Once the last bastion of therapeutic nihilism, neurology has now clearly entered the era of intense therapy for virtually every class of disease that affects the nervous system. Consequently, the modern neurology department is now subdivided into a dozen clinical subspecialties, each with its own group of experts, often with their own postresidency specialized fellowship training programs. General neurology still exists but it is usually practiced in a consultative mode in either the hospital or the ambulatory setting. Now, the movement disorder specialist is as different from the epileptologist as the hematologist is from the endocrinologist. Basic research in the neurosciences is routinely translated into new drugs, devices, and procedures aimed at ameliorating disorders in almost all the major categories of disease. Even neurodegeneration, traditionally the most therapeutically resistant class of disease, is beginning to crack under the influence of molecular genetics and its translation into drugs that may slow or prevent cell death.
In this context, the original contributors to the Manual of Neurologic Therapeutics all agreed that the 7th edition would require a major reorganization and that the sections needed to be written by experts who had dedicated their careers to each of the various areas of concentration. Furthermore, to be optimally accessible in both office and bedside venue, the Manual needed to be presented in a format conducive to electronic presentation as well as print reproduction. Thus, the information contained here is presented in a more consistent format than previously, with better use of headings and less reliance on a traditional outline.
The 7th edition contains an entire chapter on neurologic intensive care, now a well-defined subspecialty. Epilepsy management currently involves not only an array of new drugs but also innovative strategies such as vagal nerve stimulation and a greater emphasis on earlier surgical treatment. Neurootology encompasses the common complaint of dizziness, emphasizing both pharmacologic and physical therapy approaches to treatment. Back and neck pain, still among the most common complaints in all of medicine, are now evaluated with much improved diagnostic tests, which lead to more precise treatment. An entire chapter is dedicated to sleep disorders, an enormous area of disability in which major new advances in therapy have occurred. Cancer neurology now involves a complex array of chemotherapy, radiation therapy, and new cutting edge treatments using monoclonal antibodies. No area has changed more substantively than multiple sclerosis, in which fresh magnetic resonance imaging-influenced diagnostic criteria and several immunomodulatory drugs have substantively altered the clinical course of the disease. The area of neuromuscular diseases has been influenced enormously by the use of potent treatment for immune-mediated diseases and better diagnostic precision using molecular techniques applied to blood and muscle biopsy specimens. Pain management has become an art and science of its own, deserving of its own chapter in this edition. The triptan drugs, currently numbering seven, have changed the approach to migraine, and many other headache syndromes are now more clearly classified and specifically treated.
