Among neurological disorders, multiple sclerosis has the unfortunate honor of being the most frequent cause of disability in young individuals. With the evolution of the disease, the brain is progressively deprived of sensory inputs and largely loses the ability to produce adequate responses. A combination of inflammation and degeneration causes progressive brain and spinal cord atrophy, which starts very early in the disease course and increases during the disease process. In addition, widespread damage takes place in the surviving gray and white matter. Not surprisingly, the disease often impacts on higher brain functions with neuropsychiatric manifestations. These processes are all admirably reviewed in this book and, for each cognitive and psychiatric disorder, the physiopathological theories are extensively and critically examined, making the book very useful not only for physicians, but also for researchers. The exceptional experience of Anthony Feinstein in this area, demonstrated by many key papers produced in the last decade, emerges clearly, page after page: the analysis of the literature is always combined with the “personal” view and a very useful summary of the main findings.
There are many reasons why neuropsychiatric disorders assume a key role in the management of multiple sclerosis patients: they occur early and affect about half of the patients; they are the most frequent cause of unemployment and a major determinant of a reduced quality of life; moreover, they negatively affect the ability of the patients to adhere to therapeutic protocols and to benefit from the most recent advances in both etiologic and somatic treatment.