Views And Reviews

Parkinson's Disease and its Management

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6923.281 (Published 22 January 1994) Cite this as: BMJ 1994;308:281
  1. R C Hughes

    Parkinson's disease and its various mimics occur in increasing numbers in our aging population, and the chronicity of the condition puts an ever growing demand on medical and social facilities.

    For these reasons, together with the increasing number of drugs available and the fact that these are not always presented in a pharmacological order of merit, it is opportune that a small monograph such as Parkinson's Disease and its Management should become available.

    Aimed at a clinical readership, the book is essentially practical in its approach, and its brevity is laudable. It nevertheless provides a breadth of information covering all essential aspects, and the references, though not extensive, are appropriate and adequate.

    The chapter devoted to clinical scales and monitoring is first class and should be essential reading for anyone engaged in trials of drug treatment - both for newcomers and as a useful reminder to the experienced.

    The author's practical experience of managing chronic Parkinson's disease is amply illustrated in the text by his comment that Zimmer frames are not recommended (they break the natural rhythm of walking) but that, if fitted with wheels and handbrakes, they can be valuable. The text is full of useful practical advice of this type.

    Particularly attractive are the quotations from medical sages of the past, an excellent example of which is, Diagnoses are missed, not because of lack of knowledge on the part of the examiner, but rather because of lack of examination (Sir William Osler); this reminds us that, in this age of increasing complexity and availability of investigations, attention to good clinical housekeeping is still mandatory.

    No book is totally without blemish, but fortunately blemishes in this are minor - one being the omission of a clinical cameo of communicating hydrocephalus. This certainly may emulate Parkinson's disease, as evidenced by a recent refusal of a neurosurgeon to insert a shunt in such a case because it was clearly a case of Parkinson's disease. The patient's disability later resolved after a shunting procedure was performed.

    Pearce's monograph provides an excellent distillate of the historical, clinical, pathological, epidemiological, and therapeutic aspects of this disease and is highly commended not only to parkinsonologists but to those in allied disciplines and to care workers.