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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
J Neurol Neurosurg Psychiatry. 2007 August; 78(8): 912.
PMCID: PMC2117754

Neuromuscular disease. Evidence and analysis in clinical neurology

Reviewed by Carolyn Gabriel

Michael Benatar, New Jersey: Humana Press Inc, 2006, US$145.00, pp 462. ISBN 92-4-159392

This is a relevant, well written and fascinating book that will be of interest to general neurologists as well as those specialising in nerve and muscle. Michael Benatar attempts to emulate the style of a “Socratic dialogue” with a question–answer type format to analyse the complex literature surrounding neuromuscular disease. He frequently cites original studies and small series as well as systematic reviews, and is sceptical of claims made without evidence. It is well laid out, easy to read and with tables adjacent to relevant text. Of course, in any text that reviews current literature, this will with time become dated, but it is a good starting point.

Part 1 is generic, applying to any clinical study, discussing basic epidemiology and statistical analysis, treatment trials and the analysis of prognosis, with clear discussion of logistic regression and survival curves. The rest is in logical anatomical groups.

The usefulness of electromyography (EMG) in the diagnosis of amyotrophic lateral sclerosis, for instance, reminds us that abnormal paraspinal EMG is present in 19% of patients with other neurological disorders, and that EMG of the sternocleidomastoid has a higher sensitivity than that of the tongue, in practice probably performed less often. The evidence for benefit from use of non‐invasive positive pressure ventilation, percutaneous endoscopic gastrostomy or riluzole are perhaps less straightforward than many of us assume.

The discussion of chronic inflammatory demyelinating polyneuropathy (CIDP) highlights the eight papers with different electrodiagnostic criteria for this, often prepared for trials, but important to recognise. Fortunately, new criteria for defining CIDP are currently being designed from first principles. Perhaps the limits of available evidence become clear with the reported study that suggests that nerve biopsy may not improve diagnostic performance. In practice, supportive biopsy evidence may be invaluable for the uncertain physician actually starting the immunosuppression. The explosion of knowledge in the field of inherited neuropathies in recent years has left many neurologists confused, and this chapter provides a useful and detailed summary of the main findings in this ever changing world to date. There are extensive tables detailing symptoms, signs and EMG criteria in the main classes, although these mostly consist of heterogenous molecular groups, limiting their usefulness.

There is a useful chapter on carpal tunnel syndrome. Although neurologists may be surprised to hear that meta‐analysis showed that reporting nocturnal paraesthesia was not useful diagnostically, they probably will not be surprised that Tinel's and Phalen's tests were hopeless.

Dr Benatar clarifies that in the world of neuromuscular disease, the randomised controlled trial is often lacking, and treatments are frequently used on the basis of extensive uncontrolled literature. This should prove a useful reference book for any clinical neurologist, highlights areas needing further investigation for aspiring researchers and hopefully is the first in a series analysing the evidence in a range of subspecialties.


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