Practical Neurology

Book review by Jeff Cochius, Ekkehart Staufenberg and Mary NicholsFrom ACNR, Advances in Clinical Neuroscience and RehabilitationPublished 5 Jan 2019Jose Biller’s 63 chapters multi-author Practical Neurology 5th Edition paperback, separate eBook, and on-line videos provides a didactic two part overview of neurological disorders, using both overview and more in-depth information.In Section 1, concerning Diagnosis, Chapters 1-39 are all entitled: ‘Approach to the Patient with…..’. Taking a patient’s key presenting neurological problem allows the clinician to access topics which include acute confusional state, neurocognitive disorders, headache, seizures, dizziness and vertigo, muscle weakness, movement disorders, functional disorders, neuroimaging, paediatric neurology (chapters 37 & 38), and sleep disorders. Pictures and plates illustrate specific findings, and cross-reference to the e-Book and video library. However, individual chapters’ content lacks a similarly harmonising editorial structure and this reduces the book’s user-friendliness. Knowing where on the page to direct one’s gaze can be very helpful for primary care practitioners, referring to a text while consulting. The same probably applies to specialist clinicians wishing to find detail in an area of practice they rarely encounter, though they may be less likely to have access to their library while consulting, and may also be less willing to dip into their books at the time! The quality of the information available in Practical Neurology is generally high but rigour is impaired in places by lack of reference to published international consensus documents. For instance, the International League Against Epilepsy’s (ILAE; April 2017) diagnostic guidelines for seizures and epilepsies, now part of ICD11 (draft, WHO 2018), was published well before this volume. This is an omission which, perhaps, might have been avoided, especially as the compendium is not likely to be revised again for several years.The volume’s second section, concerning treatment, has twenty-four chapters with a new set of authors from the first section. The topics here are mainly pathophysiological but sometimes refer to the anatomical site of disease or to a patient group. Headings include vascular/haemodynamic-, movement-, children’s and adult epilepsies (two separate chapters), pain (two separate chapters), AIDS related -, central-, peripheral- as well as metabolic neurological disorders. There is overlap with Section 1, which is probably inevitable. Conversely, there was under emphasis of concerns about certain prescription medicines, such as opioids.Practical Neurology is not intended to replace more comprehensive reference texts for Neurology. The didactic ‘presenting complaints’ approach remains too inclusive to permit easy access to its wealth of information. For most general practitioners, the detail is too much for everyday use, although practitioners with a special interest in Neurology or an area of Neurology will find certain chapters very useful. Neurologists working mostly in a subspecialist field may find the book useful when encountering another sub-speciality. Non-Neurologists required sometimes to make decisions in neurological differential diagnosis might also benefit, and improve their effectiveness in collaborating with Neurology.This valuable text certainly deserves to appear as a further, 6th, edition. We suggest that such a work would benefit from somewhat more diligent adherence to recent international consensus on diagnostic terminology. Furthermore, adding to the 63 chapters to rectify the current paucity of Behavioural Neurology and (co-morbid) neuropsychiatric coverage, would do full justice to a readership of the 2020s.