The epilepsies. A critical review

Electroencephalography and clinical Neurophysiology, 1985, 60:370-372

370

Elsevier Scientific Publishers Ireland, Ltd.

BOOK

REVIEWS

edited by H . P E T S C H E

and J O H N

R. HUGHES

Physiological correlates of human behavior. Vol. 1. Basic issues. - - A. Gale and J.A. Edwards (Eds.) (Academic Press, New York, 1983, 350 p., U.S. $39.50) This book has been edited by two British psychologists who have engaged 13 of their countrymen and 7 Americans to write chapters on the general topic of physiological psychology. The approach to the questions which will interest many readers of this Journal is psychological, as would be expected, but a considerable amount of neurophysiology can be found in the book. The first topic is the correlation between body, behavior and mind (Farrell) and attempts to close the gap between neurophysiological and psychological discourses, concluding that 'correlation' serves as a blanket term to cover many relationships. Following is a very simple, but clear account of the structure and fundamental processes of the nervous system (Boddy), providing a good summary of neuroanatomy and neurophysiology for the novice. The same author then proceeds into informational and functioning systems in the brain, emphasizing place coding as an essential principle, synapses as the brain's logic system, feedback as the control system, and multiple pathways responding in a probabilistic mode. Toiler presents biochemistry of the nervous system, providing a well written, simple account of proteins, carbohydrates and lipids and also of neurotransmitters. Sleep patterns and functions (J. Lindsley) are next, contrasting S sleep (our NREM) and D sleep (our REM), but admitting that the reader is left with more questions than answers. However, this chapter is well done in critically evaluating the evidence on the role of different parts of the CNS in different sleep states. Warburton then has a chapter towards a neurochemical theory of learning and memory, leaving the reader somewhat discouraged by the conclusion that the flaw in the biochemical approach is that the studies can only be correlational. Furthermore, there is the logical fallacy in arguing from correlation to causality. Vision and the relations between animal and human research (Davidoff and Ratcliff) deals especially with the psychologists' approach to perception. More for the neurophysiologist is the next chapter on the frequency selectivity of the auditory system (Moore). This excellent chapter deals with the relationship between the frequency threshold curves and psychophysical tuning curves, in addition to non-linear interactions, in the form of lateral suppression. The reader then moves into the world of neuropsychology and the organization of behavior (Beaumont) with emphasis on localizationist, equipotential and interactionist theories. Even more psychological in approach is the next account on psychophysiological measurements (Porges et al.), serving as a good

introduction to an unexpected shift in emphasis to the applied psychophysiologist in which Lykken critically evaluates the 'lie detector.' A chapter on ~tress (Cox et al.) appropriately emphasizes the catecholamines and corticosteroids and the next chapter is on habitual substance use (Warburton and Wesnes). This is likely one of the best chapters, especially in the discussion of nicotine, presumably improving the efficiency of coping with situations and enabling the individual to ignore stressful thoughts. An interesting thesis is that the effects of smoking cessation are mainly the return to the pre-drug state, as opposed to the presence of chronic dependence symptoms. The last chapter is on sexual arousal (Zuckerman) summarizing well the data on 'love, chemistry and conditioning.' This reviewer would recommend this well-written book for the neuroscientist who wants the neuropsychological approach to the interesting problems of mind-body relationships, The newcomer into neuroscience would also benefit greatly from this book, but the neurophysiologist who is seeking only psychophysiological correlations will likely find much of the book somewhat elementary. JOHN R. HUGHES

University of Illinois Medical Center, Chicago, 1L 60612 (U.S.A.)

The epilepsies. A critical r e v i e w . - R.B. Aird, R.L. Masland and D.M. Woodbury (Raven Press, New York, 1984, 320 p., U.S. $52.00) For the past few years many books have been published on the epilepsies, but the great majority have been edited volumes with many chapters and many authors who have presented their own data with special idiosyncratic points of view. This book is somewhat special since each chapter represents a collaborative effort of only 3 epileptologists who are responsible for the entire 320 pages. Another special feature is that this work is the result of a combined total of over 100 years of study of the epilepsies by these 3 experts. The example of this latter point is that among the 751 references, no one else has more publications listed than two of these authors. This reviewer wishes to state emphatically at this time that the book is outstanding, since it represents both a monumental effort of a careful review of the literature on every subtopic and also it is full of the wisdom of the 3 most renowned leaders in this field from the U.S.A. On the other hand, no book is perfect and the reviewer will mention some (minor) deficiencies so long as the reader understands that the book in general is superb.

0013-4649/85/$03.30 © 1985 Elsevier Scientific Publishers Ireland, Ltd.

BOOK REVIEWS The first of 12 chapters is on neurobiologic substrates of epilepsy. The authors have simplified this difficult area, especially in their discussion of the paroxysmal depolarization shift and the roles of K ÷, Ca 2+ and glia in epileptogenesis. The s u m m a r y at the end of this chapter is also excellent and will be welcomed by most readers. The next chapter on clinical classification attempts to breathe new life into this tiresome topic. The reader may be surprised at statements like 'foci do not determine the clinical character of the seizure they trigger' and ' there is no more reason to categorize temporal lobe seizures as a focal form of epilepsy than in the case of generalized tonicclonic seizures or absence.' The authors do justify these latter points to some extent, but not fully in this ceviewer's opinion. Calling for a more flexible approach, the authors indicate that the terms focal and generalized are relative (as everything else is), but may leave the impression on the reader that classification may be impossible at this or any other time. The next topic is pathophysiologic basis of specific seizure types and the authors now resurrect the classification that they had just criticized, but use it effectively to discuss the clinical, neurophysiological and electroencephalographic aspects of each major seizure type. The 6 examples of EEG shown are not up to the quality of the text, since the electrode positions indicated will likely be unclear and unfamiliar, as will the montages, in addition to the very thick lines of most of the recordings. Some readers would argue that the example of hypsarrhythmia shown is not a good one, nor is the example of the 3 / s e c spike and wave complex. This reviewer would have wanted more discussion on why we should now change from the term cortico-reticular to cortico-thalamic, an important point, but without any references. The short discussion on benign epilepsy with rolandic spikes should have at least mentioned speech arrest. The etiologic factors in the epilepsies and basic approaches to modifying epileptic susceptibility is organized around one grand table which will be very useful to the reader. One topic which was especially helpful to this reviewer was the discussion on water restriction, and there is clinical wisdom coupled with an excellent literature review on the m a n y topics covered. The chapter on epidemiology represents a great effort to summarize the complex literature on this topic. The authors properly emphasize the variations of definitions, methods, etc. found from one study to another, indicating that 'such variation makes these data invalid.' The reader will likely look for, but not find the authors' suggestion for the best available statistic on prevalence and incidence. Genetic aspects are next, introduced by a table of over 100 syndromes associated with seizures (from McKusick). The reader may wonder about the symbols and numbers found in this table and also challenge the statements that up to one-third of infantile spasms are from tuberous sclerosis, that rolandic epilepsy manifests itself by generalized nocturnal seizures and sensorimotor attacks during the day. The clinical approach is next and is full of the great wisdom of these authors who pay appropriate homage to the EEG. This reviewer does question the curious mention of triangulation, the activation of focal abnormalities by photic stimulation, the emphasis of sleep records (only) for those with nocturnal seizures, the occasional value of Metrazol activation

371 and the statement that ' E E G is of no help in following drug therapy.' Later comments in the book will serve to modify this latter view. A m o n g the borderline conditions mentioned is the 'episodal pain syndromes,' but this reviewer could not find that adjective in either his Webster's or Roget's. The associated disorders are next, covering well the difficult areas of learning, emotional, personality and psychotic disorders. This reviewer had hoped for a more critical review of the Bear and Fedio studies, of the discussion on 'ictal dementias' and of interictal psychosis. The general pharmacologic principle of antiepileptic drug therapy is, as expected, extremely well done with very helpful tables. The reader will find useful summaries of the major action of each anticonvulsant and these discussions lead into the next chapter on drug therapy, also excellent with many helpful tables. Curious is the mention in Table 10.2 that clonazepam is the drug of first choice for infantile spasms (and myoclonic-astatic seizures), but in the text (p. 222) A C T H is listed as the 'preferred agent.' This reviewer was also surprised to see phenacemide mentioned, even as a 'drug of last resort' from a 1951 reference. Finally, febrile and post-traumatic seizures and status epilepticus are handled with great expertise. A short chapter on c o m m o n source of failure in the therapeutic management of epilepsy will be very helpful to all epileptologists, as will many of the points in the chapter on comprehensive management of epilepsy. This reviewer has mentioned a few points of controversy and debate, but overall this book will likely become the new 'Bible' for most epileptologists. The combined clinical wisdom and the excellent review of the literature should raise this work to prominence in the world of the epilepsies. J O H N R. H U G H E S

Uni~'ersity of Illinois Medical Center, Chicago, IL 60612 (U.S.A.)

Advances in epileptology: the XVth epilepsy international symposium. - - R.J. Porter, R.H. Mattson, A.J. Ward, Jr. and M. Dam (Eds.) (Raven Press, New York, 1984, 709 p., U.S. $120.00) The epileptologist has likely noticed that many books on epilepsy have been published in the past few years. The present one is important, since it summarizes the International Symposium held in Washington, D.C. in September, 1983. In the typical style of these Advances, there are 13 major sections, 113 short chapters, over 300 contributors and over 700 pages so that each chapter is usually 5 - 7 pages in length. As in previous volumes, the space limitation has likely served as an advantage since the theme of each paper is usually presented clearly and succinctly. The first section on neurotransmitters emphasizes GABA, found to be reduced in tumor patients (Floyd et hi.), to be used as an important guide for developing future anticonvulsants (Fariello), a possible explanation for damaged Purkinje cells from constant epileptic activity (Dam et al.) and together with