Electroencephalography. Basic principles, clinical applications, and related fields, 3rd edition

Electroencephalography. Basic principles, clinical applications, and related fields, 3rd edition

Electroencephalography and clinical Neurophysiology , 91 (1994) 491-492 491 © 1994 Elsevier Science Ireland Ltd. 0013-4694/94/$07.00 Book Reviews ...

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Electroencephalography and clinical Neurophysiology , 91 (1994) 491-492


© 1994 Elsevier Science Ireland Ltd. 0013-4694/94/$07.00

Book Reviews

edited by E. Niedermeyer and P.M. Rossini Non-epileptic seizures. - A.J. Rowan and J.R. Gates (ButterworthHeineman, Boston, 1993, 296 p., Price US $90.00) A significant fraction of patients referred to tertiary epilepsy centers for intractable seizures have non-epileptic seizures (NES), also known by the terms "pseudoseizures," "psychogenic seizures," and "hysterical seizures." The book Non-Epileptic Seizures resulted from a conference in Fort Lauderdale, FL in March, 1990 to consider " t h e current state of knowledge" on non-epileptic seizures. The introduction begins with an overview of non-epileptic seizures and a brief categorization of the types of epileptic seizures with which NES are contrasted. Authors review terminology, which is quite intractable, and suggest the term "non-organic attacks." The contributors admit from the outset that no single criterion can be set for distinction of NES and ES. A clinician must diagnose NES by an integrated approach and exclusion of organic conditions. Specific consideration is given to behaviors during apparent convulsive and non-convulsive complex partial seizures. The problem of overlap between NES and ES is difficult, since no population-based study has given an unbiased estimate of the frequency of non-epileptic seizures. Frontal lobe seizures specifically are analyzed, since they are bizarre and sometimes look like non-epileptic seizures. Testing is an adjunctive but important measure, including video-EEG and determination of serum prolactin. Standard neuropsychological testing shows abnormalities in many patients with NES, but there is no clear distinction between abnormalities seen in patients with epileptic seizures and those in patients with organic disturbances. Consideration is given to use of suggestion to provoke NES. Injection of normal saline or other placebos is controversial because of ethical issues, the implicit need for informed consent and the future risk to patient-physician trust. How this is handled by the medical care team, however, is probably more important than the details of the induction technique. Non-epileptic paroxysmal neurological events are outlined in a brief, but high quality, chapter by Dr. A n d e r m a n n , while parasonmias are granted a chapter of their own. Psychiatric disorders are discussed in several chapters, with emphasis on somatoform disorders. More attention might have been given to hyperventilation syndrome, panic attacks, and malingering. T r e a t m e n t strategies for psychiatric disorders are considered in 3 chapters, each emphasizing a multidisciplinary approach to the patient. Few data are presented on the efficacy of any form of treatment in non-epileptic seizures, a deficiency of the field in general, rather than of this review. Chapter styles are reasonably uniform, reflecting excellent editing and integration of the material. Production quality is quite good. Figures are sparse, but well executed. Several books have by now been written about non-epileptic seizures. This compendium stands as the most up-to-date and definitive summary of the field. This volume would be of use to every neurologist, and to psychiatrists who are concerned with differential diagnosis of psychiatric conditions and epilepsy. The book does not detail specifically the differential diagnosis of epilepsy, except as regards non-epileptic (psychogenic seizures), although other entities are considered in the context of the discussion. Physiological imitators such as dystonia, vertigo, hypoglycemia, fluctuating metabolic encephalopathies and transient global amnesia are only briefly mentioned. Nevertheless, these disorders are not the focus of the book,

which remains the best compendium to date of information on psychogenic seizures, the most diagnostically difficult imitator of epilepsy. Robert S. Fisher

Epilepsy Center, Barrow Neurological Institute, Phoenix, A Z (USA)

Electroencephalography. Basic principles, clinical applications, and related fields, 3rd edition. - E. Niedermeyer and F. Lopes da Silva (Eds.) (Williams and Wilkins, Baltimore, MD, 1993, 1164 p., Price US $150.00) The third edition of this now standard textbook is much expanded over the second edition reflecting both the editors' broad view of E E G and clinical neurophysiology (a perspective with which I wholeheartedly agree), and technical and scientific developments in the field. The two distinguished editors have assembled 53 authoritative contributors from the US, Canada, Europe and Brazil to cover the diverse topics which are divided among 62 chapters. The book now appropriately begins with a brief historical survey of E E G development that includes an excellent bibliography. The 4 chapters reviewing the cellular and network physiology and biophysics of E E G signals, including discussion of relevant models of neuronal population behavior, are as critically thorough and insightful as can be found anywhere. Steriade's chapter on the "Cellular substrates of brain rhythms" is a particularly welcome addition to the basic neurobiology section. The organization of the core clinical E E G chapters is largely unchanged, but new information has been added as appropriate, and the completely revised chapters on " E E G and dementia" by Brenner, and " N o r m a l aging and transient cognitive disorders in the elderly" by Sweden, Wauquier and Niedermeyer represent substantial improvements over the previous edition. The section on cerebral anoxia has also undergone complete revision and been greatly expanded. It now constitutes 2 chapters: one on experimental aspects (by Kirsch, Koehler and Traystman) and the other on clinical features (by Prior). Lombroso's chapter on "Neonatal E E G " remains one of the best reviews of the subject cuirently available. Two other areas have been greatly revised and expanded to reflect their increased clinical importance, on the one hand, or clinical research interest on the other. The first of these relates to specialized monitoring techniques suitable for epilepsy and epilepsy surgery. Invasive E E G techniques are covered in 4 chapters and there are, in addition, separate discussions regarding the use of extended E E G and video-EEG recordings, digital E E G technology and computer-assisted analysis, and other specialized techniques for E E G recording and transmission of data. The second major area of expansion is in psychophysiology and the clinical application of event-related potentials, computer-assisted pattern recognition, topographic brain mapping, and E E G diagnosis including neurometric analysis. The addition of 11 color plates is extremely helpful in understanding this material. It must be said, however, that the clinical relevance of some of these techniques, how and in what circumstances they should be used, and their role in neurological or



psychiatric diagnosis remain controversial. There are considerable differences of opinion a m o n g neurologists, psychiatrists, and neuropsychologists. From my perspective, I found that Lopes da Silva's chapter on "Computer-assisted E E G diagnosis: pattern recognition and brain mapping" offered a critical, biologically based and appropriately cautious, yet challenging, approach that can be readily r e c o m m e n d e d to trainees and more experienced clinical electrophysiologists alike. O n the other hand, "Principles of neurometric analysis of E E G and evoked potentials" by John and Prichep, while theoretically and technically sound, reaches conclusions about the clinical utility of neurometric discriminant functions that require several leaps of faith to accept. If the book has a weakness, it is that critical analysis is sometimes sacrified to all-inclusiveness. While a major strength continues to be an almost encyclopedic coverage of the field, trainees in particular may sometimes have difficulty separating remarks based on anecdote or personal experience from statements justified by controlled investigation. There is also considerable overlap among related sections, and trainees, again, may be frustrated by the difference in perspective provided by different authors. These small reservations aside, the third edition of Electrocephalography represents a comprehensive, integrated, and appropriately broad-based approach to E E G and clinical neurophysiology. The quality of its contributors and generous reference lists will make it of value to trainee and experienced neurophysiologist alike. T h e work is daunting in its scope, and its successful outcome is a tribute to its eminent editors, Ernst Niedermeyer and Fernando Lopes da Silva. Timothy A. Pedley

The Neurological Institute of New York, Columbia-Presbyterian Medical Center, New York, NY (USA)

The regulation of the cerebral blood flow. - J.W. Phillis (Ed.) (CRC Press, Boca Raton, FL, 1993, 425 p., Price US $195.00) The control of the cerebral circulation has occupied the minds of many over several centuries. O n e of the most significant and earliest findings in this area, that of the anastomosis of blood vessels at the base of the brain (eponymously Willisian) was described in 1664. This occurred only 50 years after the discovery of the circulation of the blood by William Harvey. Interestingly, these significant researches were conducted at the same institution: Merton College, Oxford. Since that time many discoveries have been made, but much remains to be elucidated: the m e c h a n i s m of cerebral autoregulation, whereby cerebral perfusion remains independent of peripheral m e a n arterial pressure over a wide range of this latter; the m e c h a n i s m of arterial responsiveness to changes in PO2, pCO 2 and pH; the mechanism of vasospasm following subarachnoid hemorrhage; the nature of migraine. These topics are discussed deftly and well by the many contributors to this well-edited book. It is not the fault of these individuals that after reading this book the reader will not gain a complete picture of the functioning of the cerebral vasculature. This merely reflects the state of current knowledge about this important, but still obscure, area. The contributors are scrupulously fair, summarizing well available evidence for each of the areas covered in the book and adducing information from others even when it conflicts with their own research findings. The areas discussed include: the methodology of cerebral blood flow measurement; the innervation of the cerebral vasculature; responses of the cerebral vasculature to metabolic

changes; control of the cerebral circulation in disease states, especially diabetes and hypertension. Reasons for the conflicting data which bedevil this area are many and include: species differences in blood vessel responsiveness; differential responsiveness of vascular regions within the same animal; requirement of pre-constriction of dilation of arteries in order to show responsiveness to an agent; confounding effects of varying anesthetic agents. These are all discussed and each contributor attempts to draw the available and often conflicting data into some form of coherence in a summary paragraph at the chapter's end. T h e only complaint I have, is that there are too many split infinitives; otherwise, this is an excellent compendium. The style is eminently readable, and I strongly urge anyone with even the slightest interest in the control of cerebral blood flow to buy this volume. Stephen O p p e n h e i m e r

Department of Neurology, Johns Hopkins University School of Medicine and Hospital, Baltimore, MD (USA)

An introduction to the blood-brain barrier. - H. Davson, B. Zlokovic, L. Rakic and M. Segal (CRC Press, Boca Raton, FL, 1993, 321 p., Price US $104.95) This monograph is a compilation of the current state of knowledge regarding transport of substances into and out of the brain. The authors are noted experts who have contributed significantly to the field. Their stated main purpose is to stimulate research on the pathology of central nervous system diseases. T h e material is presented in 5 sections. The first, "History and basic concepts," is an excellent presentation that clearly discusses the development of our current concept of the barrier as a complex structurally and biochemically specialized unit. This section also presents the methods by which permeability and carrier-mediated processes are quantified. T h e next 3 sections discuss transport of specific substances: glucose and amino acids; peptides and proteins; nucleotide precursors and vitamins. These sections are generally well written, and the authors do not shy away from pointing out instances of discrepancies in the literature, undoubtedly in the interest of stimulating further work. The final section on experimental models is limited and primarily discusses amphetamine-related effects, with a few pages on experimental allergic encephalomyelitis and h u m a n trauma. T h o u g h the first section (comprising over one-third of the book) is indeed an excellent "introduction to the blood-brain barrier," subsequent sections may be considered more than introductory and be of interest to a selected group of readers. Relevant clinical correlates are noted in each section. T h e book is well referenced with an extensive bibliography at the end of each section. The extensive use of graphs, tables, and line-drawings greatly facilitates the presentation and is a particularly attractive feature. Since access of substances to the brain is a major issue in the therapy of many diseases, an understanding of the processes involved is valuable to anyone developing new approaches to clinical neurological problems. This volume can provide that understanding. Christopher Guerin

Department of Neurosurgery, National Naval Medical Center, Bethesda, MD (USA)