The field of neurology is being transformed, from a therapeutically nihilistic discipline with few effective treatments, to a therapeutic specialty which offers new, effective treatments for disorders of the brain and spinal cord. This remarkable transformation has bridged neuroscience, molecular medicine, and clinical investigation, and represents a major triumph for biomedical research. This book, which contains chapters by more than 29 internationally recognized authorities who have made major contributions to neurotherapeutics, tells the stories of how new treatments for disabling disorders of the nervous system, such as stroke, multiple sclerosis, Parkinson's disease, and migraine, were developed, and explores evolving themes and technologies that offer hope for even more effective treatments and ultimately cures for currently untreatable disorders of the brain and spinal cord.
The first part of this book reviews the development of new therapies in neurology, from their inception in terms of basic science to their introduction into the clinical world. It also explores evolving themes and new technologies. This book will be of interest to everyone - clinicians and basic scientists alike - interested in diseases of the brain and spinal cord, and in the quest for new treatments for these disorders.
* Presents the evolution of the field of neurology into a therapeutic discipline
* Discusses lessons learned from past successes and applications to ongoing work
* Explores the future of this field
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A unique collection of stories relating how therapeutics were developed and are currently being developed for patients with neurological disorders.From The New England Journal of Medicine:
Stephen Waxman is the epitome of a molecular scientist who heads a clinical department. His research interests focus on membrane channels in health and disease, especially in spinal cord injury and multiple sclerosis. Waxman deplores the bad old days (i.e., as recently as the 1950s), when the inimitable Labe Scheinberg said the best we could do for multiple sclerosis was "diagnose and adios." Richard Masland, a former director of the National Institute of Neurological Disorders and Stroke, said something like "for all the good we do for multiple sclerosis, neurologists could be replaced by sympathetic nuns." (Figure) That world is thankfully gone. Imaging has improved diagnosis immeasurably. New drugs and biologic agents are available for Parkinson's disease, multiple sclerosis, migraine, viral infections, and even Alzheimer's disease. For autoimmune peripheral neuropathies, myasthenia, and myopathies, new immunosuppressive drugs, plasma exchange, and intravenous immune globulins enhance treatment. Botulinum toxin has taken on a life of its own -- in the treatment of disorders ranging from dystonic torticollis and spasticity to facial wrinkles. Endovascular catheters can be snaked into the far reaches of the brain to bust clots and occlude aneurysms. Neurosurgery has advanced to minimally invasive procedures for almost anything, including epilepsy and Parkinson's disease. Molecular genetics has elucidated the inherited diseases, and gene therapy is coming. Molecular biology has guided the development of new drugs for specific disorders. Stem cells have captured the imagination of clinicians and patients. The art of therapeutic trials has matured. Waxman had a good idea. If he could assemble experts to write about these advances, it might be possible to explain how they came about and how we might learn from the experience to plan research for coming decades. He did just that; chapters in this book cover all the neurologic advances listed above and, conforming to another current theme, include both depression and anxiety, because neurologic and psychiatric research methods overlap. Looking to the future are chapters on genomics and proteomics, neuroprotection, gene therapy, channelopathies, stem cells, and functional imaging. All of that is to the good, but there are limitations. Many chapters are such thorough reviews that they seem to be addressed to peers, not to general neurologists and certainly not to practitioners in other fields. Waxman does not identify his intended audience, and it is not likely that anyone will read this textbook from cover to cover. A minor problem is technical. Illustrations are profuse but appear only in black and white. Colored figures appear in an inconveniently separate fascicle at the end of the book. There are other considerations. The great therapeutic revolution was not restricted to neurology; all of medicine has advanced. And neurology is still faced with the giant challenges of age-related neurodegenerative diseases, which means that more than 4 million people now have Alzheimer-type or other dementia, and more than 1 million have been diagnosed with parkinsonism or with the less common but horrific amyotrophic lateral sclerosis. We can celebrate when we make real progress against these conditions. Genetic and developmental diseases and epilepsy are still targets for prevention or control. Stroke is still a leading cause of death, but even the formidable intracerebral hemorrhage may now be treatable. We know that progress is coming, even if we cannot plan for it. What we need most is a continued federal commitment to support the National Institutes of Health so that medical research is a reasonable career. Molecular research and clinical investigation are wondrous. Young investigators are the readers who will most appreciate this book; they will keep the advances coming if there is tangible encouragement. Lewis P. Rowland, M.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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