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Book Reviews

Posted in Book Reviews on 23rd Mar 2014

book-1The Behavioral Neurology of White Matter (Second edition)

Filley’s contention, elucidated in many previous journal articles and summarised in this book, is that disorders of white matter may be associated with a neurobehavioural syndrome with prominent cognitive impairments, sometimes amounting to dementia, which is in many ways akin to, and yet different, from subcortical dementia.  The key features are cognitive slowing, executive dysfunction, impairment of sustained attention, impaired memory retrieval and visuospatial deficits. The relatively preserved functions are procedural memory and language (white matter integrity correlates with full-scale and performance, but not verbal, IQ), along with neuropsychiatric aspects (one might add the relative infrequency of epileptic seizures) and, unlike subcortical dementia, extrapyramidal function.  The macroconnectivity of white matter is essential for information transfer across the brain, and contrasts with information processing microconnectivity within the grey matter; together they form complementary parts of the brain “connectome”.

The brief first section examines the nature of white matter – myelin, saltatory impulse conduction, and the critical recent contributions of various neuroimaging modalities (MRS, MTI, DTI) in identifying white matter abnormalities (including in what was previously deemed “normal appearing white matter”).  Examples of cognitive impairment in specific white matter disorders are cited in the second section; these encompass genetic, demyelinating, infectious, inflammatory, toxic, metabolic, vascular, traumatic, neoplastic and hydrocephalic disorders of both paediatric and adult provenance.  The third section examines white matter in neurodegenerative diseases (including Alzheimer’s disease, for which a “myelin hypothesis” has been developed), focal neurobehavioural syndromes (e.g. amnesia, aphasia), neuropsychiatric and neurological features. There is a final summation from the connectionist perspective of the behavioural neurology of white matter.

I must “fess up” and say that I never read the first edition of this book (published 2001), but I do not think the omission diminished my pleasure in reading this update.  Filley has a fluent writing style which carries the reader easily along. While more might have been said about some conditions (e.g. cerebral amyloid angiopathy) and the quality of some MR images left something to be desired (many dating from neuroimaging atlases of the 1980s and 1990s), this is a stimulating read – well crafted, and thoroughly recommended for anyone with an interest in cognitive disorders, white matter disorders, or both.

book-2Seizures and Epilepsy (Second Edition)

Epilepsy can be a challenge to the non-specialist.  The classification of wide-ranging, apparently mysterious epilepsy syndromes threatens to baffle any clinician. Stepping in to the breach comes ‘Seizures and Epilepsy’. The first edition was published some 25 years ago and this updated version covers epilepsy from basic physiology to recognition and management of complex syndromes.

The book is divided into Introduction, Phenomenology and Management, each of roughly the same length. The introduction covers changes in Epilepsy classification over the years and gives an update on research topics. The phenomenology section is based around the 2010 International League Against Epilepsy diagnostic criteria; the management section covers diagnostic approaches, pharmacological and non-pharmacological treatments.

This textbook is nothing if not comprehensive. The level of detail is astonishing especially as it is written by a single author. Single authorship has the advantage that the whole book hangs together seamlessly, whether on classification or treatment strategies. Despite this, areas of debate and uncertainty are acknowledged, with liberal referencing to provide support for specific points of classification or management.

The introduction guides the reader engagingly through a history of epilepsy and its context in society before moving on to an extensive discussion of its evolving classification. This discussion is clearly written by a man who has been closely associated with developments in the understanding of epilepsy nosology; brevity is not its greatest virtue. The long list of definitions is, similarly, best considered as a reference resource than a read-through. The discussion on research by contrast is easily read, with the writing particularly well handled given the fast moving changes in this field. Dr Engel concentrates on advances in physiological understanding and highlights the uses and limitations of animal models.

The phenomenology section is presented with an eye for detail and a perspective that clinical classification provides the starting point for understanding seizure mechanisms. Descriptions of clinical syndromes are written with authority, demonstrating experience of a wide variety of child and adult seizures syndromes. In addition to psychiatric comorbidities and psychosocial adaptation, the more controversial areas of personality and mood changes are confronted.

Helpful tables in the chapter on general principles of treatment cover interactions between anti-seizure medications, side effects, and dosing schedules. I will be photocopying these for use in clinic! There are also useful discussions covering management in the elderly, pregnant women and people with comorbid medical, surgical and psychiatric conditions.

The beauty of this book is the balance between its clear overview of epilepsy and its mastery of detail on every topic. Each chapter finishes with a helpful summary, and conclusions which neatly tie together the chapter’s main themes. Admittedly, the writing style is dense in places and a few bullet points might have helped break up the long pages of block text. Figures, where they appear, are often black and white line diagrams or graphs, of limited explanatory value. The quality of brain image reproduction could have been improved; in particular the many PET scans from the early 80s might have been updated to show colour and higher resolution.

This book is not for cover-to-cover reading, except for the very stout hearted. However, its detail and comprehensive coverage of the subject matter, and the author’s passion for his subject definitely justify the effort. It is certainly an ideal reference manual for anyone dealing with the day to day practicalities of epilepsy.

ACNR. Published online 3/4/14