Multiple Sclerosis: the Guide to Treatment and Management, 5th ed. (Reviews of books, computer software, and videotapes are written by invitation).

Multiple Sclerosis: The Guide to Treatment and Management, ed 5 Polman CH, Thompson AJ, Murray TJ, McDonald WI. New York, NY 10016, Demos Medical Publishing Inc, 2001, paperback, 151 pp, ISBN: 1-888799-54-4, $24.95.

The stated purpose of this book is to provide a comprehensive, readily accessible guide to the diverse therapeutic options now available to treat multiple sclerosis (MS). The text describes a large number of interventions and offers an opinion about the usefulness and effectiveness of each one. In addition to the printed version, there is a full-text, online version that can be viewed at the Web site of the Multiple Sclerosis International Federation (www.msif.org).

Four chapters follow the introduction, which provides an overview of the book's format and discusses the methods used to determine the effectiveness of the various interventions. The authors state that one of the problems with determining effectiveness of treatment programs is the fact that the intervals between relapses vary widely. This variability makes it difficult to determine whether a particular intervention or the natural course of the disease itself altered the patient's response. The authors base their opinions regarding effectiveness of interventions on scientific literature and weigh the effectiveness of the intervention against the risks associated with it.

In the chapter "Treatment for Acute Exacerbations" the authors conclude that high-dose, intravenous methylprednisolone is the intervention of choice in patients with acute exacerbations. According to the authors, plasmapheresis should only be considered in cases where the patient does not respond to intravenous steroids. Chapter 3 discusses interventions that affect the long-term course of the disease. This chapter presents a number of different treatment approaches including 2 approved drugs: interferon beta (treatment of choice for patients with active relapsing disease) and glatiramer acetate (alternative to interferon beta). Twenty-three other interventions, which are not approved for MS, are also discussed, along with the evidence for or against their use. In most cases, the authors state that there is not enough evidence available to offer a solid opinion regarding the effectiveness of an intervention.

Chapter 4, "Symptomatic Treatment and Rehabilitation," is of most interest to physical therapists because it discusses topics such as spasticity; ataxia; fatigue; bladder, bowel, and sexual dysfunction; pain; cognition; visual dysfunction; swallowing, speech, and respiratory dysfunction; and psychological dysfunction. The authors argue that a multidisciplinary approach seems to offer some benefits although the scientific evidence is lacking.

The last chapter titled "Alternative Therapies Used by People With MS" offers some of the most interesting reading. The authors present a large number of alternative or complementary therapies along with an outline of their rationale, an evaluation of the scientific and medical basis for the therapies, and the risks and costs as well as their opinion on the effectiveness of the therapies. The therapies included injected materials such as yeasts, pancreatic extracts, snake and honey bee venom, dimethyl sulfoxide (DMSO), alpha-fetoprotein, and chelation therapy. In almost all cases, the authors conclude that there is simply no evidence to support their use.

A number of oral agents such as various vitamins and supplements also appear to lack scientific evidence. The authors reviewed the evidence for acupuncture, acupressure, dorsal column stimulation, hyperbaric oxygen, transcutaneous nerve stimulation, sympathectomy, ultrasound, magnetotherapy, dental occlusion, and special diets. In almost all cases, they argued that "there appears to be no generally accepted scientific basis for the use of the therapy."

At the end of each chapter, the authors include references and guides for further reading. The references are current and direct the reader to scientific, peer-reviewed publications. Overall, the book offers the reader an excellent overview of common interventions for MS. The book is written at a level that should be appropriate not only for medical personnel but also for patients and family members who are dealing with this disease. The availability of the book on the Internet offers potential readers a chance to review the material before purchasing the text. This is an excellent resource for physical therapists, and it may serve as an important reference for their patients who have MS.

Thomas M Mohr, PT, PhD
University of North Dakota
Grand Forks, ND

Dr Mohr is Professor and Chairman in the Department of Physical Therapy. His teaching responsibilities are in the areas of neuroscience, physiology, biomechanics, and electrophysiology; his research interests are in electromyography, biomechanics, and electrotherapy.