Brain, Vol. 126, No. 9, 2108,
September 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg124
Book Review |
EPILEPSY SURGERY: CASE STUDIES AND COMMENTARIES
Kings College Neuroscience Centre, London, UK
EPILEPSY SURGERY: CASE STUDIES AND COMMENTARIES
By Kost Elisevich and Brien J. Smith
2002. Lippincott Williams & Wilkins: Philadelphia
Price $120. Pp. 233. ISBN 0–7817–1727–2.
This small book should appeal to all professionals concerned with presurgical evaluation of patients for epilepsy surgery. It is a series of selected and largely representative case studies in the major areas of surgical evaluation. The format follows that of a clinical meeting and is more or less uniform throughout the book. The presentations begin with the relevant history of epilepsy, including a seizure history. Then the remainder of the clinical review follows. After this there is a review of the basic investigations such as neuroradiology, neuropsychology including the Wada test, and basic interictal neurophysiology. At this stage a formulation is made and then usually further neurophysiological investigation is undertaken involving varying degrees and patterns of intracranial recording. The results of this are reviewed and then a plan of management is made. The details of this management, including acute corticography, resection and the pathology encountered are described. In most cases a reasonable follow-up period and any postoperative interventions, including reoperation are also described. At the end of each case there is adequate discussion, which is informed and not oversimplified, with appropriate and up-to-date literature references. The presentation of results, esecially clinical neurophysiological results, is uniform, especially the diagrams showing the location of intracranial electrodes. One minor irritation is that the clinical onset of seizures is not indicated by arrows or other methods on the otherwise excellent neurophysiological traces.
The section on temporal lobe epilepsy is excellent and the section on neocortical epilepsy is recommended. The account of frontal lobe epilepsy is reasonable. The section associating anterior callosal section with frontal resection is unusual and the review of the literature on callosal section is of limited relevance. There could have been some discussion of the management of discrete frontal lobe lesions.
The section dealing with parietal lobe epilepsy is timely and the discussion of tumoural parietal lobe epilepsy is good. The account of postoperative management and the part played by ‘run down’ are particularly valuable. The single case in the chapter on occipital lobe epilepsy illustrates a number of important aspects of the management of these patients including the relationship between occipital and temporal epileptic activity.
A single chapter associates post-infective and post-traumatic epilepsy, but it might have been better to have more cases. The discussion is a little artificial. The next chapter deals with post-ischaemic cases. It is unfortunate that the authors have not discussed somewhere in these two chapters the process of selection for hemispherectomy, which is not always a straightforward matter. One of the cases, KC, unfortunately has no detailed pathology of the resected tissue.
Case selection has determined the discussion in the chapter on neurodevelopmental disorders. The case that they have chosen, which is one of schizencephaly, although of considerable interest, is rare, and one would liked to have seen a case of major cortical migration defect, which is a commoner problem for most centres, discussed. The other case in this chapter, which is one of hypothalamic hamartoma, is discussed in considerable detail. The conclusions are rather downbeat. The discussion is based upon the identification of the epilieptogenic zone. It fails to emphasise that in patients where the seizure origin can be traced to the lesion, usually by depth recording or by ictal SPECT, or both, then a direct attack on the lesion is more likely to be successful.
The final chapter gives selected perspectives on three cases by senior figures in this field. The first case of bitemporal epilepsy is well chosen and beautifully analysed by the Spencers. The second case, NH, is complex and not dealt with so well. In particular there is no rationalization for the right temporal resection in this patient. The final case, NG, a patient with multiple cavernomas, is well analysed and presents a good discussion of the advantages and disadvantages of using intracranial recording.
The standard of clinical information and discussion in this book is exceptional. It is easy to point to omissions but this was not intended to be a textbook and therefore had to be kept short. In using these case studies to illustrate and teach the process and intellectual challenge of presurgical evaluation for epilepsy surgery, the authors have achieved an excellent result. The book is of an appropriate size and modestly priced, and as a practical introduction to the science, and art, of presurgical evaluation, is to be recommended.
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