Women are different | |
Neurologic disorders in women. |
A cornucopia of superb modern neurological texts is now available compared with the few well known and trusted classics of times past. The contemporary knowledge explosion has bred a steady supply of subspecialty monographs in areas such as stroke and epilepsy, and even several books on the neurology of pregnancy. Now there is a book devoted to neurological disorders in women. The authors, neurologists from Harvard Medical School, Boston, point out that "there are important gender differences in the epidemiology, pathophysiology, clinical course and treatment of many neurologic diseases". They address these issues in nine key areas: epilepsy, stroke, headache syndromes, neuro-oncological diseases, multiple sclerosis, neuromuscular disorders, cognition and Alzheimer's disease, movement disorders, and medical conditions with neurological manifestations. Each chapter explores the specific female aspect of the neurological condition, in terms of menarche, menstruation, menopause and reproduction. There are authoritative answers to such questions as "What is the relationship between oral hormone therapy and stroke and migraine?". (They note the incidence of cerebral infarction is not increased with the use of a low-dose [30-35 mg oestrogen] oral contraceptive pill.) Management of migraine during pregnancy is well covered. There is a useful table of medications that can be used in pregnancy for migraine prophylaxis and acute treatment, with a rating scale that delineates degree of risk in each trimester, and in lactation. Unfortunately, some of the specific drug advice in the headache chapter is aimed at an American audience. The neuro-oncology chapter is comprehensive, describing direct and paraneoplastic neurological differences between men and women. The management of meningiomas with sex hormone receptors and the management of brain tumour during pregnancy are described. In the chapter on cognition and Alzheimer's disease, the authors speculate about why women are disproportionately affected with Alzheimer's disease - with a female-to-male prevalence ratio as high as 2.8:1. They review the effects of oestrogen on cognition, Alzheimer's disease risk and symptomatology. Unusual neurological disorders in women (such as chorea gravidarum and menstrually related sciatica), which usually rate only a sentence or two in a general text, are detailed. This concise, easily read book, with its with up-to-date references, deserves a place on the bookshelf alongside other subject-specific neurology monographs. It is an excellent source on how neurological manifestations may differ in women. Robert H Edis
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