A Textbook of Epilepsy

A Textbook of Epilepsy

I02 Book Reviews who reviews progress both before and after the DNA revolution. Chapters later on in the book, one on the mapping of multiple schler...

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Book Reviews

who reviews progress both before and after the DNA revolution. Chapters later on in the book, one on the mapping of multiple schlerosis, inherited ataxias and spastic parapareses, and the other on the mapping of Freidrichs Ataxia, describe the application of genetic analysis in the study of multifactorial and autosomal recessive conditions respectively. The chapter on Charter-Marie-Tooth disease demonstrates that even in the case of autosomal dominant inheritance, the linkage analysis may not be straightforward because of genetic heterogeneity. Both the phenotypic expression and linkage analysis in CMT families are reviewed. Chapters concerned with the molecular diagnosis of inherited disorders are also included. Two of these cover Duchenne muscular dystrophy and summarise the use of RFLPs and deletion detection for prenatal diagnosis and carrier determination. Fox and Rosenberg present a clear account of mutations in the ornithine transcarbamylase gene relating the clinical diagnosis and the molecular pathology. DiMauro et al. review the biochemical and molecular studies of the important mitocbondrial myopathies. This is followed by a description of the acyl-CoA dehydrogenases. In a longer chapter, Tanaka et al. admirably summarise biochemical and molecular genetic data relating to this gene family which introduces the reader to further methods that can be applied to the isolation of gene sequences. The results also demonstrate how much information about the diversity of IVDs has emerged from the biochemical studies. The molecular cloning of the c-DNAs should lead to some exciting new insights into this gene family. Cloning of these cDNAs is presented in chapters by Zierz et al. and Tanaka's group. Several chapters are devoted to summarising the clinical genetics of various groups of disorders. For example, the inherited ataxias are reviewed by Harding and inherited neuropathies related to disorders of lipid metabolism are described by P. K. Thomas. Overall, this volume is a useful review for neurologists because it draws together the literature on the molecular basis of neurological and neuromuscular disease. Although the chapters are placed in a rather random order, the volume is well indexed and all of the chapters are well referenced. It should make interesting general reading for both molecular geneticists, biologists and clinical neurologists. KAY E. DAVIES Dr Davies is a Medical Research Council External Staff Member, Nuffield Department o f Clinical Medicine, John Radcliffe Hospital, Oxford OX3 9DU, U.K.

A Textbook of ~ y , 3rd edition. Edited by JOhN LAIDLAW, ALAN RICHENS and JOLYON OXLEY. Churchill Livingstone, Edinburgh, 1988. This is the third edition of what has become a popular textbook. It is easy to read, most aspects of epilepsy are covered, and sufficient information is included without overwhelming the reader. The trees do not block the view of the woods. Although the book suffers from defects common to multiauthor works, the editors have done a good job in integrating the subject area. Twenty-seven chapters arranged in 18 sections cover classification, epidemiology, genetics, pathophysiology, neuropsychiatry, neurophysiology, pharmacology and neurosurgery, among other topics. More unusual areas of the symptom complex

are discussed also, including epilepsy in developing countries, special ditficulties for women, dental problems, and social aspects. The writing wanders the plains and peneplains, rarely ascending even the minor heights, but avoiding the cliffs and canyons. The style varies from the acceptable to the slow. I cannot hope to review the whole book, so I will comment on some chapters of interest to pharmacologists and neurocbemists (and myself). The first section covers the intricate theology of classification. We are shown how "psychosensory complex partial seizure with hallucinatory features" in the 1969 classification of the International League Against Epilepsy becomes, still lacking clarifying commas, "psychic simple partial seizures with dysmnesic symptoms" in the 1982 classification. Faced with such legerdemain, the editors admit the continuing confusion and inconsistencies of current classifications. The section on pharmacology is workmanlike but thorough. The fact that seizures can be controlled pharmacologically in 80% of patients is balanced by the admission that patient care is still far from optimal and that no major innovations have been made for 20 years. The tone throughout is authoritative but nondogmatic. The question of when to stop treatment is left open. The perennial problem as to drug choices in the epilepsies is glossed with the comment that the lack of agreement reflects the paucity of scientific evidence on which to base rational choice. This is a sad statement considering the many millions who suffer from epilepsy. The authors of this section abandon the concept of a lower limit for the therapeutic range of phenytoin, pointing out that it is more a function of seizure type and individual response than of the drug per se. Some transatlantic differences emerge. The authors are less keen on blood measurements of drug levels than an American specialist would be, and less eager to initiate drug therapy following a first seizure. In terms of future prospects in this area of pharmacology, we are allowed a peep through the door but not an entry into the room. Newer test systems, such as the audiogenic mouse, are mentioned en passant, but the issue of appropriate ways to screen antilepileptics is not expanded upon. Although GABAmimetics are mentioned, there is no discussion of taurine analogs, such as the ill-fated taltrimide, doomed by a poorly organized trial and the engulfing of the inventing company by another. But surely agents that modulate neurotransmission have more of a potential than agents that are transmitter analogs7 'Epilepsy and behavior' is a contribution that in its slow loquacity comes perilously close to falling off the prosaic peneplain. Phrases such as "epilepsy is certainly not just about having fits" leads me to wonder for whom the author thinks he is writing. The comparison of attitudes towards epilepsy with attitudes towards "the colored person" suggests a person not in touch with the social idioms of his age. However, even this chapter of homilies and the blandly obvious can raise consciousness of certain otherwise illconsidered issues. The social prejudice about epileptics he relates for England, and the apparent reluctance of many epileptics to obtaining medical help leads me to wonder if the English hoi polloi are more backwards in their attitudes or whether I am merely unaware of the degree of corresponding prejudices in the United States. Within a somewhat specialized subgroup, that of epileptics admitted to psychiatric hospitals, the author reports his own study that

Book Reviews 28% had never seen a physician about their condition and were not on medication for it. This chapter is redeemed by the, perhaps unintentionally, dramatic case histories, leavened with a tinge of humor. The reader may consider the problems of avoiding a lamp post (i.e. a street light) at the beginning of a deadend street when you live at the end of it. Or the story of a wife who suspected her husband of having an affair in the basement with a barmaid. And then there is the bizarre story of the victim of partial seizures who developed orgasms on one side only of her vagina. She was, says the author, the subject of one of the clinic's more unusual requests to the ambulatory monitoring service. There are special ~.spects to epilepsy in developing countries. Much of the information given in the book was new and interesting to me. Some of the difficulties in treating epilepsy are to be expected, such as the nearimpossibility of obtaining blood levels. Others are more surprising, such as the difficulties of getting valproate. And how do you prescribe for poor patients with no health insurance? In Indonesia, children with epilepsy are often refused admission to schools. The social stigma against epilepsy in Latin America is such that the most common reason for prescribing anticonvulsant drugs is "cerebral dysrhythmia". Despite the section on developing countries, the orientation of this book is towards the British experience. The section of social aspects is largely concerned with British research, and English law and medical practise. This slightly parochial flavor does not sensibly diminish the value of the book, however, And perhaps because of this orientation, the book is more of a "hands on" text, with the feel of the spade and the smell of the soil about it. The American penchant for pendulous compound nouns and multisyltabic inarticulacies is refreshingly absent. Given the general low standards of multiauthor works, the editors have performed a first-rate job with this one. However, the index is distressingly meager. Only 4 pages, it includes no entry for valproate. One has to look under sodium. To be consistent, phenytoin would be similar indexed. In summary, this book is a solid achievement. It meets the stated aims, and although faintly dull is a worthy and reliable review of the state of the art of this commonest of neurological problems.


patterns of cognitive impairment that are encountered in the various illnesses causing dementia. I was not surprised to learn that a particular pattern of cognitive abnormalities is rarely, if ever, pathognomonic of the pathological process underlying a dementia. Three of the eight chapters might be of particular interest to the readers of Neurochemistry International. Frakowiak's comprehensive and well organised discussion of positron emission tomography's (PET) role in neurological research provides a timely overview. The chapter consists of selfcontained expositions first of the theory underlying PET and second of the disease entities which have been studied by PET. There will be considerable interest in PET scanning in the future since it currently offers the best prospect for determining whether neural transplantation really does enhance dopaminergic transmission within the basal ganglia in Parkinson's disease. Harding reviews the wide range of inherited neurological disorders which have been analysed by molecular genetics. Her chapter will be valuable to scientifically minded clinicians, especially those in training. But I suspect that professional neurochemists and molecular biologists will be drawn directly to the source references in the scientific literature rather than to such a chapter. In a sense her review became out-dated whilst in press. The important section devoted to Duchenne muscular dystrophy fails to mention dystrophin, the muscle protein which Kunkel's group have recently shown to be deficient in this disease. Langston and Tetrud's article about MPTP, the neurotoxic byproduct of illicit opiate synthesis which causes Parkinson's disease, will be of great use to scientists interested in the biochemical pathology of neurodegenerative disease. Despite being the discoverer of MPTP-induced Parkinsonism, Langston takes a refreshingly dispassionate view of those few ways in which MPTP-induced Parkinsonisim differs from the idiopathic disease. This book will be of undoubted value to practising clinical neurologists. For the neurochemist, isolated chapters will be useful in providing a clinical prospective to the reader's own area of scientific interest. MICHAEL DONAGHY

Dr Donaghy is clinical reader and consultant in neurology at the Radcliffe Infirmary, Department of Clinical Neurology, Woodstock Road, Oxford 0)(2 6HE, U.K.


Dr Ryan J. Huxtable is from the Department of Pharmacology, University of Arizona, College of Medicine, Tucson, AZ 85724, U.S.A.

Recent Advances in Clinical Nem'ology, Number 5. Edited by CI-n)asToPi.mR KENNAPa3. Price £35. Churchill Livingstone, Edinburgh, 1987.

This book primarily serves the continuing education needs of clinical neurologists. Like previous volumes in the series, it will do this well. Comprehensive and clearly written chapters review contemporary knowledge of problematic conditions such as dystonia, chronic pain syndromes and the role of cardiac factors in cerebrovascular disease. Given the plethora of writings derived from the American experience of AIDS, I am dubious about the need for yet another review of the neurological complications of human immunodeficiency virus infections. A long chapter is devoted to the

Frontiers in Neuroendoerinelogy, Vol. 10. Edited by L. MARTINI and W. F. GANONG. ISBN 0 88167 379 X. Price: $150. Raven Press, New York, 1988.

Over the years the Frontiers in Neuroendocrinology series has provided a valuable service in publishing topical reviews in neuroendocrinology. The latest edition in the series maintains past traditions and is a welcome addition. It ranges over a number of important subjects and provides good coverage of new and developing areas in neuroendoctinology. The identification and chemical characterisation of new active factors has been a dominant theme in neuroendocrinology for nearly two decades; at the same time neuroendocrinologists have been faced with the discovery of previously known neuropeptides in unfamiliar places. Together these themes account for a major proportion of the present volume. An opening chapter by Palkovits provides a useful checklist of the CNS distribution of all the major mare-