Brain, Vol. 127, No. 3, 713, 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh055
Book Review |
LANGUAGE AND EPILEPSY
LANGUAGE AND EPILEPSYBy Yvan Lebrun and Franco Fabbro
2002. London: Whurr Publishers
Price £20. ISBN 1-86156-312-4.
The relationship between language and epilepsy remains complex. This book attempts to address the issues involved from a variety of different angles and provides much food for thought. However, it is difficult to know at whom the book is directed. It appears to be written from a speech pathology point of view. The authors state that the book is aimed at a wide audience, of all professionals involved in epilepsy; there are parts of the book that fulfil this need, although it remains almost an impossible task.
The book takes all aspects of the possible relationship between language and epilepsy and discusses them in turn. This includes historical aspects, which have been considerably researched. Chapter one attempts to review current views and definitions of epilepsy. This, however, is very simplistic and at times inaccurate. In particular there is no mention of the ILAE classification of epilepsy, ‘old-fashioned’ terminology is used and a differential diagnosis discussed in a non-medical way. Professionals involved in epilepsy are unlikely to gain benefit from this. This may put off many who would find later portions of the book interesting, particularly as later in the book many issues that have not been tackled previously are discussed. Chapter 2 provides more interesting reading, discussing the history of the perceptions of epilepsy, particularly the sources from which any ‘stigma’ of epilepsy may have arrived. Chapter 3 discusses ictal verbal behaviour; this is again interesting but in many places inaccurate, or lay terminology is used. The discussion of the relationship to focal seizures and how this may help in localizing seizure onset is limited to the very end of the chapter. Chapters 4 and 5 discuss reflex epilepsy (as triggered by language-related activity) and stuttering and epilepsy respectively. Chapter 6, on interictal verbal behaviour, ultimately discusses the complex relationship between Landau–Kleffner syndrome and the continuous spike wave of slow sleep appropriately. However, this is under ongoing discussion in the literature, and some definitive statements are made about basic concepts within the paediatric epilepsy world that are inaccurate. The relationship between EEG abnormality and language disorder is complex, as is its treatment. Treatment and prognostic issues are discussed in a very simplistic manner that does not convey this. Chapter 7 interprets literary prose and other expressive work from three historical individuals who were thought to suffer from epilepsy—Dostoevsky, Flaubert and Van Gogh. This provides very interesting reading but appears to add little to our overall understanding of the condition.
Chapter 8 discusses language in the context of epilepsy surgery. It is obviously of relevance when considering resective surgery to be aware of possible language interference, with regard to both directing whether surgery may be safe and to possible deficits that may be seen following surgery. The issue of non-dominant/dominant right/left issues appears confused. The impression is given that memory will always be affected after temporal lobe surgery—it is disappointing that more up-to-date/appropriate references are not used, and only brief is mention given of the fact that memory might improve when seizures are controlled. Only within Chapter 9, when cortical stimulation/hemispheric anaesthesia is referred to, does language dominance get discussed. In the current climate, in which functional imaging has informed of so much, it is a shame that again no mention is made of this. Chapter 10 is brief and attempts to further discuss treatment, but again discussion of the ‘little patients’ suffers from translation problems and would have benefited from being integrated into earlier chapters.
Although this book is interesting, it is difficult to know at whom it is targeted. It is certainly written in a non-medical way, with at times inappropriate terminology and little discussion as to the cause/relationship to epileptiform activity. It is difficult to know whether the emphasis at times may be attributed to the English translation. Certainly, historical terms at times appear to be related inaccurately to current practice. The book certainly attempts to address a topic that has many facets and about which much discussion continues to take place among those involved particularly with children and epilepsy. The emphasis of the book, I am sure, reflects the perception and interests of the authors; I think they are ambitious in thinking this is going to have a varied readership and I think it is more likely to be relevant to the speech and language therapist and psychologist, who have regular contact with individuals with epilepsy. Other professionals may find portions of the book interesting according to their respective field. The book is certainly easy to read, but relevant portions may serve only as a further stimulus for discussion.
Neurosciences Unit, Institute of Child Health, The Wolfson Centre, Mecklenburgh Square, London, UK
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