central nervous system (CNS) and endocrine biology during stress; (3) discussions of pathophysiology resulting from stress, such as ischemia, gastric ulcers, immune dysfunctions, and psychiatric disorders; and (4) stress management strategies with explanations of how they may work.

Section three, which concerns itself with stress pathophysiology, is perhaps the book’s strongest section. Here the authors effectively demonstrate links between stressful events and eventual disease processes and provide critical reviews of their fields. For example, Chapter 3 tackles the role of mental stress in causing myocardial ischemia. The authors persuasively argue for ischemia as the best measurement of cardiac pathology vis-a-vis stress, and reproduce studies of ischemia during mental stress over an array of diagnostic modalities (technetium, echocardiography, PET). They further proceed to explain the possible endothelial pathophysiology in response to acetylcholine, resulting in coronary vasoconstriction and subsequent ischemia. In their summary, the authors lucidly delineate avenues of further research.

Chapter 27 reviews stress-induced immune dysfunction in humans. In this chapter, the author ably points out the gap in current research: although studies exist which show an association between psychological stress and immune changes, and psychological stress and disease, there exists a dearth of studies to demonstrate a clear association among all three. He questions the current assumption of the role of endogenous cortisol in immunosuppression by showing studies in which elevated cortisol during stressful events did not always result in depressed natural killer cell activity. Laudably, the author does not leave the reader to wonder about other mechanisms of immune suppression and presents studies which demonstrate that the autonomic nervous system may be ultimately responsible.

The book’s major missed opportunity is a cohesive chapter which connects the disparate discussions of neurobiology and pathophysiology. Chapter 2, the closest stab at this goal, is clearly written, yet digresses into dozens of areas. Instead, a lucid summary of the basic science chapters which follow, demonstrating stress as an insult to the CNS and the endocrine system, which filters down to other organ systems, would have been highly valuable. Aside from suggestive studies, however, this chapter does not include sufficient evidence to support such a theory. Chapter 29 on “Stress Technology Medicine,” another chapter which could demonstrate how various systems interact with one another, spends much of its force explaining the theory of autonomic rhythms and laterality (supported by a collection of one-subject experiments). It leaves the reader disappointed, stating that “the credibility of these sophisticated tools” (fascinating yogi relaxation techniques combining breathing and body position) “comes best through their application” without showing any studies demonstrating stress-reducing effects of these relaxation techniques.

In summary, this book is, for the most part, a well-organized contribution to the field of stress research in its cataloging of the latest findings in one accessible work. Unarguably, much of this information is not easily obtained in the standard medical and scientific texts. This volume can be especially helpful to investigators, working with one particular area of stress biology and physiology, who wish to obtain rapid knowledge of other related fields. It may also be of use to physicians and to health personnel who have a strong desire to grasp the complex science underlying stress and its influence on disease. In many ways, such a work may represent one praiseworthy attempt to gather together the current knowledge of mind’s effects and relate it to disparate organ dysfunctions. Yet it is perhaps too much to ask this work to make durable connections between the different research areas and to allow the reader “a look beyond the trees.” More to the point, that flaw may be a reflection on this still unmapped and intertwined field of neurobiology and pathophysiology, and further editions on the subject will no doubt strive to achieve just such a goal.

Stress, the Aging Brain, and the Mechanisms of Neuron Death

Stress, the Aging Brain, and the Mechanisms of Neuron Death

Robert M. Sapolsky

Cambridge, M., The MIT Press, 1992.429 pp

Does stress kill brain cells, and if so, how? In Stress, The Aging Brain, and Mechanisms of Neuronal Death, Dr. Robert Sapolsky presents data supporting the disturbing notion that psychological stresses may be associated with chemical processes in the brain that subject neurons to toxic processes. Dr. Sapolsky’s research, which has taken him from the African veldt to the neurobiology laboratory, provides a framework to orient readers to this interesting review.

In a well-crafted presentation, Dr. Sapolsky integrates his highly original research with related topics of great interest to neuroscientists, neurologists and psychiatrists. He takes care to review hot issues, such as the impact of glucocorticoids on brain function, the role of N-methyl-D-aspartate (NMDA) receptors in learning and neurotoxicity, and the function of nitric oxide as a mediator of NMDA receptor function. In a particularly creative step, Dr. Sapolsky bridges the traditional neuropharmacologic focus on neuro-modulation and the study of energy regulation within neurons during neuromodulation. He presents evidence to support the hypothesis that elevated glucocorticoid levels associated with stress deplete neuronal energy, making them less capable of fending off the toxic effects of inotropic excitatory amino acid receptor stimulation and its associated increase in calcium influx.

As the product of four years of work and “everything (he) knows as of January 10, 1992,” this book contains a prodigious amount of information presented in a thoughtful and user-friendly fashion. It is evident that Dr. Sapolsky has considered challenges facing the reader. Each chapter begins with a review of the book to that point and finishes with a summary of concepts presented within the chapter. These efforts make the text more accessible and enhance its utility as a reference source. In a scientific world dominated by least publishable units and multi-authored texts, Dr. Sapolsky succeeds in developing his views on stress and neurotoxicity in depth with an informal and somewhat socratic style. This stylistic approach makes the large body of information presented more engaging to the reader.

Dr. Sapolsky acknowledges the limitations of his book, occasionally, as they appear in the text. He reviews rapidly evolving fields of research. As a result, significant developments have already occurred in some areas of study reviewed in this book. Also, clinical perspectives on the type of stresses that push neurons “to the brink” could be developed further. The notion that routine social stresses might increase neuronal loss during a seizure is less formidable than the hypothesis that these stresses are neurotoxic in the absence of a medical crisis. One might also have appreciated a more thorough discussion of psychological trauma and its aftermath.

Overall, this is a very good book for researchers in many areas of clinical and basic neurosciences. It serves as a good entry point for researchers and clinicians interested in the areas of stress, neuroactive corticosteroids, excitatory amino acids, and neurotoxicity. Researchers well-versed in these areas may benefit from Dr. Sapolsky’s novel evaluations of a broad range of data and the numerous and intriguing hypotheses presented.

The Dementias: Crossroads between Neurology and Psychiatry

The Dementias: Crossroads between Neurology and Psychiatry

M. Girgis and K. Harris

St. Louis, Warren H. Green, Inc., 1992, 187 pp.

“The average human life expectancy has increased markedly since the turn of this century … unmasking a new epidemic: dementia.” This epidemic, dementia, is the focus of the book The Dementias: Crossroads between Neurology and Psychiatry, by Girgis and Harris, both of the University of Sydney, Australia. This book provides a fairly technical look at the role of neurotransmitters in degenerative neurologic disease. Glutamate is one major focus. The authors discuss extensively its chemical structure, synthesis, metabolism, and its many known and theorized pathways in the brain, arguing for a role of glutamate in dementia. The authors include data from their own current research, and extensively reference the work of others in the field. In addition they continually suggest new directions for research.

Additional chapters are devoted to such topics as “Neurotoxic Amino Acids in Human Degenerative Disorders” and there is a chapter providing an excellent overview of research in “Neurotransmitter Imbalance in Psychiatric Disorders”. This chapter relates the neurotransmitters discussed previously in reference to dementia to their theorized roles in depression, and in the action of antidepressant medications. The final chapter moves away from discussion of glutamate and deals with another neurotransmitter, acetylcholine, and studies of its role in Alzheimer’s disease.

The middle section of the book contains three chapters which deal with neurotransmitters in limbic epilepsy. As the authors explain in the preface, their own research focus is mediation of excitation in brain tissue in relation to limbic epilepsy. It was neurotransmitters in limbic epilepsy they were studying when data suggested to them a connection between these neurotransmitters and dementia. This specific research interest seems to be the only link between the information presented in the three chapters on limbic epilepsy and the rest of the book. These chapters do, however, present at thorough and up to date discussion of kindling in limbic epilepsy.

In summary, The Dementias: Crossroads between Neurology and Psychiatry presents a good technical discussion of research on the role of neurotransmitters, and especially glutamate, in human degenerative disorders. Although some background information is given, some prior knowledge of biochemistry and neurophysiology is helpful in understanding this text.