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More dilemmas in the management of the neurological patient
194
Elet troencephalographv and chnu al ]~europh vstology. 1988, 70 194 195 Elsevier Scientific Publishers Ireland, Ltd
Book Reviews edited by John R. Hughes and P. Rossini Children with epdepsy A parents guide - H Reisner (Ed) (Woodbine House, Waslungton, DC, 1988, 314 p., U S. $12.95) A number of excellent books have been written for the lay public to explain epilepsy in non-medical terms, but none has been more successful than thas one to serve as a parents guide Since epilepsy is a disorder found most frequently m younger mdwlduals who cannot care for themselves, parents are the major group who must be concerned about patients with seizures The present book represents an outstanding guide for this large group The first chapter appropriately begins with ' W h a t ts epilepsy' ' by F Dreffuss, whose expertise in ttus field is evident by the clear explanations of the causes, classlficatmn, 'what to do when the child has a seizure,' epileptic syndromes, consequences of smzures and finally treatment Even kindling ts briefly discussed The author has an optimistic view, but does not make the mistake of over-optimism Therefore. statements, like "People do not generally outgrow epilepsy' are included At the end of this and every other chapter are parent statements, winch reflect the practical concerns of all parents whose children have this disorder The next chapter is a bnef and clear description of an LEG and its role, written by a registered EEG techrucIan (D Kirby) from Dr Drelfuss' laboratory_ The editor has wntten chapter 3 on adjusting to the child's epdepsv, emphasizing the real unblemished truths like the anger, chromc fatigue, and stress felt by most parents The same author collaborates with a colleague who runs a support group m the next chapter, deahng with 'who do I tell and howO' The advice ts excellent, even down to seizure information for the baby'sltter A neuropsychologast deals effectively with a major problem, the child's self-esteem and provides a balanced discussion of these difficult matters Next is a helpful chapter by a developmental pediatrician on the developmental problems often associated with epilepsy The developmental rmlestones, up to 5 years of age. wall be useful for all readers, physicians included Chapter 7 is on special education with major emphasis on Public Law 94-142. as is the next one by two lawyers on legal rights, who also discuss the Rehabilitation Act of 1973 The next chapter ~s by the House MaJority Winp of the U S House of Representatives, Tony Coelho His chapter on legislative advocacy could be wn tten by no greater authority Next ~s a helpful glossary followed by a complete reading list organized by chapter, then a resource guide, with a valuable list of organIzatmns, theLr addresses and telephone numbers, grouped b', state
"Flus reviewer was pleasantly surprised at the information and the excellent advice that ts given to parents in tins book, winch is as advertised. "a complete and compassionate g u i d e ' John R Hughes
Untverstt~ of Ilhnots Medical Center, Chwago, IL 60612 ( U S A )
More dilemmas in the management of the neurological patient. - C Wurlow and J
Garfield (FAs.) (Churchill Livingstone,
Edinburgh, 1987, 212 p, £ 22.50) This book represents a companion to the Dilemmas volume published in 1984 It contains the answers and opimons offered by a number of Bntlsh experts (with the exception of Dr Van G1jn from Holland) to the problems and controversies posed by the editors The adopted formula is an interesting one for a scientific publication, even if. in my opinion, the treated matter should be more homogeneous and restricted to well defined themes I in fact found particularly interesting the chapters on the new strategies on t -D O P A and bromocnptine management (C D Marsden), the prediction of the course of MS (by A Compston), the therapeutical approach to optic neuritis (by W I McDonald), the vascular ongm of rmgralne (by M J G Harrison). the antlbloUC treatment of bacterml memngjtlS (b) H Lambert). the role of A s p m n in reducing the task of stroke (by J Van Gijn), since I felt the debated problems of large interest Less convincing to ttus reviewer were some of the dilemmas concermng new technologies, hke the ones deahng with the reliability of LEG recordings in moving subjects or with the utility of cerebral blood flow measurements Optmons on fast developing areas are destined to decline in a short t~me, not because of the authors' mabthty, but due to the effects of the enormous amount of cllmcal and basic studies I personally see such controversies to be better settled in bne f and agile "Editorials' of sclentlhc magazines than In book chapters Finally some of the dilemmas are too dehcate from the ethical point of view to be treated in 5 o r 6 p a g e s ( l e on the role of utxhty of psychosurgery) or they are not at all ddemmas (Le, should the chmcal details be revealed to neuroradlologlsts) Because of the afore-mentioned aspects and the low cost, this pubhcation can be suggested to people who deal with neurologjcal patients
0013-4649/88/$03 50 " 1988 Elsevier Scientific Publishers Ireland Lid
BOOK REVIEWS
195
Many dilemmas still remmn in the fields of chmcal neurology and of neurosurgery If a future expenence with an analogous pubhshmg line is in program, I would suggest to utlhze teams of 2 or 3 top experts who notoriously have different onentauons on a given topic m order to prosade the reader wath a more comprehensive vtew of the problem P M Rosstm
Chntca Neurologtca VI, Vie dell'Untverstt,~ 30, 00185 Rome (Italy)
Long-term potentiation: from biophysics to behavior. - P.W. Landfield and S.A. Deadwyler (Eds.) (Liss, New York, 1988, 548 p., U.S. $140.00) In the 1950s a considerable number of investigations dealt w~th post-tetamc potentlalaon (PTP), a phenomenon that represented a short-lasting increased responsiveness of the nervous system after stimulation The impetus behind many of these studies was the behef that the phenomenon may be the basis for learmng and memory and when longer lasting changes for 5 n'an or so were found (by investigators including the present revaewer) the relationship seemed more possible For the next few decades interest seemed to wane and then in the 70s and 80s a great amount of data on both long-termed potentiation (LTP) and depression (LTD) was pubhshed. Tlus volume s u r n m a n ~ s well the status of these interesting phenomena, presented by 43 authors in 5 chfferent sections The first section on an overview of mechanisms begins with the point that the trigger for LTP Is generated postsynaptlcally as result of the activation of the N M D A receptor and the opemng of the channels it controls. Also, the data would argue that it was unhkely that the phenomenon would be responsible for 'indefinite' memory, but that It could proxqde the neural basis for short-term memory The next chapter presents evadence that part of the current through the N M D A receptor channels is hkely carried by calcmm ions wluch then act as a trigger for LTP reduction. Relevant to the learmng situation it was also pointed out that stimulation of the reticular formataon could modulate LTP In the last chapter of fins section Baudry et al schemattze the sequence of events in LTP induction m a very clear manner hagh frequency stimulation occurs, glutamate is released, gating a sodium channel, followed by depolanzalaon of the postsynapttc membrane and release of the magnesium blockade of the lomc channel associated wath the N M D A receptors, influx of calcium, activating Ca-dependent protease, altering the synapttc receptor function and finally an alteration in the morphology of the synaptlc contact
The next section on temporal and associative properties includes two key features of LTP and LTD First is that LTP reqmres an associative interaction between actlvaty at an indiwdual synapse and some change in the dendnte and the second is that both processes of LTP and LTD are long lasting, but readily reversible The next chapter by Racine and De Yonge is excellent m presenting the correct tustory of these phenomena, concluding that potentiation processes may involve a number of independent mechamsms_ The thard section on cellular mechamsms emphasizes first the spines playing an essential role m conjunction with the N M D A receptor gated channels and next that phosphorylatton of proteins Is affected by the tetamzatlon of afferents in the htppocampus and therefore possibly related to LTP_ In another chapter the emphasis is on norepmephrlne (NE) required for the production of LTP which then increases synthesis of cyclic AMP, producing later an alteration in membrane receptors or channels In the penultimate chapter in tins section the major point is that N E enhances the magmtude, duration and probablhty of inducing LTP at mossy fiber synapses. The last chapter changes the emphasis to alteration in presynaptlc ultrastructure and the role of Ca 2+ Alternative perspectives is the fourth section, dealing with conduction blockage and recruitment of electncally sdent synapses in the first chapter The second proposes progressive spike invasion, electrotomc couphng and electrical field effects to account for LTP_ The last section on behavaoral correlates points to phenomenologtcal sundantws between characteristics of LTP and classical conditiomng, but data suggest a role for LTP in the rrmemomc process other than lnformalaon storage In the last chapter of the book Deadwyler et al cautiously point out that certain studies have not demonstrated that LTP per se facthtated the process independent of simply changmg the discnrmnafive quahty of the stimulus. Also in no instance was there a clear demonstration that synapses which were potenlaated were m fact reqmred for improved learning. The rewewer has been pleasantly surprised as to both the quality and the quantity of work on LTP The present book is a clear accounting of all of the past studaes on the phenomenon wath a considerable amount of neurophyslologlcal speculation, wtuch ILkely has heuristic value Although the price is relatively l'ugh, all neuroscientlsts interested in long lasting changes in the nervous system wall enjoy this book
John R Hughes
Unwersity of llhnots Medical Center, Chwago, I L 60612 ( U S A )
Elet troencephalographv and chnu al ]~europh vstology. 1988, 70 194 195 Elsevier Scientific Publishers Ireland, Ltd
Book Reviews edited by John R. Hughes and P. Rossini Children with epdepsy A parents guide - H Reisner (Ed) (Woodbine House, Waslungton, DC, 1988, 314 p., U S. $12.95) A number of excellent books have been written for the lay public to explain epilepsy in non-medical terms, but none has been more successful than thas one to serve as a parents guide Since epilepsy is a disorder found most frequently m younger mdwlduals who cannot care for themselves, parents are the major group who must be concerned about patients with seizures The present book represents an outstanding guide for this large group The first chapter appropriately begins with ' W h a t ts epilepsy' ' by F Dreffuss, whose expertise in ttus field is evident by the clear explanations of the causes, classlficatmn, 'what to do when the child has a seizure,' epileptic syndromes, consequences of smzures and finally treatment Even kindling ts briefly discussed The author has an optimistic view, but does not make the mistake of over-optimism Therefore. statements, like "People do not generally outgrow epilepsy' are included At the end of this and every other chapter are parent statements, winch reflect the practical concerns of all parents whose children have this disorder The next chapter is a bnef and clear description of an LEG and its role, written by a registered EEG techrucIan (D Kirby) from Dr Drelfuss' laboratory_ The editor has wntten chapter 3 on adjusting to the child's epdepsv, emphasizing the real unblemished truths like the anger, chromc fatigue, and stress felt by most parents The same author collaborates with a colleague who runs a support group m the next chapter, deahng with 'who do I tell and howO' The advice ts excellent, even down to seizure information for the baby'sltter A neuropsychologast deals effectively with a major problem, the child's self-esteem and provides a balanced discussion of these difficult matters Next is a helpful chapter by a developmental pediatrician on the developmental problems often associated with epilepsy The developmental rmlestones, up to 5 years of age. wall be useful for all readers, physicians included Chapter 7 is on special education with major emphasis on Public Law 94-142. as is the next one by two lawyers on legal rights, who also discuss the Rehabilitation Act of 1973 The next chapter ~s by the House MaJority Winp of the U S House of Representatives, Tony Coelho His chapter on legislative advocacy could be wn tten by no greater authority Next ~s a helpful glossary followed by a complete reading list organized by chapter, then a resource guide, with a valuable list of organIzatmns, theLr addresses and telephone numbers, grouped b', state
"Flus reviewer was pleasantly surprised at the information and the excellent advice that ts given to parents in tins book, winch is as advertised. "a complete and compassionate g u i d e ' John R Hughes
Untverstt~ of Ilhnots Medical Center, Chwago, IL 60612 ( U S A )
More dilemmas in the management of the neurological patient. - C Wurlow and J
Garfield (FAs.) (Churchill Livingstone,
Edinburgh, 1987, 212 p, £ 22.50) This book represents a companion to the Dilemmas volume published in 1984 It contains the answers and opimons offered by a number of Bntlsh experts (with the exception of Dr Van G1jn from Holland) to the problems and controversies posed by the editors The adopted formula is an interesting one for a scientific publication, even if. in my opinion, the treated matter should be more homogeneous and restricted to well defined themes I in fact found particularly interesting the chapters on the new strategies on t -D O P A and bromocnptine management (C D Marsden), the prediction of the course of MS (by A Compston), the therapeutical approach to optic neuritis (by W I McDonald), the vascular ongm of rmgralne (by M J G Harrison). the antlbloUC treatment of bacterml memngjtlS (b) H Lambert). the role of A s p m n in reducing the task of stroke (by J Van Gijn), since I felt the debated problems of large interest Less convincing to ttus reviewer were some of the dilemmas concermng new technologies, hke the ones deahng with the reliability of LEG recordings in moving subjects or with the utility of cerebral blood flow measurements Optmons on fast developing areas are destined to decline in a short t~me, not because of the authors' mabthty, but due to the effects of the enormous amount of cllmcal and basic studies I personally see such controversies to be better settled in bne f and agile "Editorials' of sclentlhc magazines than In book chapters Finally some of the dilemmas are too dehcate from the ethical point of view to be treated in 5 o r 6 p a g e s ( l e on the role of utxhty of psychosurgery) or they are not at all ddemmas (Le, should the chmcal details be revealed to neuroradlologlsts) Because of the afore-mentioned aspects and the low cost, this pubhcation can be suggested to people who deal with neurologjcal patients
0013-4649/88/$03 50 " 1988 Elsevier Scientific Publishers Ireland Lid
BOOK REVIEWS
195
Many dilemmas still remmn in the fields of chmcal neurology and of neurosurgery If a future expenence with an analogous pubhshmg line is in program, I would suggest to utlhze teams of 2 or 3 top experts who notoriously have different onentauons on a given topic m order to prosade the reader wath a more comprehensive vtew of the problem P M Rosstm
Chntca Neurologtca VI, Vie dell'Untverstt,~ 30, 00185 Rome (Italy)
Long-term potentiation: from biophysics to behavior. - P.W. Landfield and S.A. Deadwyler (Eds.) (Liss, New York, 1988, 548 p., U.S. $140.00) In the 1950s a considerable number of investigations dealt w~th post-tetamc potentlalaon (PTP), a phenomenon that represented a short-lasting increased responsiveness of the nervous system after stimulation The impetus behind many of these studies was the behef that the phenomenon may be the basis for learmng and memory and when longer lasting changes for 5 n'an or so were found (by investigators including the present revaewer) the relationship seemed more possible For the next few decades interest seemed to wane and then in the 70s and 80s a great amount of data on both long-termed potentiation (LTP) and depression (LTD) was pubhshed. Tlus volume s u r n m a n ~ s well the status of these interesting phenomena, presented by 43 authors in 5 chfferent sections The first section on an overview of mechanisms begins with the point that the trigger for LTP Is generated postsynaptlcally as result of the activation of the N M D A receptor and the opemng of the channels it controls. Also, the data would argue that it was unhkely that the phenomenon would be responsible for 'indefinite' memory, but that It could proxqde the neural basis for short-term memory The next chapter presents evadence that part of the current through the N M D A receptor channels is hkely carried by calcmm ions wluch then act as a trigger for LTP reduction. Relevant to the learmng situation it was also pointed out that stimulation of the reticular formataon could modulate LTP In the last chapter of fins section Baudry et al schemattze the sequence of events in LTP induction m a very clear manner hagh frequency stimulation occurs, glutamate is released, gating a sodium channel, followed by depolanzalaon of the postsynapttc membrane and release of the magnesium blockade of the lomc channel associated wath the N M D A receptors, influx of calcium, activating Ca-dependent protease, altering the synapttc receptor function and finally an alteration in the morphology of the synaptlc contact
The next section on temporal and associative properties includes two key features of LTP and LTD First is that LTP reqmres an associative interaction between actlvaty at an indiwdual synapse and some change in the dendnte and the second is that both processes of LTP and LTD are long lasting, but readily reversible The next chapter by Racine and De Yonge is excellent m presenting the correct tustory of these phenomena, concluding that potentiation processes may involve a number of independent mechamsms_ The thard section on cellular mechamsms emphasizes first the spines playing an essential role m conjunction with the N M D A receptor gated channels and next that phosphorylatton of proteins Is affected by the tetamzatlon of afferents in the htppocampus and therefore possibly related to LTP_ In another chapter the emphasis is on norepmephrlne (NE) required for the production of LTP which then increases synthesis of cyclic AMP, producing later an alteration in membrane receptors or channels In the penultimate chapter in tins section the major point is that N E enhances the magmtude, duration and probablhty of inducing LTP at mossy fiber synapses. The last chapter changes the emphasis to alteration in presynaptlc ultrastructure and the role of Ca 2+ Alternative perspectives is the fourth section, dealing with conduction blockage and recruitment of electncally sdent synapses in the first chapter The second proposes progressive spike invasion, electrotomc couphng and electrical field effects to account for LTP_ The last section on behavaoral correlates points to phenomenologtcal sundantws between characteristics of LTP and classical conditiomng, but data suggest a role for LTP in the rrmemomc process other than lnformalaon storage In the last chapter of the book Deadwyler et al cautiously point out that certain studies have not demonstrated that LTP per se facthtated the process independent of simply changmg the discnrmnafive quahty of the stimulus. Also in no instance was there a clear demonstration that synapses which were potenlaated were m fact reqmred for improved learning. The rewewer has been pleasantly surprised as to both the quality and the quantity of work on LTP The present book is a clear accounting of all of the past studaes on the phenomenon wath a considerable amount of neurophyslologlcal speculation, wtuch ILkely has heuristic value Although the price is relatively l'ugh, all neuroscientlsts interested in long lasting changes in the nervous system wall enjoy this book
John R Hughes
Unwersity of llhnots Medical Center, Chwago, I L 60612 ( U S A )