Tolcapone

Parkinson's Disease: The Treatment Options Wolfgang Oertel, Peter LeWitt Martin Dunitz, 65 [pounds sterling], pp 272 ISBN 1 85317 379 7

Rating: ***

It was a pleasure to read this authoritative text on the treatment of Parkinson's disease. Oertel and LeWitt are well known for their contribution to the struggle against this particularly common neuro-degenerative disease, and, with the help of distinguished colleagues from north America and Europe, they have perfectly summarised both the established regimens and new developments in only 260 pages and in a clear and bright style. Essential data on epidemiology, diagnosis, and genetics are condensed to fewer than 80 pages and are illustrated by algorithms and tables and supported by a consistent bibliography.

This book is original in presenting recent advances in neurosciences and pathophysiology as rationales for new treatment strategies or to orientate clinical research. Another unusual feature of the book is its listing of all those signs and symptoms commonly associated with Parkinson's disease (sleep disorders, depression, sexual dysfunction, cognitive disorders, etc), each followed by a description of the appropriate therapeutic approach.

The core of the book remains the presentation of the armamentarium of drugs we have at our disposal today to counteract symptoms and, though less well established, to halt the progression of the disease. For each compound, the benefit:risk ratio is presented according to the principles of evidence based medicine, to which is added a firm expert opinion. The editors have achieved an excellent balance between the "ancient drugs" (levodopa) and the most recent ones (pramipexole, ropinirole, entacapone) and have provided explanations of recent safety problems (such as tolcapone withdrawal in Europe).

On the downside, the chapter on neurosurgical approaches concentrates too much on pathophysiology and does not clearly explain the indications for surgery or the long term effects and drug adjustments that are commonly necessary. The book also lacks any comment on the occurrence, admittedly rare, of Parkinson's disease in young adults, and fails to mention the genomic impact of the dopaminergic agonists and levodopa, which could be a breakthrough in the understanding of long term side effects of pharmacotherapy.

However, these are minor faults, and, despite a relatively severe presentation, this book must command a place on any neurologist's bookshelf.

Herve Allain professor, Laboratory of Experimental and Clinical Pharmacology, Rennes Medical School, France

COPYRIGHT 1999 British Medical Association
COPYRIGHT 2000 Gale Group