Brain, Vol. 122, No. 3, 583-584,
March 1999
© 1999 Oxford University Press
Book Reviews |
NEUROPATHOLOGY OF EPILEPSY.
Edited by F. Scaravilli. 1998. Pp. 590. London: World Scientific Publishing. Price $86. ISBN 9-81023-1709..
Department of Neuropathology, University of Glasgow, Scotland, UK
Progress in the understanding of a disease process and provision of the relevant clinical service increasingly demands a multidisciplinary approach. This new volume on the neuropathology of epilepsy edited by Francesco Scaravilli, Professor of Neuropathology at the Institute of Neurology, London, UK, exemplifies this approach as it contains not only neuropathology but also contributions from the fields of neurology, neurosurgery, neurophysiology and neuroradiology. Most of the contributors to the book work at the National Hospital for Neurology and Neurosurgery and so the book is firmly based on the epilepsy practice at this hospital; however, in addition, there are contributors from elsewhere who give the book an international flavour. This integrated multidisciplinary approach places the neuropathology of epilepsy firmly in the clinical context and this book will be of value both to neuropathologists and also to clinicians involved in the management of patients with epilepsy.
An interesting and entertaining introduction by Professor Scaravilli places our understanding of epilepsy in a historical context. There are many prescient quotations from historical figures dating back some 4000 years to the Mesopotamian civilisations, from ancient Greece, the medieval period and more recent history. There is even consumer advice on the purchase of slaves who are found, after the purchase, to suffer from epilepsy.
The first chapter succinctly outlines the epidemiology, clinical presentation and classification of epilepsy from the perspective of a neurologist. The second chapter deals with the pathophysiology of epilepsy, principally dealing with the use of animal models of epilepsy to study basic mechanisms. The third chapter describes the role of imaging in epilepsy; particularly the important role which MR imaging has in identifying focal lesions, not previously identifiable, which are the origin of seizure activity and therefore directing the neurosurgeon to the appropriate anatomical location. There are clear reproductions of MR scans illustrating hippocampal sclerosis, neuronal heterotopias, dysembryoplastic neuroepithelial tumour, arteriovenous malformations, cysticercosis, etc. Also included are illustrations of more adventurous uses of imaging such as three-dimensional reconstructions from scans to illustrate abnormal gyral patterns and MR images of a resected formalin-fixed hippocampus made in a small bore high-field-strength magnet. Covered in the same chapter is functional imaging (SPECT, PET and MR spectroscopy) principally for the purposes of anatomical localization of seizure activity. Chapter four covers the surgical perspective, describing how the recent upsurge in surgery for epilepsy is largely a consequence of improved imaging, allowing the identification of structural lesions which are potential targets for the neurosurgeon. Topics covered in this chapter include the history of epilepsy surgery, indications for surgical intervention and invasive electrical recording to achieve localization. The operative procedures that are described include lesionectomy and focal cortical resection, temporal lobe resection, hemispherectomy, corpus callosotomy and multiple subpial transection. The likelihood of a beneficial effect on seizure acitivity is described for each procedure.
There follows a substantial chapter on the pathology of epilepsy in childhood, which is prefaced by a discussion of clinical aspects which are specific for this age group. There is an extremely comprehensive description of the pathology of epilepsy associated with malformations, metabolic diseases, tumours and phakomatoses, vascular lesions, infectious diseases and Ammon's horn sclerosis.
Chapter six comprehensively describes forms of pathology which may underlie epilepsy in adults including tumours, trauma, cerebrovascular disorders, inflammatory and infectious diseases, degenerative and genetic disorders, metabolic disorders, neuronal migration disorders and hamartomas. There are useful sections on changes secondary to epilepsy. The difficult concept of sudden unexpected death in epilepsy (SUDEP) is clearly explained.
A short chapter on Rasmussen's syndrome is followed by a chapter on hippocampal sclerosis. In this last chapter, the arguments on whether hippocampal sclerosis is a cause or effect of epilepsy are clearly mustered.
No chapter is included on medical treatment for epilepsy or on clinical neurophysiology, but it seems somewhat churlish to criticise a neuropathology book for omission of such chapters. To be fair the emphasis of the book is appropriately on focal brain lesions which can be imaged and surgically resected, thereby providing specimens for interpretation by the neuropathologist.
The title is misleading in the sense that more than simply the neuropathology of epilepsy is covered—the book represents a truly multidisciplinary approach. In general, it is clear that each chapter is based on the extensive personal experience of its respective authors; the quality of the writing is high and the explanations are clear. Each chapter has a comprehensive bibliography. Bearing in mind that this is not intended as an atlas, the book is well illustrated. The photographs are in black and white, whereas colour is increasingly the norm these days, and the quality of reproduction is adequate. I have no doubt that this book will be of great interest and use not only to neuropathologists but also to neurologists, neurosurgeons, research scientists and others who have dealings with patients who suffer from epilepsy.
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