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Epilepsy. Current approaches to diagnosis and treatment
376
Electroencephalof;raphy and clinical Neurophvsioloyo~', 1990~ 76: 376- 378 Elsevier Scientific Publishers Ireland, Ltd.
Book Reviews edited by John R. Hughes and P.M. Rossini Brainstem control of wakefulness and sleep. - M. Steriade and R.W. McCarley (Plenum Press, New York, 1990, 499 p., U.S. $85.00) In the preface the authors point out that they had the choice of producing an edited volume with invited chapter authors or writing the book on wake and sleep themselves. They decided on the latter without any claim on encyclopedism for all aspects of this topic. The result is somewhat of a surprise to this reviewer and in a few words consists of the most detailed neuroanatomical and neurophysiological treatise on any topic that this reviewer has seen for many years, The 13 chapters vary considerably as to the extent of detailed analysis that is included. In chapter 1 the changing concepts of the relevant mechanisms are surveyed, emphasizing the 3 major discoveries that belong to (1) Bremer, (2) Moruzzi and (3) Jouvet. The authors clarify the importance of the experiments on (1) enc6phale isol~ and cerveau isol& (2) reticular formation, and (3) rapid eye movements. Even in this chapter that represents a historical survey, the reader will taste the flavor of this book when the figures with original data are viewed. Chapter 2 is on methodological advances and will feature many neuroanatomical techniques, including immunohistochemical, anterograde and retrograde tracing techniques, The next 2 chapters deal with afferents and efferents to and from the brain-stem core and will look like both a detailed neuroanatomical journal article and a neurophysiological treatise of single neuron activity. At this point the reader who demands the original data and all of it from the world literature will be delighted and the reader who wants just a summary of all these data will be disappointed. An example of the detail can be illustrated by a typical section heading: Bulbar T F G Neurons Sending Axons in the Ipsilateral M L F (BFTG-toiMLF) Neurons or Contralateral M L F (BFTG-to-cMLF) Neutons. Chapter 5 is on the relationship to behavioral control and will continue to show the reader the original data for each and every point, found also in the next chapter on neurotransmitter, modulated ionic currents. In chapter 7 this readership will likely show considerable interest, since synchronized brain oscillations are the topic. The authors make the point that the mechanisms of alpha waves are poorly understood, while the cellular bases of spindles and theta waves have been disclosed, For the former the two main theories are the ones proposed by Andersen and Andersson and also the one of Steriade. One of the conclusions here is that the blockage of spindle rhythms during EEG desynchronization results from a decoupling in the synaptic network of reticular thalamic nuclei by brain-stem and basal forebrain axons,
After a detailed survey of brain-stem ascending systems, an excellent chapter is found on the ponto-geniculo-occipital (PGO) waves, an area of special interest to the two authors of this book. Motor systems and neuronal control of sleep-wake states will follow the major theme of the book - extreme detail of all relevant data. In the penultimate chapter, REM sleep is discussed, especially with regard to Lotka-Volterra equations to describe interactions of populations of neurons. Many readers will be attracted to the last chapter on dreaming and sleep disorders. Here original data are again presented, but more of a summary of data is also found here than in other chapters with considerable and surprising emphasis on the neurobiologically based dream theory of Sigmund Freud. This book is special and different from most reviewed in this journal. For the readers who want to survey tons of original data on the brain-stem to decide for themselves the conclusions drawn from these data, this book is an extraordinary example of that enormous effort on the part of Steriade and McCarley. For the reader who wants a summary of brain-stem mechanisms related to sleep and wakefulness, this book will be definitely overwhelming. As an example of the latter point, there are nearly 50 pages of references, numbering close to 1000, rarely from this journal. One more comment is that the authors have accomplished an outstanding feat to put all of these data together in one large volume. John R. Hughes
Universi(v of Illinois Medical Center, Chicago, IL 60612 (U.S.A.)
Epilepsy. Current approaches to diagnosis and treatment. D.B. Smith (Ed.) (Raven Press, New York, 1990, 276 p., U.S. $85.00) In the preface the editor appropriately asks whether still another book on epilepsy is needed, indicating that this one will not provide a comprehensive overview, but instead is to be directed to the primary care physician. The 13 chapters, divided into 3 sections, were written by 17 authors, most of whom are well known. The first chapter is the usual one on classification, but is modified well by Cereghino by his adding the treatment implications. Some readers may question why the author described the spikes in benign epilepsy of childhood as 'blunt,' claimed an uncertain prognosis in childhood epilepsy with occipital paroxysms and used the term 'grand real' after the classifica-
0013-4649/90/$03.50 ~ 1990 Elsevier Scientific Publishers Ireland, Ltd.
BOOK REVIEWS tion made clear that generalized tonic-clonic was the preferred term. However, the author has written a clear, concise and helpful chapter. Of greatest interest to this readership is the next chapter by Kramer on EEG. One small problem for this reviewer was the use of the term, epileptogenic, as a modifier of an EEG discharge. The -genic refers to epilepsy producing and properly modifies a focus, not an EEG event, but only epileptiform should be an adjective for the EEG spike. Other questions are that positive spikes at 14 and 6 / s e c are not usually bilaterally synchronous, as was stated (p. 37), the high amplitude frontal form of 6 / s e e spike and wave complexes is said to be only a normal variant, the failure to mention tonic seizures associated with slow spike and wave complexes, which man 5' authors have reported as the most common type of seizure in this syndrome and the claim that costly shielded rooms are still necessary for magnetoencephalography, disregarding the new gradiometers, which no more are single channel, but can be 35-channel machines. On the other hand, the chapter is clearly written with some good illustrations. Prolonged EEG monitoring by King and advance neuroimaging techniques by Sackellares and Abou-Khalil are both well done. especially the discussion on PET scans which are presented in a balanced view. Dodson does his usual excellent job in dealing with the special problems of children, but still using the term, petit real. One problem appearing here and noted elsewhere is the discussion of rolandic epilepsy with the spikes on the centro-temporal areas and then adding that these spikes may occur on the occipital areas. Gastaut has designated these spikes as belonging to a separate clinical entity, which nov, seems well established as benign occipital epilepsy, rather than representing an uncommon focus for rolandic epilepsy, The editor (Smith) then presents a very helpful chapter on drug selection in adults. The use of tables and figures, especially the lists of advantages and disadvantages of the major anticonvulsants, will be most welcomed by the primary care physician for whom this book was written. Also, the conclusions are definite and therefore helpful, in contrast to other authors whose summaries may be only short comments about the problems under discussion. Next is a useful discussion on the elderly by Troupin and Johannessen whose only problem is the use of large page-size figures with tiny, nearly unreadable numbers on the abscissa and ordinate. Treiman has written an excellent chapter on special problems and especially well done is the section on the pregnant patient, enlarging the comments of Smith who briefly dealt with the same topic in his chapter, Also, worthy of note are the discussions on discontinuation of therapy and status epilepticus, the latter an area that Treiman knows well. Section II closes with Wyler's fine concise chapter on surgery. Psychosocial management (Green and Mercille) is brief, but well done before Blumer's excellent summary of psychiatric problems and Treiman's chapter on aggression which clearly presents well supported conclusions. The last chapter could have been the first on molecular mechanisms by Harris and DeLorenzo. Although well done, the primary care physician may not care a great deal about patch-clamp recording
377 and TTX-binding sites. The book ends in an appendix written by G u m n i t whose experience in epilepsy centers unfolds in a very readable and enjoyable account of the interplay of economics, politics and quality of care. This book has accomplished its goal by providing a helpful summary of epilepsy to the primary care physician. Only rarely does it go into too much detail and usually the authors have presented their points in a simplified manner. Although the cost is a bit high for the number of pages, the book is highly recommended for its intended audience and anyone else interested in a useful overview of epilepsy. John R. Hughes
Uni~,ersityoflllinois Medical Center, Chicago, 1L 60612 (U.S.A.)
The clinical relevance of kindling. - T.G. Bolwig and M.R. Trimble (Eds.) (Wiley, Chiehester, 1989, 302 p., U.N. $67.50) Since the discovery of the kindling phenomenon in 1967 by Goddard, hundreds of papers have appeared in neuroscientific journals with the anticipation and hope that this phenomenon would shed light on the pathophysiological explanation of epilepsy in man. This book is based on a symposium held in Denmark, Nov. 1988, and includes 29 contributors, mainly from Denmark, U.S.A., England and Canada. There are 17 chapters punctuated by a few pages of discussion appearing every 3 chapters or so. This reviewer read this book with interest, hoping to find more evidence that kindling does have clinical relevance in man. The first chapter by the senior editor lays the groundwork for the rest of the book by surveying the different clinical phenomena that could be explained by kindling. Racine and colleagues have contributed a great deal to this field, adding here the developments of kindling induced sprouting, the activation of astrocytes and the increased response of kindled cells to depolarizing pulses, as potential mechanisms to explain the phenomenon. Next is chemical kindling by Wasterlain el al., summarizing well for the reader by helpful tables the chemical kindling successes and failures, the positive or partial transfer of chemical and electrical effects and also the cellular changes in kindled brains. Antiepileptic drugs follow and again impressive tames are included to simplify for the reader the effects of all of the major anticonvulsants on the phenomenon. In general, phenobarbital and, to a lesser degree, phenytoin and carbamazepine inhibited kindled seizures, whereas ethosuximide exacerbated them. The second session begins with grafting of fetal neurons as a means of seizure suppression, showing that functional synaptic neurotransmission with host brain cells can modulate the excitability of an epileptic focus. Memory is the topic for Majkowski, showing a relationship between different types of after-discharge and impairment of memory retrieval. Further additions are also made by the next two authors whose belief is that seizures should be treated not only to reduce the number
Electroencephalof;raphy and clinical Neurophvsioloyo~', 1990~ 76: 376- 378 Elsevier Scientific Publishers Ireland, Ltd.
Book Reviews edited by John R. Hughes and P.M. Rossini Brainstem control of wakefulness and sleep. - M. Steriade and R.W. McCarley (Plenum Press, New York, 1990, 499 p., U.S. $85.00) In the preface the authors point out that they had the choice of producing an edited volume with invited chapter authors or writing the book on wake and sleep themselves. They decided on the latter without any claim on encyclopedism for all aspects of this topic. The result is somewhat of a surprise to this reviewer and in a few words consists of the most detailed neuroanatomical and neurophysiological treatise on any topic that this reviewer has seen for many years, The 13 chapters vary considerably as to the extent of detailed analysis that is included. In chapter 1 the changing concepts of the relevant mechanisms are surveyed, emphasizing the 3 major discoveries that belong to (1) Bremer, (2) Moruzzi and (3) Jouvet. The authors clarify the importance of the experiments on (1) enc6phale isol~ and cerveau isol& (2) reticular formation, and (3) rapid eye movements. Even in this chapter that represents a historical survey, the reader will taste the flavor of this book when the figures with original data are viewed. Chapter 2 is on methodological advances and will feature many neuroanatomical techniques, including immunohistochemical, anterograde and retrograde tracing techniques, The next 2 chapters deal with afferents and efferents to and from the brain-stem core and will look like both a detailed neuroanatomical journal article and a neurophysiological treatise of single neuron activity. At this point the reader who demands the original data and all of it from the world literature will be delighted and the reader who wants just a summary of all these data will be disappointed. An example of the detail can be illustrated by a typical section heading: Bulbar T F G Neurons Sending Axons in the Ipsilateral M L F (BFTG-toiMLF) Neurons or Contralateral M L F (BFTG-to-cMLF) Neutons. Chapter 5 is on the relationship to behavioral control and will continue to show the reader the original data for each and every point, found also in the next chapter on neurotransmitter, modulated ionic currents. In chapter 7 this readership will likely show considerable interest, since synchronized brain oscillations are the topic. The authors make the point that the mechanisms of alpha waves are poorly understood, while the cellular bases of spindles and theta waves have been disclosed, For the former the two main theories are the ones proposed by Andersen and Andersson and also the one of Steriade. One of the conclusions here is that the blockage of spindle rhythms during EEG desynchronization results from a decoupling in the synaptic network of reticular thalamic nuclei by brain-stem and basal forebrain axons,
After a detailed survey of brain-stem ascending systems, an excellent chapter is found on the ponto-geniculo-occipital (PGO) waves, an area of special interest to the two authors of this book. Motor systems and neuronal control of sleep-wake states will follow the major theme of the book - extreme detail of all relevant data. In the penultimate chapter, REM sleep is discussed, especially with regard to Lotka-Volterra equations to describe interactions of populations of neurons. Many readers will be attracted to the last chapter on dreaming and sleep disorders. Here original data are again presented, but more of a summary of data is also found here than in other chapters with considerable and surprising emphasis on the neurobiologically based dream theory of Sigmund Freud. This book is special and different from most reviewed in this journal. For the readers who want to survey tons of original data on the brain-stem to decide for themselves the conclusions drawn from these data, this book is an extraordinary example of that enormous effort on the part of Steriade and McCarley. For the reader who wants a summary of brain-stem mechanisms related to sleep and wakefulness, this book will be definitely overwhelming. As an example of the latter point, there are nearly 50 pages of references, numbering close to 1000, rarely from this journal. One more comment is that the authors have accomplished an outstanding feat to put all of these data together in one large volume. John R. Hughes
Universi(v of Illinois Medical Center, Chicago, IL 60612 (U.S.A.)
Epilepsy. Current approaches to diagnosis and treatment. D.B. Smith (Ed.) (Raven Press, New York, 1990, 276 p., U.S. $85.00) In the preface the editor appropriately asks whether still another book on epilepsy is needed, indicating that this one will not provide a comprehensive overview, but instead is to be directed to the primary care physician. The 13 chapters, divided into 3 sections, were written by 17 authors, most of whom are well known. The first chapter is the usual one on classification, but is modified well by Cereghino by his adding the treatment implications. Some readers may question why the author described the spikes in benign epilepsy of childhood as 'blunt,' claimed an uncertain prognosis in childhood epilepsy with occipital paroxysms and used the term 'grand real' after the classifica-
0013-4649/90/$03.50 ~ 1990 Elsevier Scientific Publishers Ireland, Ltd.
BOOK REVIEWS tion made clear that generalized tonic-clonic was the preferred term. However, the author has written a clear, concise and helpful chapter. Of greatest interest to this readership is the next chapter by Kramer on EEG. One small problem for this reviewer was the use of the term, epileptogenic, as a modifier of an EEG discharge. The -genic refers to epilepsy producing and properly modifies a focus, not an EEG event, but only epileptiform should be an adjective for the EEG spike. Other questions are that positive spikes at 14 and 6 / s e c are not usually bilaterally synchronous, as was stated (p. 37), the high amplitude frontal form of 6 / s e e spike and wave complexes is said to be only a normal variant, the failure to mention tonic seizures associated with slow spike and wave complexes, which man 5' authors have reported as the most common type of seizure in this syndrome and the claim that costly shielded rooms are still necessary for magnetoencephalography, disregarding the new gradiometers, which no more are single channel, but can be 35-channel machines. On the other hand, the chapter is clearly written with some good illustrations. Prolonged EEG monitoring by King and advance neuroimaging techniques by Sackellares and Abou-Khalil are both well done. especially the discussion on PET scans which are presented in a balanced view. Dodson does his usual excellent job in dealing with the special problems of children, but still using the term, petit real. One problem appearing here and noted elsewhere is the discussion of rolandic epilepsy with the spikes on the centro-temporal areas and then adding that these spikes may occur on the occipital areas. Gastaut has designated these spikes as belonging to a separate clinical entity, which nov, seems well established as benign occipital epilepsy, rather than representing an uncommon focus for rolandic epilepsy, The editor (Smith) then presents a very helpful chapter on drug selection in adults. The use of tables and figures, especially the lists of advantages and disadvantages of the major anticonvulsants, will be most welcomed by the primary care physician for whom this book was written. Also, the conclusions are definite and therefore helpful, in contrast to other authors whose summaries may be only short comments about the problems under discussion. Next is a useful discussion on the elderly by Troupin and Johannessen whose only problem is the use of large page-size figures with tiny, nearly unreadable numbers on the abscissa and ordinate. Treiman has written an excellent chapter on special problems and especially well done is the section on the pregnant patient, enlarging the comments of Smith who briefly dealt with the same topic in his chapter, Also, worthy of note are the discussions on discontinuation of therapy and status epilepticus, the latter an area that Treiman knows well. Section II closes with Wyler's fine concise chapter on surgery. Psychosocial management (Green and Mercille) is brief, but well done before Blumer's excellent summary of psychiatric problems and Treiman's chapter on aggression which clearly presents well supported conclusions. The last chapter could have been the first on molecular mechanisms by Harris and DeLorenzo. Although well done, the primary care physician may not care a great deal about patch-clamp recording
377 and TTX-binding sites. The book ends in an appendix written by G u m n i t whose experience in epilepsy centers unfolds in a very readable and enjoyable account of the interplay of economics, politics and quality of care. This book has accomplished its goal by providing a helpful summary of epilepsy to the primary care physician. Only rarely does it go into too much detail and usually the authors have presented their points in a simplified manner. Although the cost is a bit high for the number of pages, the book is highly recommended for its intended audience and anyone else interested in a useful overview of epilepsy. John R. Hughes
Uni~,ersityoflllinois Medical Center, Chicago, 1L 60612 (U.S.A.)
The clinical relevance of kindling. - T.G. Bolwig and M.R. Trimble (Eds.) (Wiley, Chiehester, 1989, 302 p., U.N. $67.50) Since the discovery of the kindling phenomenon in 1967 by Goddard, hundreds of papers have appeared in neuroscientific journals with the anticipation and hope that this phenomenon would shed light on the pathophysiological explanation of epilepsy in man. This book is based on a symposium held in Denmark, Nov. 1988, and includes 29 contributors, mainly from Denmark, U.S.A., England and Canada. There are 17 chapters punctuated by a few pages of discussion appearing every 3 chapters or so. This reviewer read this book with interest, hoping to find more evidence that kindling does have clinical relevance in man. The first chapter by the senior editor lays the groundwork for the rest of the book by surveying the different clinical phenomena that could be explained by kindling. Racine and colleagues have contributed a great deal to this field, adding here the developments of kindling induced sprouting, the activation of astrocytes and the increased response of kindled cells to depolarizing pulses, as potential mechanisms to explain the phenomenon. Next is chemical kindling by Wasterlain el al., summarizing well for the reader by helpful tables the chemical kindling successes and failures, the positive or partial transfer of chemical and electrical effects and also the cellular changes in kindled brains. Antiepileptic drugs follow and again impressive tames are included to simplify for the reader the effects of all of the major anticonvulsants on the phenomenon. In general, phenobarbital and, to a lesser degree, phenytoin and carbamazepine inhibited kindled seizures, whereas ethosuximide exacerbated them. The second session begins with grafting of fetal neurons as a means of seizure suppression, showing that functional synaptic neurotransmission with host brain cells can modulate the excitability of an epileptic focus. Memory is the topic for Majkowski, showing a relationship between different types of after-discharge and impairment of memory retrieval. Further additions are also made by the next two authors whose belief is that seizures should be treated not only to reduce the number