A leading neuroscientist argues that the peripheral nervous system, long understood to play a key role in regulating basic bodily functions, also signals the onset of illness.

The central nervous system, consisting of the brain and the spinal cord, has long been considered the command center of the body. Yet outside the central nervous system, an elaborate network of nerve cells and fibers extends throughout our bodies, transmitting messages between the brain and other organs. The peripheral nervous system, as it’s known, regulates such vital functions as heart rate, digestion, and perspiration and enables us to experience the barrage of sounds, tastes, smells, and other sensory information that surrounds us. But beyond these crucial roles, the peripheral nervous system might do even more: it might warn us of diseases in our future.

As Moses Chao argues in Periphery, from Parkinson’s disease to autism to dementia, many neurological conditions emerge not in the brain but rather within the peripheral nervous system, in the dense network of nerves that wrap around the gastrointestinal tract. What’s more, dysfunctions of the peripheral nervous system can signal the onset of disease decades before symptoms like tremor or memory loss occur. Fortunately, unlike nerves in the brain and spinal cord, peripheral nerves can heal and regenerate in response to injury and aging. The therapeutic implications are remarkable. Chao shows how, with a better understanding of the peripheral nervous system, we could not only predict and treat neurological diseases long before their onset, but possibly prevent them altogether.

Full of new ideas and bold interpretations of the latest data, Periphery opens exciting avenues for medical research while deepening our understanding of a crucial yet underappreciated biological system.

Most neurology is done by general physicians rather than by neurologists. Still, neurology is perceived by doctors to be one of the most troublesome and difficult medical specialties. Neurologic symptoms are often vague and uncertain, and seemingly insignificant symptoms can reflect frightening disorders.

Thomas Glick, a superb teacher as well as an experienced clinician, has written this book in the belief that errors in handling neurologic cases stem not so much from a failure to command a daunting body of knowledge as from inadequate clinical reasoning. Dr. Glick shows how the skills of the primary-care physician can be applied to the special problems of neurologic history-taking and physical examination. He emphasizes time-saving ways to focus the exam and avoid diagnostic error. The book describes clear procedures for cases that the generalist can handle comfortably and offers guidelines on when (and how) to seek the advice of the consultant neurologist. Case histories, scattered liberally throughout the text, highlight the discussions and give the reader a rich sampling of specific methods of problem solving.

Clinicians who feel skeptical about the effectiveness of neurologic therapy or frustrated by its application will find here a commonsense approach to therapeutic planning. Chapters on ambulatory and chronic neurologic care also convey a positive sense of the broader therapeutic possibilities that exist in neurologic practice. Neurologic residents, senior medical students, psychiatrists, and allied health professionals, as well as primary caregivers, will benefit from the insights contained in this sensitive and articulate book.