Posts Tagged ‘neuropsychiatric disorders’

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.

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.

Handbook of Behavioral State Control

Handbook of Behavioral State Control: Cellular and Molecular Mechanisms

Lydic R, Baghdoyan HA, editors

Boca Raton (FL): CRC Press LLC; 1999. 700 pp. with index

ISBN 0-8493-3151-X (hard cover)

Although one may argue that any change in neuronal activity may ultimately lead to behavioural alterations, a closer relation between single cell function and behavioural consequences is needed. This relation is complex, and there are numerous and inter-related regulatory levels between cellular/molecular processes and behavioural outcome. It is therefore not surprising that there is a remarkable lack of exhaustive textbooks that explain cellular mechanisms underlying behavioural activity more globally. This book, edited by Lydic and Boghdoyan, both from Pennsylvania State University, partially fills this gap. It is a carefully planned handbook divided into 38 chapters organized in 8 sections, and written by 95 authors. The book’s major goal is to provide updated material on the cellular and molecular mechanisms generating diverse behavioural states. The authors do not explain cellular mechanisms of particular behaviours but rather provide information about the neural processes that regulate behavioural states, such as sleep, wakefulness, consciousness, arousal, etc. Different behavioural states, in turn, determine a subset of possible behavioural outcomes. The dominating theme of the book is sleep, wakefulness, arousal, and vigilance; this theme is compatible with the research interest and experience of the editors in the neurobiology of sleep mechanisms.

The handbook represents a working reference for numerous topics relating to physiological, psychological and pathophysiological states, including information on epidemiology, diagnosis, and treatment of common state disorders. The chapters in the first section discuss mammalian circadian rhythms, structure and function of the suprachiasmatic nuclei, melatonin rhythm-generation systems, and genetic circadian clock mechanisms. The subsequent chapters of the second section describe daily alterations in the arousal state, REM sleep dreaming, NREM sleep mentation, and neurological disorders of sleep. Section 3 deals with the anatomical substrate, neurochemical coding, and functional organization of components of the ascending reticular activating system, which includes ascending cholinergic, monoaminergic, and glutamatergic pathways. Particular attention is paid to the mesopontine cholinergic system and its role in REM sleep, wakefulness and cortical activation, and the noradrenergic and serotonergic pathways and their role in sleep, wakefulness, regulation of motor output and sensory information processing. The same systems are further discussed in more detail in the next section. Successive chapters deal with intrinsic membrane properties, synaptic activity, membrane current characteristics and excitability of cholinergic, noradrenergic, and serotonergic neurons. Particular attention is focused on the state-dependent cellular oscillations in the corticothalamic system and on the rhythmic oscillations in the hippocampal formation.

Mechanisms of behavioural state control may be altered by centrally active drugs. Several chapters in the section entitled “Molecules modulating mental state” discuss this issue. Neuronal and neurochemical mediation of addictive behaviour, and alterations in behavioural state caused by benzodiazepines, barbiturates, ethanol, caffeine, nicotine, marijuana, and serotonin antagonists are discussed.

The following 2 sections of the handbook review the current knowledge regarding state-dependent processing in somatosensory pathways and the role of the rostral ventromedial medulla in regulating ascending sensory transmission. Several chapters of the last 2 sections of the handbook deal with pathophysiological states. There is a particular emphasis on pain sensation, anesthesia, pharmacological and surgical treatment of pain, and immunological alterations in the arousal state. The topics cover cytokines in sleep regulation, immune effects on neurotransmission, and finally, body temperature, fever and microbial modulations of arousal.

Although the textbook covers vast areas of behavioural neuroscience, there are several important areas that are not represented. Results of the vast research concerning emotional states, such as anxiety or fear, and relevant regulatory functions of the limbic structures are not included. Also, psychopathological states of panic, depression, or euphoria are not described, except in parts of one chapter about addictive behaviour and neural mechanisms of reward. This topical selection was probably necessary to keep the textbook at the manageable size.

The textbook is well illustrated and contains overall 3500 references, more than 90 references per chapter. The book may serve as an excellent resource for advanced undergraduate and graduate students, postdoctoral fellows and biomedical researchers working with animal models of neurological and neuropsychiatric disorders. It will also be highly useful for medical residents, lecturers in neuroscience courses, and other professionals interested in problems of behavioural neuroscience and general neural principles governing animal and human behaviour.