Basic mechanisms of the EEG

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BOOK REVIEWS

tion, stereotactic amygdalotomy, multiple subpial transection, and they mention others: they write, " t h e brain is a big place" and there are no clear answers in this complex and diverse disorder. In early studies with chronic depth electrodes and subdural strips (Electroenceph. clin. Neurophysiol., 1962, 15: 568-587) Fischer-Williams and R.A. Cooper, although concentrating on the temporal lobe as so many have done, reported widespread abnormalities even including the caudate nucleus, and the nagging doubt remains that some of these diagnostic techniques resemble needles in a haystack. New antiepileptic drugs such as felbamate may also bring changes. T h e pre-surgical evaluation protocols of 33 surgical centers in the USA, Canada, Europe and Australia, given in Appendix II, are of great value. They enable clinicians, Looking to refer candidates for surgery, to see which centers consider in detail the psycho-social effects, the long-term ramifications, the emotional impact on all concerned, as well as which operations are performed and the complex technical teamwork required. Of special interest are the excellent neuropsychological testings for localizing and lateralizing the epileptogenic region by the Montreal and Toronto groups; and the chapter on complications, both surgical and neurobehavioral, multiauthored from 7 centers. Cost benefit is difficult to evaluate but the considerable financial cost cannot be ignored; the Mayo Clinic group in Rochester, MN, analyzes cost benefit. Unrealistic expectations from surgery should be avoided. However, improvement in quality of life, which is not necessarily linked to reduction in seizure frequency and severity, cannot be assessed monetarily, and improved self-esteem is worth a high price, as several authors show. Although the book size may appear daunting, the well-organized contents and the important material make study rewarding. Appendix IV on Basic Research covers new and interesting ground. M. Fischer-Williams

Milwaukee, WI (USA)

Basic mechanisms of the EEG. - St. Zschocke and E.-J. Speckmann (Eds.) (Birkhfiuser, Boston, MA, 1993, 370 p., Price US $99.00)

This book is based upon the proceedings of a symposium held in H a m b u r g in September 1990 (in honor of Rudolf Janzen, a G e r m a n E E G pioneer and eminent neurologist, 1907-1991). Considering the rapid advances recently made in basic E E G research, one deplores the long period from the original presentation to the appearance of the book. T h e reader should not expect a book dealing exclusively with neuronal electrogenesis or the modern biophysical concepts of EEG. As a matter of fact, the scope is wide and reaches from the clinical E E G (brain-stem dysfunction, Ch. 16, Zschocke) and stereo-EEG, Ch. 11, Wieser and Siegel) to bold concepts of the E E G frequency bands (Andresen, Ch. 18) and a preview of J.S. Barlow's new model for normal and abnormal E E G phenomena: the "extrema-slopes hypothesis," Ch. 5, soon to appear in monographic form. A historical view of the classical electrogenesis is presented by Caspers (Ch. 1), followed up by Speckmann and Altrup (Ch. 3) in the typical lucid style of the Mfinster School. Petsche (Ch. 2) stresses psychophysiological E E G studies with coherence analysis (The E E G - a cryptogram?). Pijn and Lopes da Silva investigate the relationships between signals along with the time delay in propagation (Ch. 4). Sustained potential shifts and the role of glia and neurons are the topic of Somjen's paper (Ch. 7). Kuschinsky (Ch. 8) notes relationships between cerebral blood flow, cerebral metabolism and E E G activity. The recently m u c h discussed 4 0 / s e e rhythm and its role in arousal is stressed by Steriade and co-workers (Ch. 10). All these and the remaining chapters provide for interesting reading. O n e of these presentations deals entirely with the anatomy of the thalamus (Lierse, Ch. 9). The chaos theory - a centerpiece of earlier works in this

series entitled "Brain Dynamics" - is presented in a contribution of Ba~ar and co-workers (Ch. 6). This book is not as audaciously dynamic and future-oriented as its predecessor entitled " I n d u c e d R h y t h m s in the Brain" (Ba~ar and Bullock (Eds.), Birkh~iuser, 1992) had been. Nevertheless, the message is clear: modern basic E E G research is more progressive than it has been in decades. Basic and clinical electroencephalographers alike will greatly enjoy this book (which is not cheap but "reasonably priced"). E. Niedermeyer

The Johns Hopkins Hospital and University, Baltimore, MD (USA)

Handbook of Pediatric Epilepsy. - J.B. Murphy and F. Dekharghani (Eds.) (Marcel Dekker, New York, 1993, 392 p., Price US $129.00)

This is the latest edition to the series "Neurologic Disease and Therapy" with the series editor William C. Koller. The stated purpose of this small volume of 360 pages is to be "an available reference for those responsible for the primary medical care of pediatric patients who have epileptic seizures." With well known contributors recognized for their expertise in the field of pediatric epileptology, the editors have compiled a very readable and timely review of the expanding field of epileptic disorders in children. The clinical approach, classification of epileptic seizures and epilepsies, and the use of anti-epileptic drugs were reviewed in the initial chapters. Then, the treatment of generalised seizures and partial seizures was outlined, as well as seizures in the first week of life. Additional chapters covered status epilepticus, febrile seizures and myoclonic epilepsy. Of particular interest was the second half of the book covering behavioural changes, adverse effects of antiepileptic drugs, the adolescent female and pregnancy. The surgical treatment of partial seizures with cortical resection and callosotomy was covered in two separate chapters, including temporal and extratemporal resections, hemispherectomy and callosotomy. Some of the EEGs were very poor in their reproduction and would have benefited from high contrast photographic reproduction. The section on status epilepticus was almost exclusively focused on generalised tonic clonic status epilepticus with scant mention of non-convulsive status epilepticus or epilepsia partialis continua. Most cases in children are due to chronic focal encephalitis (Rasmussen syndrome) which was mentioned only in a single sentence. T h e typical variation in a multi-authored text is minimised by a firm editorial hand, giving consistency across chapters, even by different authors with obviously different styles. T h e chapter on laboratory studies in patients with epilepsy could benefit from a few illustrations of the modalities of neuroimaging, particularly functional imaging. On the other hand, the section on catamenial seizures is the most detailed discussion I have reviewed on this topic, with up-to-date references. The chapter on access to community support services listed a n u m b e r of agencies (mainly American) with addresses and telephone n u m b e r s which would allow a primary health care professional to access these services without difficulty. On the other hand, an international body such as the International League Against Epilepsy and some non-American sources can be similarly listed with benefit. In summary, this " H a n d b o o k of Pediatric Epilepsy" fulfils its m a n d a t e very well. A very complex field is reviewed and appropriate references were made to the recent medical literature. Although it does not have the depth of a single-authored text such as Aicardi or O ' D o n o h u e ' s , the balanced approach and the broad coverage of a n u m b e r of issues pertinent to the child with an epileptic disorder deserves at least a place of prominence in the library of paediatri-