A Thoughtful Perspective on Atypical Parkinsonian Disorders

Extract

Atypical Parkinsonian Disorders: Clinical and Research Aspects. Irene Litvan (Ed.). 2005. Totowa, NJ: Humana Press, 512 pp., $175.00 (HB).

This edited collection of perspectives on Atypical Parkinson's Disease, or Parkinson's plus as it is often called, is both a treasure and a pleasure. The editor, Irene Litvan, ably accomplishes the daunting task of bringing order to what might be considered a grab bag of diagnostic leftovers in Chapter 1. To the generalist, fair warning that Parkinson's plus may be misconstrued as Parkinson's minus, since tremor, the most commonly recognized symptom may not be a feature of at least some of these syndromes. Litvan provides us with an organizational structure for summarizing clinical features and surmising etiologies. An extensive literature review is distilled to give impressions of when to suspect these diagnoses, hints to the natural progression, and discussion of the validity of specific diagnoses within the atypical PD spectrum. Chapter 2, on historical perspectives, is one that is so tempting to skip in the rush to get to the most up to date science. Please don't, because it is one of the gems of this tome. In his readable style, Christopher Goetz reminds us that clinical skill begins with being a good observer and this will serve the field throughout time. His selection of historical anecdotes, literary passages, and classic photographs illustrates the timelessness of some of these clinical entities. The photograph from the 1925 Lhermitte et al. report so captured the syndrome of cortical basal degeneration, that I suddenly recalled several similar patients and was reassured that there was something more than idiosyncratic imposition of this diagnosis.