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Atlas of epileptic seizures and syndromes
Book Reviews
good, although not ideal for reproductions, and the binding is solid and durable.
Child Neurology
Robert J. Baumann, MD Department of Neurology University of Kentucky
Edited by John H. Menkes and Harvey B. Sarnat. Sixth Edition. 1,280 pp., illustrated. Philadelphia: Lippincott Williams & Wilkins, 2000. $139.00. ISBN 0-7817-2385-X. Like clockwork, this widely respected reference book is updated every 5 years. These frequent revisions represent an enormous amount of work but accurately convey the senior author’s commitment to scientific accuracy. In many ways, this revision is like the others. The book’s basic organization remains the same (although with an additional chapter). Most importantly, the clarity of writing and of thought that has always distinguished this book is preserved. This continues to be a text with its own style, wherein the author clarifies a subject by a carefully written precis of the literature and not by the juxtaposition of tables and lists. In other ways, this edition represents a major transition. Another author, Harvey Sarnat, shares the title page and the number of assisting authors has increased to 17. This compares with eight co-authors in the fifth edition and five in the fourth edition. Surely, this reflects several realities, including the increasing complexity of child neurology. The text has also grown from 801 pages in 1985 and 964 pages in 1990 to 1,211 pages (excluding index) in this edition. This textbook’s style is most effective in the initial chapters, which review “Metabolic Diseases” and “Heredodegenerative Diseases.” The first chapter covers disorders with a known biochemical deficit, whereas the second chapter covers those with a presumed but still not defined biochemical explanation. Menkes is the sole author of these chapters, which exemplify his ability to integrate basic neuroscientific knowledge with clinical information in an economic but easy-to-read format. As always, the casual reader can find references to classical descriptions of the disorder, whereas the busy clinician can access the details of the most recent diagnostic tests and a review of the effectiveness of proposed treatments. These chapters continue to be a wonderful resource for medical students and house officers. Such readers will garner enough information to decide whether or not their patient might have a specific inborn error without having to review all of first-year biochemistry. Yet they come away from their reading with a knowledge of the underlying biochemistry that is more than just the memorized name of a defective enzyme or gene. In a few paragraphs, Menkes can make clear the biochemical pathology of kinky hair disease or the range of peroxisomal defects. With the addition of Sarnat to the title page comes a welcome expansion of the section on malformations. The first part of this chapter, “The New Neuroembryology,” integrates traditional descriptive embryology with recent insights derived from molecular genetics. A detailed yet readable review, it is difficult to imagine any reader, from medical student to professor, who would not find reading it a profitable investment. The second section of the chapter, which covers the standard malformations, also benefits from the integration of basic neuroscience and clinical information. Another noteworthy revision occurs with the co-authorship of Robert Rust who joins Menkes in revising the chapter on “Autoimmune and Postinfectious Diseases.” The section on childhood multiple sclerosis, which has always been strong, is joined by an equally extensive discussion of acute disseminated encephalomyelitis. The discussion of rheumatic chorea and of the so-called PANDAS has also been amplified. No book is perfect, and this one is no exception. There are tradeoffs. To keep the book within a reasonable size, there are fewer figures, pictures, and illustrations of imaging studies and pathology than most readers would prefer. Nevertheless, long-time readers of this textbook will be pleased with the new edition. It builds on the book’s traditional strengths. It is an excellent text for those who want a detailed but not exhaustive review that attentively integrates basic neuroscience into every section. The typeface is clear and easy to read, the paper quality is
164
PEDIATRIC NEUROLOGY
Vol. 26 No. 2
Lexington, KY
Atlas of Epileptic Seizures and Syndromes Edited by Hans O. Lu¨ders and Soheyl Noachtar. 204 pp. with CD-ROM, illustrated. Philadelphia: WB Saunders, 2001. $89.00. ISBN 0-72166946-8. Pediatric electroencephalographers might approach this book with two hopes—to understand the classification system proposed by Lu¨ders et al. and to refresh their knowledge about the electroencephalographic (EEG) aspects of epileptic syndromes. I was a bit disappointed. The atlas is accompanied by a CD-ROM, which provides excellent videos that illustrate seizure and epilepsy types. The CD connects with a website to display the videos that require a very modern computer with up-to-date software. I needed help from our departmental computer technician. The atlas itself is 204 pages long and is divided into 12 sections. After a brief introduction, the next 12 sections, covering 50 pages, are mostly text and illustrations related to the text. These sections explain in detail why Lu¨ders et al. developed their classification schema, what it looks like, and how to use it. The next section covers 146 pages and is devoted to illustrative cases. The cases are summarized in the text and are well illustrated on the CD-ROM. Details including ictal recordings and imaging studies support the authors’ diagnoses and classification scheme. If you work through these cases you will be “fluent” in the Lu¨ders scheme. The illustrations are excellent and very clear. The EEG recordings are beautifully reproduced with very good commentaries about the findings. The electrode names expand on the 10 –20 system without explanation—a potential problem for the nonexpert. The last section has a crucial page that gives the symbols that are used in all of the subdural recordings that illustrate many of the cases. It is important to look at these before viewing the illustrations. The classification of seizures proposed by Lu¨ders and Noachtar is different from that of the International League Against Epilepsy (ILAE). The authors argue convincingly that the ILAE system has some important flaws. For example, much of the ILAE system requires detailed knowledge of the EEG and other patient characteristics to classify the seizure, let alone the syndrome. The system of Lu¨ders and Noachtar is based solely on what actually is observed and experienced—the clinical semiology. So if a patient stops and stares with a few eye blinks and appears unconscious, the seizure is defined as “dialeptic.” In the ILAE classification, this attack might be an absence but it might also be a partial complex seizure—you cannot tell without the EEG and knowledge of other features about the patient. If an absence seizure is accompanied by a lot of automatisms it is classified by Lu¨ders and Noachtar as automotor—again, without the EEG you cannot be sure whether this is a complex partial seizure. Lu¨ders and Noachtar clearly discuss the importance, in partial epilepsy, of the distinction between the epileptic zone and the symptomatic zone. If seizures begin in a “noneloquent” cortex, they may spread a considerable distance before creating recognizable symptoms. I particularly liked the emphasis on “negative” effects of seizure discharge to help explain this concept. For example, if a seizure arises in a part of the brain devoted to calculation, then patients only realize the effect of the seizure if they are calculating at the time. The seizure becomes symptomatic only when they note their left hand twitching. I do not wish to judge whether the system of Lu¨ders and Noachtar really produces better communication about epilepsy than the system of the ILAE. The problem is that the ILAE system, with all of its flaws, is widely used, and Lu¨ders system is fighting an uphill battle. These authors retain many of the terms used in the ILAE system but add many of their
© 2002 by Elsevier Science Inc. All rights reserved. PII S0887-8994(01)00373-3 ● 0887-8994/02/$—see front matter
own, such as dialeptic. Only in a center actively using this terminology will the seizure description and epilepsy classification be understood. For the child neurologist, however, the book may be disappointing. There are few pediatric cases, and the richness of many pediatric epilepsy syndromes is missing. The authors clearly acknowledge this shortcoming. The video illustrations are restricted to West syndrome, LennoxGastaut, absence (all collapsed into one syndrome), benign rolandic, and juvenile myoclonic epilepsy. All other cases fall into symptomatic and cryptogenic partial categories. Disorders such as benign neonatal familial seizures, severe myoclonic epilepsy of infancy, and benign occipital epilepsy are not shown in detail. I have a few bones to pick with the authors about some of the details. The authors use the term benign focal epilepsy of childhood, which is a concept to which I personally have a difficult time relating. Benign rolandic is a distinct disorder and should not be confused with other partial epilepsies in children. The role of febrile seizures as antecedents
for mesial temporal lobe epilepsy is much more complex than the text would lead one to believe. I still think that all epilepsy with absence is not the same, and disorders such as myoclonic absence are very distinct. If you want to refresh your knowledge of the clinical/EEG features of many childhood-onset epilepsy syndromes, this atlas and video are not sufficient. So who might best make use of this book and CD? Neurology trainees and, in particular, those interested in epilepsy should look at it, at least to understand the many reasons why the ILAE classification system is inadequate and to know that at least someone has an alternative. Working through the cases on the CD-ROM is an excellent introduction to adult epileptic disorders. Peter Camfield, MD Department of Pediatrics Dalhousie University and the IWK Health Center Halifax, Nova Scotia, Canada
Book Reviews 165
good, although not ideal for reproductions, and the binding is solid and durable.
Child Neurology
Robert J. Baumann, MD Department of Neurology University of Kentucky
Edited by John H. Menkes and Harvey B. Sarnat. Sixth Edition. 1,280 pp., illustrated. Philadelphia: Lippincott Williams & Wilkins, 2000. $139.00. ISBN 0-7817-2385-X. Like clockwork, this widely respected reference book is updated every 5 years. These frequent revisions represent an enormous amount of work but accurately convey the senior author’s commitment to scientific accuracy. In many ways, this revision is like the others. The book’s basic organization remains the same (although with an additional chapter). Most importantly, the clarity of writing and of thought that has always distinguished this book is preserved. This continues to be a text with its own style, wherein the author clarifies a subject by a carefully written precis of the literature and not by the juxtaposition of tables and lists. In other ways, this edition represents a major transition. Another author, Harvey Sarnat, shares the title page and the number of assisting authors has increased to 17. This compares with eight co-authors in the fifth edition and five in the fourth edition. Surely, this reflects several realities, including the increasing complexity of child neurology. The text has also grown from 801 pages in 1985 and 964 pages in 1990 to 1,211 pages (excluding index) in this edition. This textbook’s style is most effective in the initial chapters, which review “Metabolic Diseases” and “Heredodegenerative Diseases.” The first chapter covers disorders with a known biochemical deficit, whereas the second chapter covers those with a presumed but still not defined biochemical explanation. Menkes is the sole author of these chapters, which exemplify his ability to integrate basic neuroscientific knowledge with clinical information in an economic but easy-to-read format. As always, the casual reader can find references to classical descriptions of the disorder, whereas the busy clinician can access the details of the most recent diagnostic tests and a review of the effectiveness of proposed treatments. These chapters continue to be a wonderful resource for medical students and house officers. Such readers will garner enough information to decide whether or not their patient might have a specific inborn error without having to review all of first-year biochemistry. Yet they come away from their reading with a knowledge of the underlying biochemistry that is more than just the memorized name of a defective enzyme or gene. In a few paragraphs, Menkes can make clear the biochemical pathology of kinky hair disease or the range of peroxisomal defects. With the addition of Sarnat to the title page comes a welcome expansion of the section on malformations. The first part of this chapter, “The New Neuroembryology,” integrates traditional descriptive embryology with recent insights derived from molecular genetics. A detailed yet readable review, it is difficult to imagine any reader, from medical student to professor, who would not find reading it a profitable investment. The second section of the chapter, which covers the standard malformations, also benefits from the integration of basic neuroscience and clinical information. Another noteworthy revision occurs with the co-authorship of Robert Rust who joins Menkes in revising the chapter on “Autoimmune and Postinfectious Diseases.” The section on childhood multiple sclerosis, which has always been strong, is joined by an equally extensive discussion of acute disseminated encephalomyelitis. The discussion of rheumatic chorea and of the so-called PANDAS has also been amplified. No book is perfect, and this one is no exception. There are tradeoffs. To keep the book within a reasonable size, there are fewer figures, pictures, and illustrations of imaging studies and pathology than most readers would prefer. Nevertheless, long-time readers of this textbook will be pleased with the new edition. It builds on the book’s traditional strengths. It is an excellent text for those who want a detailed but not exhaustive review that attentively integrates basic neuroscience into every section. The typeface is clear and easy to read, the paper quality is
164
PEDIATRIC NEUROLOGY
Vol. 26 No. 2
Lexington, KY
Atlas of Epileptic Seizures and Syndromes Edited by Hans O. Lu¨ders and Soheyl Noachtar. 204 pp. with CD-ROM, illustrated. Philadelphia: WB Saunders, 2001. $89.00. ISBN 0-72166946-8. Pediatric electroencephalographers might approach this book with two hopes—to understand the classification system proposed by Lu¨ders et al. and to refresh their knowledge about the electroencephalographic (EEG) aspects of epileptic syndromes. I was a bit disappointed. The atlas is accompanied by a CD-ROM, which provides excellent videos that illustrate seizure and epilepsy types. The CD connects with a website to display the videos that require a very modern computer with up-to-date software. I needed help from our departmental computer technician. The atlas itself is 204 pages long and is divided into 12 sections. After a brief introduction, the next 12 sections, covering 50 pages, are mostly text and illustrations related to the text. These sections explain in detail why Lu¨ders et al. developed their classification schema, what it looks like, and how to use it. The next section covers 146 pages and is devoted to illustrative cases. The cases are summarized in the text and are well illustrated on the CD-ROM. Details including ictal recordings and imaging studies support the authors’ diagnoses and classification scheme. If you work through these cases you will be “fluent” in the Lu¨ders scheme. The illustrations are excellent and very clear. The EEG recordings are beautifully reproduced with very good commentaries about the findings. The electrode names expand on the 10 –20 system without explanation—a potential problem for the nonexpert. The last section has a crucial page that gives the symbols that are used in all of the subdural recordings that illustrate many of the cases. It is important to look at these before viewing the illustrations. The classification of seizures proposed by Lu¨ders and Noachtar is different from that of the International League Against Epilepsy (ILAE). The authors argue convincingly that the ILAE system has some important flaws. For example, much of the ILAE system requires detailed knowledge of the EEG and other patient characteristics to classify the seizure, let alone the syndrome. The system of Lu¨ders and Noachtar is based solely on what actually is observed and experienced—the clinical semiology. So if a patient stops and stares with a few eye blinks and appears unconscious, the seizure is defined as “dialeptic.” In the ILAE classification, this attack might be an absence but it might also be a partial complex seizure—you cannot tell without the EEG and knowledge of other features about the patient. If an absence seizure is accompanied by a lot of automatisms it is classified by Lu¨ders and Noachtar as automotor—again, without the EEG you cannot be sure whether this is a complex partial seizure. Lu¨ders and Noachtar clearly discuss the importance, in partial epilepsy, of the distinction between the epileptic zone and the symptomatic zone. If seizures begin in a “noneloquent” cortex, they may spread a considerable distance before creating recognizable symptoms. I particularly liked the emphasis on “negative” effects of seizure discharge to help explain this concept. For example, if a seizure arises in a part of the brain devoted to calculation, then patients only realize the effect of the seizure if they are calculating at the time. The seizure becomes symptomatic only when they note their left hand twitching. I do not wish to judge whether the system of Lu¨ders and Noachtar really produces better communication about epilepsy than the system of the ILAE. The problem is that the ILAE system, with all of its flaws, is widely used, and Lu¨ders system is fighting an uphill battle. These authors retain many of the terms used in the ILAE system but add many of their
© 2002 by Elsevier Science Inc. All rights reserved. PII S0887-8994(01)00373-3 ● 0887-8994/02/$—see front matter
own, such as dialeptic. Only in a center actively using this terminology will the seizure description and epilepsy classification be understood. For the child neurologist, however, the book may be disappointing. There are few pediatric cases, and the richness of many pediatric epilepsy syndromes is missing. The authors clearly acknowledge this shortcoming. The video illustrations are restricted to West syndrome, LennoxGastaut, absence (all collapsed into one syndrome), benign rolandic, and juvenile myoclonic epilepsy. All other cases fall into symptomatic and cryptogenic partial categories. Disorders such as benign neonatal familial seizures, severe myoclonic epilepsy of infancy, and benign occipital epilepsy are not shown in detail. I have a few bones to pick with the authors about some of the details. The authors use the term benign focal epilepsy of childhood, which is a concept to which I personally have a difficult time relating. Benign rolandic is a distinct disorder and should not be confused with other partial epilepsies in children. The role of febrile seizures as antecedents
for mesial temporal lobe epilepsy is much more complex than the text would lead one to believe. I still think that all epilepsy with absence is not the same, and disorders such as myoclonic absence are very distinct. If you want to refresh your knowledge of the clinical/EEG features of many childhood-onset epilepsy syndromes, this atlas and video are not sufficient. So who might best make use of this book and CD? Neurology trainees and, in particular, those interested in epilepsy should look at it, at least to understand the many reasons why the ILAE classification system is inadequate and to know that at least someone has an alternative. Working through the cases on the CD-ROM is an excellent introduction to adult epileptic disorders. Peter Camfield, MD Department of Pediatrics Dalhousie University and the IWK Health Center Halifax, Nova Scotia, Canada
Book Reviews 165