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The treatment of epilepsy: Principles and practice
Book Reviews
Cerebral Dysgenesis: Embryology and Clinical Expression
The Treatment of Epilepsy: Principles and Practice
By Harvey B. Sarnat. 473 pp., illustrated. New York, Oxford University Press, 1992. $75.00.
Edited by Elaine Wyllie. 1,238 pp., illustrated. Philadelphia, Lea and Febiger, 1993, $99.50.
The Treatment of Epilepsy: Principles and Practice is a multi-authored book, which discusses in detail the diagnosis and treatment of epilepsy. The more than 100 contributors are well-known in both the basic and clinical aspects of epilepsy. The book is organized into 6 parts: Basic Mechanisms of Epileptogenesis, Basic Principles of Electroencephalography, Clinical Epileptology, Antiepileptic Medications, Epilepsy Surgery, and Psychosocial Aspects of Epilepsy. There are 103 chapters devoted to these subjects. Chapters 1-13 discuss the basic mechanisms of epileptogenesis, including the neuroanatomic, neurophysiologic, and genetic principles underlying epilepsy. These basic mechanisms are given appropriate emphasis and are well illustrated. The chapter on the Genetic Aspects of Epilepsy is very informative. A more detailed discussion of the animal models of epilepsy would have been desirable. Chapters 14-23 discuss the principles of EEGs. Although the chapters are quite basic, they provide a good review of the basic principles of EEG required for the diagnosis of epilepsy. Chapter 23, EEG Atlas of Epileptiform Abnormalities, demonstrates a variety of abnormalities seen in children and adults with epilepsy. Part 3 on Clinical Epileptology, chapters 24-56, includes Epileptic Seizures and their EEG and Clinical Manifestations, The Epilepsies, Seizures in Special Clinical Settings, and The Differential Diagnosis of Epilepsy. Although the various epileptic syndromes have been discussed in detail, the section on differential diagnosis fails to emphasize appropriately different types of conditions that can mimic epilepsy. The chapter on status epilepticus lacks details about treatment. Part 5 on Antiepileptic Drugs, chapters 57-83, discusses the neuropharmacology, general principles of antiepileptic drug therapy, and also specific antiepileptic medications. The chapters, in general, are well-written and informative. The organization is geared towards helping the clinician manage the various forms of seizure disorders in an appropriate manner with available antiepileptic drugs. Section 5 consisting of chapters 84-97 focuses on Epilepsy Surgery for the Treatment of Epilepsy. It discusses the various techniques required for evaluation of potential surgical candidates and the types of surgery available for intractable epilepsy patients. The discussion is quite comprehensive, although readers interested in more detailed aspects of epilepsy surgery are referred to Epilepsy Surgery edited by Hans Luders. The final section is on Psychosocial Aspects of Epilepsy, a topic that can be a significant issue for physicians involved in the treatment of epileptic patients. Overall, the book is perhaps the most comprehensive text contributed to by multiple authors on this subject. The book should provide important information for those clinicians engaged in the treatment of epilepsy on a day-to-day basis. Dr. Wyllie deserves high credit for expending the effort to compile all of this information into a detailed and comprehensive text.
Tucson, AZ
Dinesh Talwar, MD Arizona Health Sciences Center
This comprehensive book on brain malformations was written by an acknowledged expert in the field and it certainly shows. It is filled with useful information and countless pearls of wisdom. But it also includes some viewpoints that are not accepted by the scientific community, and these differences were not always made clear to the reader. The first 2 chapters describe the mechanisms and processes that form the basis of CNS development. These chapters proved fascinating to read although I found the organization hard to follow. Sections on cellular elements, such as intermediate filaments, are combined with discussions of basic embryologic mechanisms, such as neural induction. The third chapter discussing clinical manifestations and results of laboratory tests is accurate and excellent. The next 3 chapters discuss several of the most common brain malformations in more detail. Although very informative and usually accurate, I found some errors, most of which were minor. For example, the legend for Figure 5-1 describes abnormalities of pregnancy in a patient with lissencephaly, with no diagnosis specified. The figure clearly shows that the patient has Miller-Dieker syndrome and so must have deletion of 17p whether the chromosome study showed it or not. He states that absent or thin corpus callosum is observed in most patients with lissencephaly, and that Miller-Dieker syndrome may be associated with pachygyria rather than agyria. Both of these statements are incorrect. In his discussion of Dandy-Walker malformation, he describes only the classic, severe form and does not mention that others recognize a much wider spectrum as described in detail by Barkovich et al. [AJNR 1989; 10:977-88]. The book also relies heavily on CT rather than MRI studies. I mentioned that Dr. Sarnat presented some viewpoints that differ from most other workers in the field. A minor example is his use of "aprosencephaly" instead of the widely accepted term "anencephaly." A more significant example which, in my opinion, detracts from the quality of this book is his approach to several types of neuronal migration disorders. He implies in several sections that schizencephaly is an unimportant variant of lissencephaly and provides a supporting figure. But the figure (Fig 5-8) actually depicts classic lissencephaly with an unbroken brain surface, not schizencephaly; the supposed cleft is simply subarachnoid space within a partially formed sylvian fissure. The chapter does not discuss or show any examples of schizencephaly as described by others, which consists of true clefts extending from the cerebral surface inward toward the ependyma. Clefts are lined by polymicrogyric cortex, which is very different from agyria and pachygyria. The pathogenesis is completely different from classic lissencephaly. He also neglects to discuss polymicrogyria, a rather glaring omission. Despite its faults, this is a very interesting book which I enjoyed reading. It contains a wealth of information, and is probably the best book available discussing all aspects of brain malformations. Some of the author's divergent viewpoints will likely prove confusing to readers not familiar with this field.
Minneapolis, MN
William B. Dobyns, MD University of Minnesota Medical Center
PEDIATRIC NEUROLOGY Vo[.9 No. 5 415
Cerebral Dysgenesis: Embryology and Clinical Expression
The Treatment of Epilepsy: Principles and Practice
By Harvey B. Sarnat. 473 pp., illustrated. New York, Oxford University Press, 1992. $75.00.
Edited by Elaine Wyllie. 1,238 pp., illustrated. Philadelphia, Lea and Febiger, 1993, $99.50.
The Treatment of Epilepsy: Principles and Practice is a multi-authored book, which discusses in detail the diagnosis and treatment of epilepsy. The more than 100 contributors are well-known in both the basic and clinical aspects of epilepsy. The book is organized into 6 parts: Basic Mechanisms of Epileptogenesis, Basic Principles of Electroencephalography, Clinical Epileptology, Antiepileptic Medications, Epilepsy Surgery, and Psychosocial Aspects of Epilepsy. There are 103 chapters devoted to these subjects. Chapters 1-13 discuss the basic mechanisms of epileptogenesis, including the neuroanatomic, neurophysiologic, and genetic principles underlying epilepsy. These basic mechanisms are given appropriate emphasis and are well illustrated. The chapter on the Genetic Aspects of Epilepsy is very informative. A more detailed discussion of the animal models of epilepsy would have been desirable. Chapters 14-23 discuss the principles of EEGs. Although the chapters are quite basic, they provide a good review of the basic principles of EEG required for the diagnosis of epilepsy. Chapter 23, EEG Atlas of Epileptiform Abnormalities, demonstrates a variety of abnormalities seen in children and adults with epilepsy. Part 3 on Clinical Epileptology, chapters 24-56, includes Epileptic Seizures and their EEG and Clinical Manifestations, The Epilepsies, Seizures in Special Clinical Settings, and The Differential Diagnosis of Epilepsy. Although the various epileptic syndromes have been discussed in detail, the section on differential diagnosis fails to emphasize appropriately different types of conditions that can mimic epilepsy. The chapter on status epilepticus lacks details about treatment. Part 5 on Antiepileptic Drugs, chapters 57-83, discusses the neuropharmacology, general principles of antiepileptic drug therapy, and also specific antiepileptic medications. The chapters, in general, are well-written and informative. The organization is geared towards helping the clinician manage the various forms of seizure disorders in an appropriate manner with available antiepileptic drugs. Section 5 consisting of chapters 84-97 focuses on Epilepsy Surgery for the Treatment of Epilepsy. It discusses the various techniques required for evaluation of potential surgical candidates and the types of surgery available for intractable epilepsy patients. The discussion is quite comprehensive, although readers interested in more detailed aspects of epilepsy surgery are referred to Epilepsy Surgery edited by Hans Luders. The final section is on Psychosocial Aspects of Epilepsy, a topic that can be a significant issue for physicians involved in the treatment of epileptic patients. Overall, the book is perhaps the most comprehensive text contributed to by multiple authors on this subject. The book should provide important information for those clinicians engaged in the treatment of epilepsy on a day-to-day basis. Dr. Wyllie deserves high credit for expending the effort to compile all of this information into a detailed and comprehensive text.
Tucson, AZ
Dinesh Talwar, MD Arizona Health Sciences Center
This comprehensive book on brain malformations was written by an acknowledged expert in the field and it certainly shows. It is filled with useful information and countless pearls of wisdom. But it also includes some viewpoints that are not accepted by the scientific community, and these differences were not always made clear to the reader. The first 2 chapters describe the mechanisms and processes that form the basis of CNS development. These chapters proved fascinating to read although I found the organization hard to follow. Sections on cellular elements, such as intermediate filaments, are combined with discussions of basic embryologic mechanisms, such as neural induction. The third chapter discussing clinical manifestations and results of laboratory tests is accurate and excellent. The next 3 chapters discuss several of the most common brain malformations in more detail. Although very informative and usually accurate, I found some errors, most of which were minor. For example, the legend for Figure 5-1 describes abnormalities of pregnancy in a patient with lissencephaly, with no diagnosis specified. The figure clearly shows that the patient has Miller-Dieker syndrome and so must have deletion of 17p whether the chromosome study showed it or not. He states that absent or thin corpus callosum is observed in most patients with lissencephaly, and that Miller-Dieker syndrome may be associated with pachygyria rather than agyria. Both of these statements are incorrect. In his discussion of Dandy-Walker malformation, he describes only the classic, severe form and does not mention that others recognize a much wider spectrum as described in detail by Barkovich et al. [AJNR 1989; 10:977-88]. The book also relies heavily on CT rather than MRI studies. I mentioned that Dr. Sarnat presented some viewpoints that differ from most other workers in the field. A minor example is his use of "aprosencephaly" instead of the widely accepted term "anencephaly." A more significant example which, in my opinion, detracts from the quality of this book is his approach to several types of neuronal migration disorders. He implies in several sections that schizencephaly is an unimportant variant of lissencephaly and provides a supporting figure. But the figure (Fig 5-8) actually depicts classic lissencephaly with an unbroken brain surface, not schizencephaly; the supposed cleft is simply subarachnoid space within a partially formed sylvian fissure. The chapter does not discuss or show any examples of schizencephaly as described by others, which consists of true clefts extending from the cerebral surface inward toward the ependyma. Clefts are lined by polymicrogyric cortex, which is very different from agyria and pachygyria. The pathogenesis is completely different from classic lissencephaly. He also neglects to discuss polymicrogyria, a rather glaring omission. Despite its faults, this is a very interesting book which I enjoyed reading. It contains a wealth of information, and is probably the best book available discussing all aspects of brain malformations. Some of the author's divergent viewpoints will likely prove confusing to readers not familiar with this field.
Minneapolis, MN
William B. Dobyns, MD University of Minnesota Medical Center
PEDIATRIC NEUROLOGY Vo[.9 No. 5 415