Book Reviews Multiple Sclerosis Therapeutics edited by Richard A. Rudick and Donald E. Goodkin, 592 pp., ill., London, UK, Martin Duntz, 1999, $79.95 No aspect of neurology is changing more dramatically than MS treatment. There are now, for the first time, immunomodu- latory treatments that impact favorably on the natural history of the disease. In this context, this impressive review is especially welcome. The book is organized into five sections following the editors’ brief introduction. The first section covers methodology of clinical trials with par- ticular emphasis on MS. It encompasses chapters on a wide rage of key issues ranging from study design to MRI as a surrogate marker to neuropsychology and contains unique coverage of prac- tical issues of new drug development, such as relations between investigators and industry study sponsors as well as governmen- tal regulatory pathways in the United States and elsewhere. The authors are many of the world’s most experienced experts. The section on clinical trial results thoroughly surveys the most important published results in recent years. These include studies of plasma exchange, interferon beta, and mitoxantrone in secondary progressive MS, and approaches to combination ther- apy among others. Although the timeliness of a review text is inherently limited as new trial results are released, this type of survey will be of value for practitioners (MS specialists and more generally oriented neurologists alike) as an easy reference source for multiple studies in one volume. The following sections outline expert therapeutic approaches to relapsing MS, progressive MS, and MS symptom management. Not surprisingly for a multiauthored text, there are some inevita- ble areas of overlap and some unevenness of coverage and style. This is an ambitious overview of a topic with explosive growth. The well-organized text should be easily accessible to the novice in the MS field as well as a valuable resource for experts owing to its outstanding reviews of research topics. Andrew Goodman, MD Copyright © 2000 by the American Academy of Neurology Within Reason: Rationality and Human Behavior by Donald B. Calne, 332 pp., ill., New York, NY, Pantheon Books, 1999, $26 In this strikingly ambitious work, Professor Calne addresses the role of reason in human affairs. Drawing liberally from history, literature, moral philosophy, anthropology, and cognitive science, he begins by exploring the relationship between reason and lan- guage. This is followed by an account of the role of reason in fostering ethical behavior and social development, contributing to the evolution of commerce, enabling governments to adapt to changing cultural norms and translate these norms into enforce- able laws, and influencing the choice of religious belief or disbelief, as well as its place in artistic and scientific development. Throughout this survey, reason is cast as a method for achiev- ing efficiency in reaching biological or communal goals—albeit a method that can produce disastrous consequences when misap- plied (e.g., the bloody failure of the British army at the Battle of Somme in World War I, the ultimately self-defeating depredations of the Nazis). Thus, reason “is a real, specifiable, and indispens- able human capability active in most domains of human existence but . . . cannot assign or control the purposes to which it is put.” The final chapters consider reason in the context of brain– behavior relationships and the “mind– body problem.” There is an admirably concise portrait of current thinking about instincts, emotions, learning, development of human brain (including concepts of modular organization, parallel processing, and “neural Darwinism”), Cartesian dualism, the problem of de- fining a “physical basis” (e.g., a thalamic regulator) for conscious- ness, and the enduring conundrum of whether animals have minds. The closing pages consider how extant models of mind can explain knowledge, memory, motivation, and reasoning. Based on clinical and neuropathologic data from human brain diseases, Calne proposes that “responsibility for reason seems to reside in the association areas of the cerebral cortex, which are richly endowed with interconnecting pathways lining different regions of the brain.” Faced with a work of this scope, an unavoidable question is whether the author’s reach exceeds his or her grasp. From this reader’s perspective, the answer is a resounding “no.” Specialists in the cognitive and behavioral sciences and those who wish to expand their understanding of how the human brain operates will profit from the erudition and cogency displayed here. H. Richard Beresford, MD, JD Copyright © 2000 by the American Academy of Neurology Outcomes in Neurological and Neurosurgical Disorders edited by Michael Swash, 612 pp., ill., New York, NY, Cambridge University Press, 1998, $120 This timely book examines outcomes of various neurologic and neurosurgical disorders. As clinicians, we are increasingly asked to prognosticate outcomes for patients or colleagues. The compar- ison of outcomes is also becoming more common as clinicians strive to provide the highest quality care possible with multiple new treatment options. The 31 chapters deal with common neurologic and neurosurgic diseases, including head injury, cerebrovascular malformations, aneurysms, degenerative diseases of the CNS, and epilepsy. The introductory chapters provide an excellent overview of the main issues related to defining and measuring outcomes. The following chapters explore specific neurologic or neurosurgical dis- orders. Most chapters define a disorder and describe the natural history, potential treatment options, known grading systems, and expected outcomes. The chapters dealing with neurosurgical dis- eases do a better job of defining grading systems and predicting and comparing outcomes, perhaps because these diseases have had grading systems in place longer and have more data from which to draw. Some chapters—that on stroke in particular— have very little outcome data but provide an overview of the disease and clinical course. This book is primarily intended for the clinician but can be used by researchers as well. Its value is in its descriptions of disease-specific severity grading systems and in predicting and comparing outcomes when possible. Clinicians must understand the use of grading systems to standardize disease severity and outcome measures. Only by standardization can we compare out- comes and ensure that we are providing the best care based on evidence. This book needs to be continuously updated as new measure- ment systems and treatment options emerge. Judy Hinchey, MD Copyright © 2000 by the American Academy of Neurology Books Received Neural Transplantation Methods by Stephen B. Dunnett, Alan A. Boulton, and Glen B. Baker, 556 pp., ill., Totowa, NJ, Humana Press, 1999, $125 Neurodevelopmental Disorders by Helen Tager-Flusberg, 614 pp., ill., Cambridge, MA, MIT Press, 1999, $75 2194 NEUROLOGY 54 June (1 of 2) 2000