Since 1955, this landmark masterwork has been revered for its authoritative presentation of the entire state of scientific and clinical knowledge about multiple sclerosis. The state-of-the-art 4th Edition presents the most recent information on the genetics and epidemiology, clinical neurology, pathogenesis, and management of this common neurological disease. Amply illustrated and referenced and beautifully written, McAlpine's Multiple Sclerosis has been described as "A standard reference for multiple sclerosis researchers, embryonic 'MS-ologists' and hard-pressed clinical neurologists alike" (Brain, review of the last edition).
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REVIEWS OF THE LAST EDITION:
"The principal merit of this book is the clear and coherent approach of the six authors, who are the world's leading figures in the field, to describing and interpreting the many complex and variable aspects of multiple sclerosis."-NEJM
" Since its inception, McAlpine's Multiple Sclerosis has achieved the rare distinction of becoming one of the classical neurological texts of the last century. The possession of this book was a priority for anyone practising neurology and a necessary acquisition for any self-respecting medical library."-Brain
"The authors must be warmly congratulated on producing an outstanding reference text that Nigel Compston and his original coauthors would be immensely proud of, their intention at the outset being that of simulating interest 'in the ever widening field of demyelinating disease'. This book clearly fulfils that legacy and definitively presents the current state of knowledge."- J Neurol Neurosurg Psychiatry
SECTION ONE: THE STORY OF MULTIPLE SCLEROSIS
1. The story of multiple sclerosis
The evolving concept of multiple sclerosis
Naming and classifying the disease: 1868-1983
Clinical descriptions of multiple sclerosis: 1838-1981
Personal accounts of multiple sclerosis: 1824-1991
The social history of multiple sclerosis: 1945-1998
The pathogenesis and clinical anatomy of multiple sclerosis: 1849-1977
The laboratory science of multiple sclerosis: 1912-1981
Discovery of glia and remyelination: 1858-1988
The aetiology of multiple sclerosis: 1883-1976
Attitudes to the treatment of multiple sclerosis: 1841-1983
SECTION TWO: THE CAUSE AND COURSE OF MULTIPLE SCLEROSIS
2. The distribution of multiple sclerosis
The rationale for epidemiological studies in multiple sclerosis
Definitions and statistics in epidemiology
Strategies for epidemiological studies in multiple sclerosis
The geography of multiple sclerosis
Epidemics and clusters of multiple sclerosis
The environmental factor in multiple sclerosis
3. The genetics of multiple sclerosis:
Genetic analysis of multiple sclerosis
Methods of genetic analysis
Racial susceptibility
Sex differences in susceptibility
Familial multiple sclerosis
Candidate genes in multiple sclerosis
Systematic genome screening
Lessons from genetic studies of experimental allergic encephalomyelitis
Conclusions
4. The natural history of multiple sclerosis
Introduction
Definitions
Onset
Course
Inter-individual variability
Factors affecting the prognosis
General considerations
Environmental influences
Chapter 5: The aetiology of multiple sclerosis: an epitome
SECTION THREE: THE CLINICAL FEATURES AND DIAGNOSIS OF MULTIPLE SCLEROSIS
6. The symptoms and signs of multiple sclerosis.
Multiple sclerosis as a neurological illness
Initial symptoms
Symptoms and signs in the course of the disease
Individual symptoms and sign
Associated diseases
Conclusion
7. The diagnosis of multiple sclerosis
Diagnostic criteria for multiple sclerosis
Selection of investigations
Magnetic resonance imaging
Evoked potentials
Examination of the cerebrospinal fluid
A strategy for the investigation of demyelinating disease
8. The differential diagnosis of multiple sclerosis
The spectrum of disorders mimicking multiple sclerosis
Diseases that may cause multiple lesions of the CNS and also often follow a relapsing remitting course
Systematized central nervous system diseases
Isolated or monosymptomatic CNS syndromes
Non organic symptoms
How accurate is the diagnosis of multiple sclerosis?
9. Multiple sclerosis in the individual and in groups: a conspectus
The typical case
Isolated syndromes and their outcome: judicious use of investigations and critique of the new diagnostic criteria
Co-morbidity and associated diseases
Situations in which alternative diagnoses should be considered
When to ignore "inconvenient” laboratory results or clinical findings: taking the best position
"Pathognomonic” and "un-heard of” features of multiple sclerosis
SECTION FOUR: THE PATHOGENESIS OF MULTIPLE SCLEROSIS
10. The neurobiology of multiple sclerosis.
Organisation in the central nervous system
Development of the central nervous system
Macroglial lineages in the rodent and human nervous system
Axon-glial interactions and myelination
Demyelination
Axon degeneration and restoration of function
Remyelination
11. The immunology of inflammatory demyelinating disease
Multiple sclerosis as an autoimmune disease
Immune responses: innate and adaptive
T lymphocytes
B lymphocytes
Autoimmunity and self tolerance in the central nervous system
Regulation of central nervous system autoimmune responses
Immune reactivity in the central nervous system
Pathogenesis of demyelination and tissue damage
Peripheral blood biomarkers for multiple sclerosis and disease activity
Markers of multiple sclerosis and disease activity in cerebrospinal fluid
Conclusion
12. The pathology of multiple sclerosis
Introduction
Pathological classification of demyelinating diseases
The demyelinated plaque
Immunopathology of inflammation
Demyelination and oligodendroglial damge
Remyelination
Axonal pathology
Grey matter pathology / cortical plaques
Astroglia reaction
Abnormalities in the "normal” white matter
Distribution of lesions in the nervous system
Is there evidence for an infectious agent in the lesions of multiple sclerosis?
Dynamic evolution of multiple sclerosis pathology
Differences between acute relapsing and progressive multiple sclerosis
Molecular approaches to the study of the MS lesion: Global profiling of transcriptome and proteome.
Association of multiple sclerosis with other diseases
Conclusions
13. The pathophysiology of multiple sclerosis
Introduction
Methods for exploring the pathophysiology of multiple sclerosis
Relapsing remitting multiple sclerosis: loss of function due to conduction block
Relapsing remitting multiple sclerosis: recovery of function and remission
Physiological explanations for other clinical symptoms in multiple sclerosis
Permanent loss of function in the context of disease progression
Summary
SECTION FIVE: THE TREATMENT OF MULTIPLE SCLEROSIS
15. Care of the person with multiple sclerosis
General approach to the care of people with multiple sclerosis
The early stages of disease: minimal disability
The middle stages of disease: moderate disability
The later stages of disease: severe disability
Guidelines for the management and investigation of multiple sclerosis
Conclusion
16. Treatment of the acute relapse
The features of active multiple sclerosis
The treatment of relapse in multiple sclerosis
Other approaches to the treatment of acute relapse
Treatment of acute optic neuritis
Management of other central nervous system demyelinating disorders
Adverse effects of corticosteroids
Mode of action of corticosteroids
Practice Guidelines
17. The treatment of symptoms in multiple sclerosis and the role of rehabilitation
The general principles of symptomatic treatment in multiple sclerosis
Disturbances of autonomic function
Mobility and gait disturbance
Fatigue
Disturbances of brain stem function
Perturbations of nerve conduction
Cognition
Visual symptoms
Rehabilitation in multiple sclerosis
Summary
18. Disease modifying treatments in multiple sclerosis
The aims of disease modifying treatment
The principles of evidence based prescribing in multiple sclerosis
The role of magnetic resonance imaging in clinical trials
Drugs that stimulate the immune response
Drugs that non-specifically suppress the immune response
The beta interferons
Molecules that inhibit T cell-peptide binding
Specific treatments that target T cells
Agents which inhibit macrophages and their mediators
Recent miscellaneous treatments
Postscript
19: The person with multiple sclerosis: present and future
Empirical versus hypothesis driven therapeutics
New opportunities for immunological intervention
Axon protection; acute and chronic
Treatment in special situations
Remyelination:
Index
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