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Fatigue, multiple sclerosis, and clinical practice
Media Watch
Finding the “epileptogenic zone” This volume gives an overview of various techniques used to locate areas of the cortex important for presurgical diagnostics in patients with epilepsy. 15 years ago Hans Lüders derived these hypothetical zones from the earlier work of Bancaud, Penfield, and Jasper. Although the “epileptogenic zone” cannot be measured directly, several diagnostic tools have been used in an attempt to define the location and boundaries of the “epileptic zone”. The volume is divided into four sections; the first describes the concept of different cortical zones which are an index of the location and extent of the epileptogenic zone. Neurophysiological and functional imaging techniques are described in the second section. The relative value of application of these diagnostic techniques with regard to different causes is discussed in section 3 and some examples of ongoing clinical research reported in section 4. The text is well structured and the figures and tables support the information given in the text. However, many of the keywords in the text are only scarcely listed in the subject index. Most of the contributing authors are associated with the Cleveland Clinic School and the approach to different causes in presurgical assessment is interesting. Some of the information presented is not
extensive enough—eg, first reports of findings from 1992 rather than earlier. The chapter on PET includes a detailed history of its development. I think the affective sphere should have been included in the categories of seizure semiology: sensorial, autonomic, consciousness, and motor sphere. The autonomic sphere could have been discussed in more detail, particularly localisation and lateralisation—eg, piloerection and sexual activity. Although magnetoencephalography is covered, there is no chapter on magnetic resonance spectroscopy. Findings of metabolic-pathway lateralisation associated with seizure outcome and neuropsychological postoperative outcome are therefore also missing. This book is worth reading for its coverage of many concepts of localisation, but these must be put into context. Research of the past years has highlighted the complex neural network of the brain; we cannot only think in hypothetically defined zones.
Handbook of Clinical Neurophysiology, Volume 3: Presurgical Assessment of the Epilepsies with Clinical Neurophysiology and Functional Imaging Edited by Felix Rosenow and Hans O Lüders Elsevier, 2004 £150, 582 pages ISBN 0 444 51046 X
Hermann Stefan [email protected] This book is published by Elsevier, of which The Lancet Neurology is part.
Fatigue, multiple sclerosis, and clinical practice Dr Krupp’s monograph is written for physicians and other paramedical professionals who care for patients with multiple sclerosis (MS). It provides a concise overview of the important and under-recognised topic of fatigue in MS. Difficulties in quantifying patients’ subjective experience of fatigue make the topic of this book difficult to address. I found the text readable and informative. The text logically explores the topic in a series of concise well-referenced chapters. The first chapters discuss definitions of MS-related fatigue and possible methods of measuring fatigue, including practical advice on various scales that can be used to quantify fatigue. There is much speculation on the cause of fatigue symptoms and I found the chapter on pathophysiology a useful discussion and reasonable reference. However, the chapter on pathophysiology could be omitted by busy clinicians who are mostly reading this text to gain practical advice to help in their management of patients. The relation between MS-related fatigue and depressive symptoms or affective state is another controversial subject. Dr Krupp gave a brief but informative discussion of this association, including reasons why these symptoms should be differentiated. A brief chapter addresses history and examination, and the text concludes with two chapters that cover nonpharmacological and pharmacological approaches to treatment. The discussion of pharmacological treatments http://neurology.thelancet.com Vol 4 January 2005
includes a brief discussion of any relevant clinical trials and practical guidelines on the use of individual drugs. These chapters are, in my opinion, the most useful in the monograph. Neurologists should be aware of strategies to improve the fatigue that patients with MS experience, because this symptom is commonly a very disabling part of the disease. The text includes references to recently published articles and the index is adequate. I especially liked the useful summary tables and the brief conclusions paragraph that ends each chapter. The author has published several papers on fatigue in MS and has a comprehensive knowledge of this topic. Overall I enjoyed reading this book. It is a concise synopsis of an important topic, and would be of use to neurologists, other physicians, and paramedical personnel who care for patients with MS. I think this book would also be of use to patients and their relatives looking for scientific information on fatigue in MS. The text might be more detailed than the non-MS specialist needs in his day-to-day care of patients with MS.
Fatigue in Multiple Sclerosis: A Guide to Diagnosis and Management Lauren B Krupp Demos Medical Publishing, 2004 US$19·95, 93 pages ISBN 1 888799 81 1
Alan Wright [email protected]
19
Finding the “epileptogenic zone” This volume gives an overview of various techniques used to locate areas of the cortex important for presurgical diagnostics in patients with epilepsy. 15 years ago Hans Lüders derived these hypothetical zones from the earlier work of Bancaud, Penfield, and Jasper. Although the “epileptogenic zone” cannot be measured directly, several diagnostic tools have been used in an attempt to define the location and boundaries of the “epileptic zone”. The volume is divided into four sections; the first describes the concept of different cortical zones which are an index of the location and extent of the epileptogenic zone. Neurophysiological and functional imaging techniques are described in the second section. The relative value of application of these diagnostic techniques with regard to different causes is discussed in section 3 and some examples of ongoing clinical research reported in section 4. The text is well structured and the figures and tables support the information given in the text. However, many of the keywords in the text are only scarcely listed in the subject index. Most of the contributing authors are associated with the Cleveland Clinic School and the approach to different causes in presurgical assessment is interesting. Some of the information presented is not
extensive enough—eg, first reports of findings from 1992 rather than earlier. The chapter on PET includes a detailed history of its development. I think the affective sphere should have been included in the categories of seizure semiology: sensorial, autonomic, consciousness, and motor sphere. The autonomic sphere could have been discussed in more detail, particularly localisation and lateralisation—eg, piloerection and sexual activity. Although magnetoencephalography is covered, there is no chapter on magnetic resonance spectroscopy. Findings of metabolic-pathway lateralisation associated with seizure outcome and neuropsychological postoperative outcome are therefore also missing. This book is worth reading for its coverage of many concepts of localisation, but these must be put into context. Research of the past years has highlighted the complex neural network of the brain; we cannot only think in hypothetically defined zones.
Handbook of Clinical Neurophysiology, Volume 3: Presurgical Assessment of the Epilepsies with Clinical Neurophysiology and Functional Imaging Edited by Felix Rosenow and Hans O Lüders Elsevier, 2004 £150, 582 pages ISBN 0 444 51046 X
Hermann Stefan [email protected] This book is published by Elsevier, of which The Lancet Neurology is part.
Fatigue, multiple sclerosis, and clinical practice Dr Krupp’s monograph is written for physicians and other paramedical professionals who care for patients with multiple sclerosis (MS). It provides a concise overview of the important and under-recognised topic of fatigue in MS. Difficulties in quantifying patients’ subjective experience of fatigue make the topic of this book difficult to address. I found the text readable and informative. The text logically explores the topic in a series of concise well-referenced chapters. The first chapters discuss definitions of MS-related fatigue and possible methods of measuring fatigue, including practical advice on various scales that can be used to quantify fatigue. There is much speculation on the cause of fatigue symptoms and I found the chapter on pathophysiology a useful discussion and reasonable reference. However, the chapter on pathophysiology could be omitted by busy clinicians who are mostly reading this text to gain practical advice to help in their management of patients. The relation between MS-related fatigue and depressive symptoms or affective state is another controversial subject. Dr Krupp gave a brief but informative discussion of this association, including reasons why these symptoms should be differentiated. A brief chapter addresses history and examination, and the text concludes with two chapters that cover nonpharmacological and pharmacological approaches to treatment. The discussion of pharmacological treatments http://neurology.thelancet.com Vol 4 January 2005
includes a brief discussion of any relevant clinical trials and practical guidelines on the use of individual drugs. These chapters are, in my opinion, the most useful in the monograph. Neurologists should be aware of strategies to improve the fatigue that patients with MS experience, because this symptom is commonly a very disabling part of the disease. The text includes references to recently published articles and the index is adequate. I especially liked the useful summary tables and the brief conclusions paragraph that ends each chapter. The author has published several papers on fatigue in MS and has a comprehensive knowledge of this topic. Overall I enjoyed reading this book. It is a concise synopsis of an important topic, and would be of use to neurologists, other physicians, and paramedical personnel who care for patients with MS. I think this book would also be of use to patients and their relatives looking for scientific information on fatigue in MS. The text might be more detailed than the non-MS specialist needs in his day-to-day care of patients with MS.
Fatigue in Multiple Sclerosis: A Guide to Diagnosis and Management Lauren B Krupp Demos Medical Publishing, 2004 US$19·95, 93 pages ISBN 1 888799 81 1
Alan Wright [email protected]
19