The Neurology of Autism
http://www.100md.com
《新英格兰医药杂志》
Pediatric neurologist Mary Coleman has written or edited eight medical books, four of them about autism. This latest book, consisting of 10 chapters with contributions by international experts Catalina Betancur, G. Robert DeLong, Christopher Gillberg, Yoshiko Nomura, Lorenzo Pavone, Martino Ruggieri, and Michele Zappella, is informative and comprehensive in its treatment of the neurologic basis of autism. With the explosion of books and other forms of information on autism, the title might suggest that this is just another book on autism and that it might be a bit boring. To the contrary, I found the book absorbing. With its tidbits of history and its sometimes provocative concepts, it makes for interesting reading.
The book is well written and easy to understand, which is important given the target audience of students, researchers, clinicians, and parents. Recognizing this diverse audience, the contributing authors have done an excellent job of making complex medical concepts understandable to all. The glossary at the end of the book is extremely helpful in this regard. The book is well referenced, provides helpful tables throughout, and includes a summary of relevant points at the end of each chapter. With few exceptions, the information is up to date and reflects current thinking related to possible biologic mechanisms, epidemiology, diagnosis, medical treatment, and the multidisciplinary management of autism. The "Targeted Neurological Examination" in the appendix is a nice feature, although I imagine many researchers and clinicians have their own preferences as to items to be included in a clinical examination.
As others have done before, Coleman calls for the use of terminology and a conceptualization of autism not as a "spectrum" disorder but, instead, as a collection of syndromes — autism as not one disease but, rather, a final, common phenotypic pathway for many different underlying disorders. Evidence in support of this view is presented by means of a parallel with nonsyndromic and syndromic mental retardation. The distinction between nonsyndromic and syndromic autism is highlighted throughout the book and seems sometimes (but not always) to correlate with neurologic signs such as head circumference and the presence of epilepsy and abnormalities of muscle tone. Problems of nosology in autism are briefly noted, but after 60 years of confusion in this area, that these remain confusing is merely acknowledged. The chapter on prevalence provides, in addition to summaries of epidemiologic studies according to the decade of publication, a section on possible reasons for recent reports of higher prevalence estimates, with the conclusion that evidence from recent epidemiologic studies indicates that autism is not a rare disorder.
The book describes many different therapeutic approaches, from neuropathological to genetic, to answering the question of exactly what is wrong with the brain in autism and where in the brain the pathology resides. For example, several models are proposed that support new thinking that autism might be related to the abnormal development of a distributed neural network involving many regions of the brain; however, Coleman admits that it is unlikely that any of the three models discussed can explain the symptoms of autism in most persons with this condition. Of all the areas of the brain that have been studied in people with autism, the one that was earliest shown to be abnormal and that continues to be studied extensively with the use of imaging and neuropathological and neurochemical analysis is the cerebellum. Interestingly, the role of the cerebellum in cognitive functioning, affect, language, and social behavior was not recognized until recently. In the quest for a better understanding of the neurologic underpinnings of autism, Rett's syndrome has a prominent place because of the phenotypically similar yet different features of this syndrome and autism. I found both the chapter on alternative therapies and the chapter on an integrated approach to therapy particularly useful for clinicians.
The Neurology of Autism is a thoughtful commentary on what we currently know about the brain in autism, and it should serve as an excellent reference for those interested in research on or clinical aspects of autism. The authors are to be commended for presenting a very balanced view of current knowledge; they also indicate what we do not yet understand about brain functioning in autism and provide an important road map for ongoing exploration.
Marshalyn Yeargin-Allsopp, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
mxy1@cdc.gov(Edited by Mary Coleman. 2)
The book is well written and easy to understand, which is important given the target audience of students, researchers, clinicians, and parents. Recognizing this diverse audience, the contributing authors have done an excellent job of making complex medical concepts understandable to all. The glossary at the end of the book is extremely helpful in this regard. The book is well referenced, provides helpful tables throughout, and includes a summary of relevant points at the end of each chapter. With few exceptions, the information is up to date and reflects current thinking related to possible biologic mechanisms, epidemiology, diagnosis, medical treatment, and the multidisciplinary management of autism. The "Targeted Neurological Examination" in the appendix is a nice feature, although I imagine many researchers and clinicians have their own preferences as to items to be included in a clinical examination.
As others have done before, Coleman calls for the use of terminology and a conceptualization of autism not as a "spectrum" disorder but, instead, as a collection of syndromes — autism as not one disease but, rather, a final, common phenotypic pathway for many different underlying disorders. Evidence in support of this view is presented by means of a parallel with nonsyndromic and syndromic mental retardation. The distinction between nonsyndromic and syndromic autism is highlighted throughout the book and seems sometimes (but not always) to correlate with neurologic signs such as head circumference and the presence of epilepsy and abnormalities of muscle tone. Problems of nosology in autism are briefly noted, but after 60 years of confusion in this area, that these remain confusing is merely acknowledged. The chapter on prevalence provides, in addition to summaries of epidemiologic studies according to the decade of publication, a section on possible reasons for recent reports of higher prevalence estimates, with the conclusion that evidence from recent epidemiologic studies indicates that autism is not a rare disorder.
The book describes many different therapeutic approaches, from neuropathological to genetic, to answering the question of exactly what is wrong with the brain in autism and where in the brain the pathology resides. For example, several models are proposed that support new thinking that autism might be related to the abnormal development of a distributed neural network involving many regions of the brain; however, Coleman admits that it is unlikely that any of the three models discussed can explain the symptoms of autism in most persons with this condition. Of all the areas of the brain that have been studied in people with autism, the one that was earliest shown to be abnormal and that continues to be studied extensively with the use of imaging and neuropathological and neurochemical analysis is the cerebellum. Interestingly, the role of the cerebellum in cognitive functioning, affect, language, and social behavior was not recognized until recently. In the quest for a better understanding of the neurologic underpinnings of autism, Rett's syndrome has a prominent place because of the phenotypically similar yet different features of this syndrome and autism. I found both the chapter on alternative therapies and the chapter on an integrated approach to therapy particularly useful for clinicians.
The Neurology of Autism is a thoughtful commentary on what we currently know about the brain in autism, and it should serve as an excellent reference for those interested in research on or clinical aspects of autism. The authors are to be commended for presenting a very balanced view of current knowledge; they also indicate what we do not yet understand about brain functioning in autism and provide an important road map for ongoing exploration.
Marshalyn Yeargin-Allsopp, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
mxy1@cdc.gov(Edited by Mary Coleman. 2)