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Essentials of clinical neurophysiology
274 Book Reviews three editors have ensured that the book is well laid out, is organized with lots of tables and is easy to read. The MRI reproductions are excellent. This book would enhance the library of any practising neurologist and is an essential addition to those with a particular interest in MS. LESLIE SEDAL ST VINCENT'S HOSPITAL MELBOURNE
Essentials of Clinical Neurophysiology Karl E: Misulis Butterworth-Heinernann 1997 378 pp ISBN: 0 7506 9887 X The Essentials of Clinical Neurophysiology is a primer of basic principles and clinical applications in neurophysiology. Misulis covers a broad range of investigations, including EEG, nerve conduction studies, EMG, evoked potentials, polysomnography and intraoperative and ICU monitoring. It has a strong introductory section on basic electronics and electrical properties of biological tissues; it is easy to read and covers these fundamentals extremely well. The weaknesses of the book are largely apparent in the clinically applied sections. Many of these weaknesses are simply due to the necessary brevity required for a primer covering such a diverse array of procedures. It would be difficult for a junior doctor to begin reading EEGs after simply reading the EEG section of the book. For example, although normal variant patterns and artefacts of non-cerebral origin are frequently concisely described, this section would be greatly enhanced for the beginner by including illustrations of representative examples. It would be difficult for the novice to recognize phenomena such as 14 and 6 positive spikes and SREDA from the descriptions alone. There is also the occasional error in the editing in this section of the book, where, for example, the periodic discharges of SSPE are described as having a higher frequency than those in herpes simplex encephalitis in the section on herpes encephalitis. In the following section on SSPE the long latency between periodic discharges in this condition is appropriately stressed. The section on nerve conduction studies and electromyography is beset by similar problems. Although the basic principles are well discussed, the table on recommended evaluation on common neuromuscular problems is occasionally misleading in its brevity. For example, the evaluation of foot drop nearly always involves more than simply conducting the peroneal motor nerve and performing needle EMG solely on the muscles innervated by this nerve. As a minimum, a clinically uninvolved lower limb motor nerve should also be studied in such a situation to exclude an occult predisposing neuropathy. By comparison the table recommends a much more extensive work up for the evaluation of meralgia paraesthetica, a diagnosis which in my experience is rarely enhanced by neurophysiological assessment except to exclude a coexisting neuropathy. As a primer for students, junior doctors and technical staff intending to familarize themselves with the field of clinical neurophysiology the book is concise, easy to read and broad ranging. Anyone intending to practise in the area, however, would ultimately be better served to study the relevant major texts as set out in the useful bibliography at the end of the book. BRUCE DAY MELBOURNE
Journal of Clinical Neuroscience (1999) 6(3), 272-274
Linac Radiosurgery; A Practical Guide William Friedman, John Buatti, Francis Bova Pub/isher Springer-Verlag 1997 176 pp ISBN: 0 387 94698 5 Experience is a great teacher. When we started our radiosurgery practice in 1990 there were only a limited number of centres worldwide practising in this field, and while there were occasional meetings that one could go to in which the refinements of actual treatment delivery were discussed, these were few and far between. There was certainly no published documents on how best to deliver this treatment. Thus for those who are beginning in the field this type of book has very definite value. Importantly, it discusses aspects such as headring application, not so much in the normal circumstance but in those difficult situations such as the patient with a large head, and where a previous craniotomy has taken place. Typically the circumstances that one sees in any 'training case' is the straight forward situation, thus to encounter description about what to do in the less common circumstance is certainly appreciated. Guidance through the situation such as the patient with severe kyphoscoliesis is also invaluable as one is gaining experience. The chapters cover aspects such as the necessary types of imaging for the more common situations and the types of doses necessary to provide for optimal control against a background of the likelihood of complications (usually related to the volume treated). One needs to be aware that while this treatment offers significant benefit to many patients, it also has the potential given the high dose employed as a single fraction, to cause significant deficit. It is thus pleasing that in the chapter titled 'Dose Selection' that the first general principal is 'first, do no harm'. There are quite specific limits to what size lesions can be treated, against the background of the particular part of the brain in which that lesion exists. The reference section at the end of the book is certainly an extensive one giving a background to this treatment technique and the particular conditions treated. One needs to be aware, however, that it was even at the time of publication somewhat dated, that there are always new articles coming out covering this topic. The only significant drawback is the fact that this book represents a particular version of Linac based radiosurgery, ie. the University of Florida developed method. They have developed a particular treatment method involving a radiosurgery subsystem designed to 'correct' for gantry sag and table rotation inaccuracies. R is fair to say that there is some debate as to whether this subsystem is necessary for accurate treatment delivery. Also the planning system mentioned in the book is a 'home grown' but now commercially available system that is different to other commercially available systems. These caveats, however, are not designed to indicate that the book does not have value for somebody using a different system. One can certainly still gain value from what is described in this book, as it covers many of the aspects as stated that are not freely available, unless one spends time in a department that has been involved with this for a considerable time frame. Who would most gain from having this book? It is certainly a limited market, however, I would suggest it is for anyone considering embarking upon radiosurgery or has recently established that type of programme. There is information to gain from reading this book irrespective of which particular type of system one is using. The authors are committed practitioners in this field, and there is always a place for 'how I do it' type books such as this. ROBERT SMEE SYDt,~Y
© 1999 Harcourt Brace & Co. Ltd
Essentials of Clinical Neurophysiology Karl E: Misulis Butterworth-Heinernann 1997 378 pp ISBN: 0 7506 9887 X The Essentials of Clinical Neurophysiology is a primer of basic principles and clinical applications in neurophysiology. Misulis covers a broad range of investigations, including EEG, nerve conduction studies, EMG, evoked potentials, polysomnography and intraoperative and ICU monitoring. It has a strong introductory section on basic electronics and electrical properties of biological tissues; it is easy to read and covers these fundamentals extremely well. The weaknesses of the book are largely apparent in the clinically applied sections. Many of these weaknesses are simply due to the necessary brevity required for a primer covering such a diverse array of procedures. It would be difficult for a junior doctor to begin reading EEGs after simply reading the EEG section of the book. For example, although normal variant patterns and artefacts of non-cerebral origin are frequently concisely described, this section would be greatly enhanced for the beginner by including illustrations of representative examples. It would be difficult for the novice to recognize phenomena such as 14 and 6 positive spikes and SREDA from the descriptions alone. There is also the occasional error in the editing in this section of the book, where, for example, the periodic discharges of SSPE are described as having a higher frequency than those in herpes simplex encephalitis in the section on herpes encephalitis. In the following section on SSPE the long latency between periodic discharges in this condition is appropriately stressed. The section on nerve conduction studies and electromyography is beset by similar problems. Although the basic principles are well discussed, the table on recommended evaluation on common neuromuscular problems is occasionally misleading in its brevity. For example, the evaluation of foot drop nearly always involves more than simply conducting the peroneal motor nerve and performing needle EMG solely on the muscles innervated by this nerve. As a minimum, a clinically uninvolved lower limb motor nerve should also be studied in such a situation to exclude an occult predisposing neuropathy. By comparison the table recommends a much more extensive work up for the evaluation of meralgia paraesthetica, a diagnosis which in my experience is rarely enhanced by neurophysiological assessment except to exclude a coexisting neuropathy. As a primer for students, junior doctors and technical staff intending to familarize themselves with the field of clinical neurophysiology the book is concise, easy to read and broad ranging. Anyone intending to practise in the area, however, would ultimately be better served to study the relevant major texts as set out in the useful bibliography at the end of the book. BRUCE DAY MELBOURNE
Journal of Clinical Neuroscience (1999) 6(3), 272-274
Linac Radiosurgery; A Practical Guide William Friedman, John Buatti, Francis Bova Pub/isher Springer-Verlag 1997 176 pp ISBN: 0 387 94698 5 Experience is a great teacher. When we started our radiosurgery practice in 1990 there were only a limited number of centres worldwide practising in this field, and while there were occasional meetings that one could go to in which the refinements of actual treatment delivery were discussed, these were few and far between. There was certainly no published documents on how best to deliver this treatment. Thus for those who are beginning in the field this type of book has very definite value. Importantly, it discusses aspects such as headring application, not so much in the normal circumstance but in those difficult situations such as the patient with a large head, and where a previous craniotomy has taken place. Typically the circumstances that one sees in any 'training case' is the straight forward situation, thus to encounter description about what to do in the less common circumstance is certainly appreciated. Guidance through the situation such as the patient with severe kyphoscoliesis is also invaluable as one is gaining experience. The chapters cover aspects such as the necessary types of imaging for the more common situations and the types of doses necessary to provide for optimal control against a background of the likelihood of complications (usually related to the volume treated). One needs to be aware that while this treatment offers significant benefit to many patients, it also has the potential given the high dose employed as a single fraction, to cause significant deficit. It is thus pleasing that in the chapter titled 'Dose Selection' that the first general principal is 'first, do no harm'. There are quite specific limits to what size lesions can be treated, against the background of the particular part of the brain in which that lesion exists. The reference section at the end of the book is certainly an extensive one giving a background to this treatment technique and the particular conditions treated. One needs to be aware, however, that it was even at the time of publication somewhat dated, that there are always new articles coming out covering this topic. The only significant drawback is the fact that this book represents a particular version of Linac based radiosurgery, ie. the University of Florida developed method. They have developed a particular treatment method involving a radiosurgery subsystem designed to 'correct' for gantry sag and table rotation inaccuracies. R is fair to say that there is some debate as to whether this subsystem is necessary for accurate treatment delivery. Also the planning system mentioned in the book is a 'home grown' but now commercially available system that is different to other commercially available systems. These caveats, however, are not designed to indicate that the book does not have value for somebody using a different system. One can certainly still gain value from what is described in this book, as it covers many of the aspects as stated that are not freely available, unless one spends time in a department that has been involved with this for a considerable time frame. Who would most gain from having this book? It is certainly a limited market, however, I would suggest it is for anyone considering embarking upon radiosurgery or has recently established that type of programme. There is information to gain from reading this book irrespective of which particular type of system one is using. The authors are committed practitioners in this field, and there is always a place for 'how I do it' type books such as this. ROBERT SMEE SYDt,~Y
© 1999 Harcourt Brace & Co. Ltd