Book Reviews
Intractable Focal Epilepsy
Edited by Oxbury JM, Polkey CE, Duchowny M. $225.00. London, W.B.
Saunders, 2000. 878 pp.
Eighty-three authors have contributed to Intractable Focal Epilepsy,a
fairly comprehensive text that is a unique contribution to the field of
epileptology. Recently several new epilepsy texts have been published,
yet the editors and authors of this text have managed to focus on topics
related to the diagnosis and management of intractable epilepsy that have
not been well addressed in any other single volume. As is the case with
most multi-authored texts, the chapters in this volume vary in the quality
of the prose and differ by the degree to which a comprehensive review of
the topic was undertaken. Fortunately, some of the best chapters are of
interest to child neurologists.
The text is divided into the following four sections: semiology,
investigations, medical and surgical management, and economics. There
is a welcome emphasis on the etiology and pathology of intractable
partial epilepsy not found in most epilepsy texts. This pathologic
emphasis is best demonstrated by the excellent review of malformations
of cortical development by Drs. Sisodiya, Squier, and Anslow, who
richly illustrate their chapter with 37 pictures of gross pathology,
microscopic pathology, and neuroimaging images of cortical malforma-
tions. The review of partial seizures in West syndrome by Weiss and
Snead is well referenced and presents a well-documented approach to
diagnosis and management of these patients. The chapter on Landau-
Kleffner syndrome and the acquired epileptic aphasias by Neville and
colleagues emphasizes the need for additional documentation of the
efficacy of corticosteroids and mulptiple subpial transection before the
widespread use of these treatments. Chapters on brain tumors (Riviello et
al.), Rasmussen syndrome (Hart and Andermann), and cerebrovascular
disorders in children (Cross and Kirkham) should all be of special interest
to child neurologists.
The investigations section include a relatively brief chapter on mag-
netic resonance imaging (MRI) techniques; a more detailed chapter on
positron emission tomography (PET), which emphasizes the fluorode-
oxyglucose PET but does not mention the new, promising flumazenil
PET techniques; a nice review of ictal single-photon emission computed
tomograhy; and a brief discussion of magnetoencephalography. The
coverage of neuropsychologic defects in temporal-lobe epilepsy and
frontal-lobe epilepsy is extensive. The chapters on ontogenetic special-
ization of hemispheric function and quality of life among children and
adolescents with epilepsy are especially well written.
The chapter on drug therapy in children by Dr. Gilman presents an
excellent review of developmental pharmacology (required reading for
physicians caring for children with epilepsy) and assessment of drug-
resistant epilepsy. All clinicians working in epilepsy surgery centers will
find Cendes’ review of radiologic evaluation of hippocampal sclerosis,
which is well illustrated with both MRI and MRI spectroscopy, very
helpful. The thoughtful chapter on seizure reduction by Oxbury and
Polkey offers an excellent review of outcome studies of epilepsy surgery,
as well as issues for future investigation.
The chapter on the ketogenic diet presents only introductory informa-
tion on the topic, and clinicians who wish to treat children with the
ketogenic diet will need to consult more detailed reviews of the subject.
Although the review of invasive neurophysiologic evaluation of partial
epilepsy in children by Jayakar and Duchowny is excellent, epileptolo-
gists working in epilepsy centers will require more detailed treatment of
this topic found elsewhere in the literature and in texts on epilepsy
surgery. The chapters on temporal-lobe surgery and extratemporal
surgery are nicely written but with inadequate detail for neurosurgeons
and epileptologists active in the operating room.
The authors and editors successfully have completed an epilepsy text
that should be accessible to all epileptologists. Child neurologists who
find the price excessive should recommend that this book be acquired by
their nearest medical library for consultation.
Edwin Trevathan, MD, MPH
Associate Professor of Neurology & Pediatrics
Director, Pediatric Epilepsy Center
Washington University School of Medicine
St. Louis, Missouri St. Louis Children’s Hospital
Comprehensive Clinical Neurophysiology
By Kerry H. Levin, MD and Hans O. Luders, MD, PhD. 630 pp.
illustrated. Philadelphia: WB Saunders Company, 2000, $159.00. ISBN
0-7216-76
The American Board of Medical Specialties approved Clinical Neu-
rophysiology (CNP) as an added qualification certification in 1990, and
the first CNP examination was given in 1992. Simultaneously, the
Cleveland Clinic Foundation began offering an intensive review course
in comprehensive clinical neurophysiology aimed at helping prepare
neurologists for the American Board of Psychiatry and Neurology
certificate for added qualification in clinical neurophysiology. The course
format has allowed the faculty to receive input from the audience and
revise and refine their lectures over the years. As the syllabus material
became more complete, the idea for a textbook of comprehensive clinical
neurophysiology developed. This 627-page textbook, Comprehensive
Clinical Neurophysiology, compiled by 36 experts in the field, represents
that work. The editors state that the goals are (1) to guide proper
physiologic testing, (2) to provide a reference for interpretation of
clinical electrophysiology data, and (3) to review physiologic concepts
underlying neurophysiology. The text is divided into the following
nine sections: (1) basic neurophysiology, (2) electromyography, (3)
electrodiagnosis of neuromuscular disorders, (4) evaluation of central
influences on peripheral function, (5) electroencephalography, (6)
electroencephalography in disturbances of cerebral functions, (7)
electroencephalography in the epilepsies, (8) evoked potentials in
interoperative monitoring, and (9) sleep disorders. Each of these
sections is well done and details the principles, scope, limitations,
diagnostic importance, and prognostic relevance for each of these
techniques. The textbook is well written and has an adequate amount
of illustrations that are clear and illustrate the primary points. Most
importantly, the book reads easily.
Strengths of this book are the first section on basic neurophysiology,
which encompasses nine chapters. These chapters are succinct yet
provide some of the best chapters available to review this information for
the clinical neurophysiology board examinations. A second feature of
this book, which is very helpful, is the case vignettes that are found in
each one of the chapters on neuromuscular disorders. These are espe-
cially helpful in refining the concepts for the reader, who may not have
extensive training in neuromuscular disease.
For the physician preparing for the clinical neurophysiology board
examinations, this title represents the single best review textbook
available. It is priced reasonably when compared with other textbooks
that are also single volume reviews of clinical neurophysiology. If the
goal of the person buying this textbook is to review for the added
qualifications of the clinical neurophysiology board, this is the text they
should buy. However, for the pediatric neurologist who may be looking
for a single reference book, this textbook has several weaknesses. For
instance, there are no sections devoted to pediatric studies. There are no
normals for pediatric nerve conduction studies and no pediatric normals
or chapters for any of the evoked-potential modalities. There are no
sections on pediatric sleep disorders or electroretinography. There are no
sections on the use of digital electroencephalography or topographic
396 PEDIATRIC NEUROLOGY Vol. 24 No. 5 © 2001 by Elsevier Science Inc. All rights reserved.
0887-8994/01/$—see front matter