Reviews with preexisting interest or expertise in headache as well as a neurology resident’s first book in this field.

Headache Edited by Peter J. Goadsby and Stephen D. Silberstein Newton, MA, Butterworth-Heinemann, 1997 41 1 pp, illustrated

Headache, a field once considered at the backwater of serious neuroscience investigation, has been trans- formed during the Decade of the Brain. We are enter- ing an exciting era in which research has brought about new concepts in pathophysiology and patient manage- ment. The recent description of voltage-gated calcium channel abnormalities in patients with familial hemi- plegic migraine suggests similarities between migraine and the so-called channelopathies (eg, periodic paraly- sis, episodic ataxia), in which patients are normal be- tween attacks yet have profound clinical problems dur- ing attacks. Functional effects assigned to a specific receptors are continuously being reappraised. In 1989 the effect of sumatriptan was thought to be mediated solely by the 5-HT 1D receptor. Subsequently two dif- ferent 5-HT 1D receptor isoforms have been identi- fied, and sumatriptan is now regarded as a 5-HT 1B/ 5-HT 1D agonist.

The issues in basic neuroscience have been admira- bly summarized in Headache, edited by two leaders in the field, Peter Goadsby and Stephen Silberstein. Chapters reviewing the trigeminovascular system, sero- tonin receptors in the pathogenesis of migraine, new targets for antimigraine drug development, and the ge- netics of migraine are well written and thought pro- voking. Extensive bibliographies at the end of each chapter prove valuable for those who want to pursue the topics in greater depth. Clinical aspects of mi- graine, nonmigrainous headaches, and secondary head- ache disorders are also summarized. The chapters on low cerebrospinal fluid pressure headache, headache in spontaneous carotid and vertebral artery dissection, and brain tumor headache are thorough and excellent syn- opses of these topics. In diagnosing these conditions the authors wisely remind us that “a full house is as rare in medicine as it is in poker.”

The biggest deficiency in Headache is that several important clinical topics-such as late-life migrainous equivalents, the neuro-ophthalmologic aspects of mi- graine, and visual loss in patients with idiopathic intra- cranial hypertension-are not adequately summarized. Although the authors prudently caution that “statistical efficacy does not necessarily equate with patient satis- faction,” the sections on the treatment of migraine are also relatively brief and disappointing, considering the importance of this topic. Overall, Headache achieves its goals and is a valuable addition to the library of anyone

Howard D. Weiss, M D Baltimore, M D

Amyotrophic Lateral Sclerosis Edited by Hiroshi Mitsumoto, David A. Chad, and Erik I? Pioro Philadelphia, FA Davis, 1998 480 pp, illustrated, $1 40.00

Publication of Amyotrophic Lateral Sclerosis is testimony to the acceleration of research these days and to an ac- celeration in the rate of book publishing. Until 1990, comprehensive texts on amyotrophic lateral sclerosis (ALS) appeared about once a decade: there was not much to report and much of what was reported turned out to be wrong. Since 1990, however, at least 11 books have been published on ALS, and another is on the way. There must be an explanation beyond the sights of acquisition editors and tireless authors. There must be something inherent in the disease itself.

The challenge of ALS is multifaceted. Although a rare disease, ALS must be considered in the differential diagnosis of many other conditions, so neurologists think about it often. In making the diagnosis and con- sidering treatment, the neurologist encounters neuro- anatomy and physiology, electrodiagnosis, neuropathol- ogy, neuropharmacology, and immunology. Once the diagnosis is made, it becomes a test of the physician’s ability to help the patient without being able to cure, an effort that requires compassion and thoughtfulness. The ethical issues at the end of life arise in full force. Knowledge of biostatistics and controlled therapeutic trials is a new requirement.

The fascination with ALS arises from the intellectual challenge, too. Molecular genetics has made its mark, linking one form of ALS to the gene for superoxide dismutase on chromosome 2 1. Transgenic mice bear- ing the human mutation provide the best animal model available for the study of pathogenesis. Aberrant glutamate metabolism and evidence of peroxidation provide new theories for the pathogenesis of sporadic ALS. And new cellular observations of intraneuronal inclusions provide another approach to the molecular basis of the disease.

More, ALS is linked to the more prevalent diseases of parkinsonism and dementia as an age-related neuro- degenerative disease. Pharmaceutical companies see the needs and opportunities for the development of effec- tive therapies; they are entering the field in growing

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