Nutrition and the brain (Volume 8)

BOOK REVIEWS vision and consistency, but these are relatively minor ones. The book is divided into sections of clinical phenomenology, epidemiology, co-morbid conditions, neurochemistry and neuropathology, genetics, neuroima~ng, pharmacologic treatments, nonpharmacologic intervention, and perspectives. In such a broad-reaching text, there is something for nearly everyone. Issues range from those that might only interest researchers in the field (such as neurochemical analysis of postmortem cortical and striatal brain tissue in patients with Gilles de la Tourette's syndrome) to practical questions that clinicians face every day (Is there a role for megavitamin therapy in the treatment of attention deficit hyperactivity disorder?). The authors chosen all represent recognized authorities in their particular fields; the volume is thus an exceedingly useful compendium of information that represents the states of several arts at the time of publication. Given the multiauthor nature of the book, it can be used as easily as a reference or read in brief periods of free time during the day. For researchers in the field, this will obviously prove an invaluable benchmark. For clinicians who see appreciable numbers of patients with Gilles de la Tourette's syndrome, this will prove an essential resource. Perhaps in another decade, when another volume on this subject is due, we will have returned to a more proper name for this fascinating and troublesome clinical syndrome. David K. Urion, M.D. Learning Disabilities/ Behavioral Neurology Program Children's Hospital Boston, MA, U.S.A.

The Headaches, edited by Jes Olesen, Peer Tfelt-Hansen, and K. M. A. Welch. New York: Raven Press,

1993, 230 pp. Price: $165.00

The Headaches is an encyclopedic textbook with 125 chapters written by 121 international contributors. As noted in the foreward by Dr. Fred Plum, the editors attempted to recruit every known headache expert as contributors. The book is divided into six parts: Part I, "Background"; Part II, "Applied Anatomy, Physiology, Psychology, and Pharmacology"; Part HI, "Migraine"; Part IV, "Tension, Cluster, and Miscellaneous Headaches"; Part V, "Secondary Headaches"; Part VI, "Special Management Problems in the Headaches."

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Parts III through V are so detailed and comprehensive that they could stand alone as textbooks. Similar to the approach taken to epilepsy, a chapter devoted to the classification of headache using the criteria of the Internatoinal Headache Society is included. The chapter on neurophysiology includes a discussion of quantified EEG and evoked potentials as they pertain to headaches. There are separate chapters on the various categories of agents used for both the symptomatic and prophylactic therapy of migraines (nonsteroidal anti-inflammatory drugs, ergotamine, dihydroergotamine, sumatriptan, for symptomatic treatment and ~-adrenoceptor blockers, antiserotonin drugs, calcium antagonists, nonsteroidal anti-inflammatory drugs, for prophylactic treatment), and chapters on prioritizing acute pharmacotherapy and prophylactic treatment. A very complete section on the secondary headaches is provided, including several chapters on aspects of tension-type headache, cluster headache, chronic paroxysmal headache, miscellaneous headaches, and post-traumatic headaches, to name only a few. One significant and surprising shortcoming is that there is little mention of epilepsy. In the chapter on genetics, an association between migraine and other disorders, including epilepsy, is included. Epilepsy is included in a table of the causes of headache in the chapter on diagnosis and differential diagnosis, and the authors then say that epilepsy can result in recurrent headaches, but that the seizure prior to the headache indicates the nature of the disorder. The chapter on headaches in children by Hockaday and Barlow does discuss the migraine variants that mimic epilepsy and includes the only reference to Andermann and Lugaresi's book on migraine and epilepsy. Rather than just another book on headaches, this is a superb encyclopedic textbook and should be on the shelf of every neurologist, psychologist, or other health care provider who takes care of people with headaches. James J. Riviello, Jr., M.D. Harvard Medical School Children's Hospital Boston, MA, U.S.A.

Nutrition and the Brain (Volume 8), by Richard J. Wurtman and Judith J. Wurtman. New York: Raven Press, 1990, 203 pp. Price: $94.00. This member of the series contains six chapters on various subjects that are related by the theme of nutri-

BOOK REVIEWS t-ion and the brain. Although none of these chapters directly discusses epilepsy or seizures (except for a brief mention in Chapter 1), this volume is nonetheless of great importance to epilepsy research. The opening chapter, "Supply of n-3 Polyunsaturated Fatty Acids and Their Significance in the Central Nervous System (N. G. Bazen), reviews the metabolic pathways and the fate of n-3 fatty acids in an extremely useful way. The series of n-3 fatty acids starts with linoleic and linolenic acids, two fatty acids that are "essential"; the body cannot produce these fatty acids itself and rather depends on food supply for its availability. N-3 fatty acids are involved in many brain functions, for example, seizures, ischemia, and anoxia are among the clinical events that induce a dramatic increase in the levels of several n-3 f~tty acids. To be sure, the role of n-3 fatty acids in epilepsy is not clearly understood; however, some reseachers report beneficial effects following the implementation of a ketogenic diet with epileptic patients. Moreover, recent studies have implicated n-3 fatty acids in the maintenance of a normal physiological state of the neuronal membrane, where it appears that they play a role among the mediators of the conduction of the action potential (i.e., neuronal information). The important issue discussed in Chapter 2, "Regulation of Metal Uptake and Distribution Within the Brain" (G. R. Smith), is concerned with the study of the blood-brain barrier (BBB) mechanism. Several studies indicate that changes in the BBB occur during and after natural or experimentally induced seizures. This important aspect of epilepsy has not received appropriate attention from researchers in the field. Also discussed in this chapter is the uptake and distribution of iron in the brain. Injections of iron salts into various brain loci induce seizures, with some parts of the brain more sensitive than others. It has been proposed that iron functions as a neurotoxin, and most probably produces high levels of free radicals. Both Chapter 3 ("Biological Consequences of Choline Deficiency," S. H. Zeisel) and Chapter 5 ("Choline Utilization by Central Cholinergic Neurons," I. Wecker) discuss choline as a precursor of the neurotransmitter acetylcholine. Chapter 3 deals with the formation of choline and the supply of choline from the diet, whereas Chapter 5 deals with the interesting question of whether the choline supply via the diet is

of functional significance. The link of acetylcholine to seizures is demonstrated by the fact that some cholinergic drugs are capable of inducing seizures (e.g., pilocarpine). The type of seizure that is induced is unique, since neither diphenylhydantoin nor carbamazepine are capable of blocking this effect. Moreover, studies have shown that pentylenetetrazolinduced seizures and electroconvulsive shock cause significant changes in the acteylcholine-enzyme system, i.e., a marked decrease in the ChAT enzyme, and downregulation of binding sites of muscarinic receptors in many parts of the brain (cortex, hippocampus, and striatum). "Iron Deficiency and Behavior" (E. Politt and E. Metallinos-Katsaras) provides a detailed summary of the behavioral effects of iron deficiency, mainly among children. More recently, the material of this chapter appears in updated form as a chapter in the Annual Review of Nutrition, Volume 13, 1993. As mentioned earlier, the role of iron in epilepsy (both in its deficient as well as in its excessive states) has received some attention. Chapter 6, "The Pharmacology of Serotonergic Drugs Affecting Appetite," is a classic psychopharmacological presentation. Although this chapter deals with a single aspect of the serotonergic system, the issues are similar to discussions concerning the involvement of serotonin in epilepsy. Serotonergic behavior seems to be enhanced by the administration of electroconvulsive shock, although some antidepressants are able to block this effect. The unanswered problem, however, is whether the effects are mediated by pre- or postsynaptic serotonergic events. Overall, the book is very readable even for scientists who may not be experts in the field. The six indepth reviews condense vast amounts of information in a relatively small space. The index is very useful. Each of the authors is clearly an expert in his field. In addition, the book serves to remind us of the importance of nutritional variables for epilepsy research, a topic that has not received the attention it would otherwise deserve. There is a need for a similar volume dealing with nutritional topics that would address specific elements of epilepsy and seizure research. Shlomo Yehuda Bar Ilan University Ramat Gan, Israel

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