Book Review: McAlpine’s Multiple Sclerosis. Third Edition.

The reviewed book is McAlpine’s Multiple Sclerosis – Third Edition. The book is edited by Alistair Compston. The book begins with a historical perspective including Charcot’s early description of a number of cases and the formation of the the Multiple Sclerosis Society by Miss Sylvia Lawry who’s brother had developed MS. The refinement of the diagnosis through time is also discussed. The impact of Russell Brain’s Diseases of the Nervous System in 1933 was an interesting event in the history of the field and in disseminating the information known then on the pathological course of the illness. Indeed Compston writes

Never before had this amount of information been so cogently reviewed and Brain’s grasp of an increasingly difficult subject was magisterial

The other seminal work in the field was McAlpine’s Multiple Sclerosis and it is interesting to see the book itself (appropriately) featuring in the historical review! The early revision in 1972 of McAlpine’s Multiple Sclerosis was also reported to have affected the health of the first author Charles Lumsden. The description of early treatments including arsenic and silver nitrate is far removed from contemporary interventions.

Compston then writes a chapter on the epidemiology of MS introducing terminology and epidemiological methodology before focusing on genetic studies carefully explaining the underlying principles. He then covers the distribution of MS in the next chapter including the hypothesis that MS originated in Scandinavia where it was then spread to other parts of the world through migration. There follows a fascinating continent by continent account of the epidemiology of multiple sclerosis and how this relates to the scandinavian hypothesis.  He also looks at the relationship of infections to MS as well as a number of genetic relationship including those with the HLA system, T-cell receptor genes and immunoglobulin genes.

Bryan Matthews writes a chapter on the neurology of Multiple Sclerosis and there are many fascinating insights including the origins of ‘Bristow’s symptom’. George Ebers writes on the natural history of Multiple Sclerosis and Bryan Matthews then writes a chapter on the differential diagnosis and goes through each of the differentials explaining the overlapping and distinguishing features. Ian McDonald writes on diagnosis and investigation and focuses particularly on MRI while also covering other methods including evoked potentials.

Compston then covers the neurobiology of Multiple Sclerosis in the process examining the growth factors that are involved in the differentiation of neuronal cell types, the immune response and the properties of oligodendrocytes again with each of these being carefully explained. Hans Lassman looks at the pathology of multiple sclerosis considering the various pathological findings including cell types present in the tissues, while Ian McDonald looks at the pathophysiology focusing particularly on the abnormalities nerve conduction. As one might expect, the chapter on immunology (by Hartmut Wekerle and Hans Lassmann) is complex and this field is likely to be in a state of flux. The pair also consider models of MS. In the final chapter Compston looks at the treatment and management of MS. His chapter is carefully considered wide a breadth of material, explanations and principles described.

I was very impressed by this textbook which was clearly written and provided detailed information on Multiple Sclerosis and appears to be aimed at the specialist with an interest in MS. The book is written by a team of authors who have clearly coordinated the chapters to avoid overlap particularly given that this runs to over 500 pages!


Alistair Compston. McAlpine’s Multiple Sclerosis. Third Edition. Churchill Livingstone. 1998.


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The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.


  1. Thank you for your thorough review on McAlpine’s Multiple Sclerosis, 3rd ed., 1998. However, it might have been even more appropriate to have a look at the 4th edition which appeared in Dec, 2005


  2. Dear Dr Connemann,

    Many thanks for your helpful comment. I should have mentioned that there is a subsequent edition in press and will bear this in mind for future reviews. However I would argue that even though this is a fast changing field, the book is valuable in it’s own right and the review has validity. In particular I was impressed by the quality of the editing, the highly structured approach and the breadth of topics covered in detail by Professor Compston which offers the reader an invaluable opportunity to get their bearing in this complex field. Many thanks again

    Kind regards

    Justin Marley


  3. No matter if it’s a review about the third or the fourth edition, one thing is for sure. This book is helpful, for doctors and patients alike. Needless to say, even if the information is not as new, it still provides important pieces of insight into this condition, insight that is always useful. Plus, taking under consideration that the changes in MS treatment aren’t extreme, patients and doctors that are not familiar with MS should find this book more than helpful.

    Thank you for reviewing the book!


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