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BOOKS
Reviews
Asymmetrical Brain
Edited by Kenneth Hugdahl and Richard Davidson
Cambridge, MA, MIT Press, 2003
732 pp, illustrated, $90.00
Childhood Headache
Edited by Ishaq Abu-Arafeh
London, United Kingdom, Mac Keith Press, 2002
200 pp, illustrated, $65.00
Headache is the most common health complaint in adolescents and the most common pain syndrome in adults and
children. As such, it is of interest to both primary care physicians and neurologists. Dr Abu-Arafeh has produced a
comprehensive new book on childhood headache with an international cast of authors who are leaders in the field of
pediatric headache.
Childhood Headache focuses on migraine, with chapters on
migraine inheritance, pathophysiology, diagnostic criteria,
and migraine syndromes. Chronic daily headache, episodic
tension headache, and more rare causes of headache are also
reviewed. Throughout Childhood Headache, there is an emphasis on data and evidence-based medicine. For example,
the authors have compiled tables listing the published epidemiological studies on recurrent headache in childhood, as
well as the double-blind placebo controlled studies on prophylactic drug treatment for migraine in children.
Strengths of Childhood Headache include clinical vignettes
and case studies, practical tables reviewing aspects of differential diagnosis in headache syndromes, and a sample headache diary and new patient questionnaire found in the appendix. Chapters on migraine variant syndromes and the
nonpharmacological treatment of headache (cognitive and relaxation techniques, biofeedback, and self-hypnosis) are particularly strong. The final chapter in Childhood Headache
emphasizes the value of specialized headache clinics and the
need for a multidisciplinary approach to headache therapy.
One limitation of Childhood Headache is the textpredominant format. While the tables and figures contained
are useful, they are very few in number, making it impractical for quick reference. Furthermore, Childhood Headache
lacks detail in some clinically relevant areas. As such, the section on pharmacological therapy is brief and forgoes review
of the newer abortive or prophylactic medications. For example, sumatriptan, albeit in multiple forms, is the only
triptan mentioned.
We recommend Childhood Headache to those interested in
pediatric headache from a research perspective; the chapters
on pain and headache physiology, epidemiology, and inheritance should serve as excellent background reading. In addition, the review of published studies and extensive references, often more than 100 per chapter, should prove
invaluable. The text may also find an audience with general
pediatricians, residents, and fellows completing training in
child or adult neurology who would like to own a current,
thorough reference book on headaches in children.
Lori C. Jordan, MD
Eric H. Kossoff, MD
Baltimore, MD
DOI: 10.1002/ana.10652
The Asymmetrical Brain by Kenneth Hugdahl and Richard
Davidson bears little relationship to but follows from an earlier book on this topic, Brain Asymmetry, by the same authors
(in reverse authorship order) published in 1995. Asymmetrical
Brain contains 21 original chapters, and only a handful of
the authors from the first book contribute to this volume.
The increased sophistication of functional imaging approaches in the interim time, coupled with the presence of a
great deal of new data on brain asymmetry, has led to a
whole new section containing chapters on functional magnetic resonance imaging (MRI), positron emission tomography, event-related potentials, magnetoencephalography, and
transcranial magnetic stimulation. There is also a greater coverage of brain anatomy, as disclosed by structural MRI,
which in some ways improves on the time-revered autopsy
studies but in others uncovers spatial complexity at levels
above that which can be visualized by the average reader.
There is a section on animal models that publishes a
sprinkling of works aiming at understanding the fundamental mechanisms underlying cerebral asymmetry. These chapters have a distinctly cognitive neuroscience or systems neuroscience bent, as opposed to a molecular orientation, which
does not represent neglect on the part of the editors, but
rather the paucity of information on the molecular biology
of cerebral lateralization. This is indeed a challenge for the
future, which I hope will make the list of chapters in the
next version of Asymmetrical Brain.
A section on brain imaging has a chapter on statistical
methods, important for anyone contemplating becoming involved in imaging brain asymmetries, a chapter reviewing the
gamut of brain asymmetries disclosed by MRI, and a chapter
in which the usefulness of transcranial magnetic stimulation
for looking at causal relationships between brain activation
and function, as it pertains to cerebral lateralization, is outlined.
Then come a series of three sections, each concerned with
lateralization in a particular system—visual, auditory, and
emotional—an organization that has a good deal of heuristic
value and not present in the previous book. In this group,
there is a chapter dealing with visual-spatial processing in the
brain, in which different contributions to spatial processing
are attributed to the right and left hemispheres, a couple of
chapters stressing the importance of attention on the degree
of cerebral lateralization that can be measured, and an interesting review of findings showing the relative, rather than
absolute asymmetry of participation of the prefrontal cortex
in emotional behaviors.
The section on neurological disorders will be somewhat
disappointing to neurologists, not so much because of what
is presented, but because of all the asymmetric neurological
disorders that are not covered. This limitation is made a bit
more acceptable by the inclusion of a section on psychiatric
disturbances and the presence throughout the volume of allusions to pathology when discussing the normal state. However, pathology of asymmetry is not the focus of Asymmetrical Brain.
© 2003 American Neurological Association
Published by Wiley-Liss, Inc., through Wiley Subscription Services
279
Interest in or at least curiosity regarding the asymmetric
nature of the human brain for controlling perceptual, cognitive, and motor processes will remain for as long as there are
questions regarding its fundamental origins, and for as long
as this phenomenon can be linked to human achievement
and human suffering. In Asymmetrical Brain, Davidson and
Hugdahl continue to provide a welcome service by selecting
and publishing representative examples of progress in this
field.
Albert M. Galaburda, MD
Boston, MA
DOI: 10.1002/ana.10653
A Clinical Guide to Epileptic Syndromes and Their
Treatment: Based on the New ILAE Diagnostic Scheme
By C. P. Panayiotopoulos
Chipping Norton, Oxfordshire, United Kingdom,
Bladon Medical Publishing, 2002
278 pp, illustrated, $65.00
The International League Against Epilepsy (ILAE) has recently proposed a new system for classifying seizures and epilepsy syndromes (Engel J, Epilepsia 2001;42:796). Seizures
are described using five axes: ictal semiology, seizure types,
syndromic diagnosis, etiology, and degree of impairment. Dr
C. P. Panayiotopoulos’ new book A Clinical Guide to Epileptic Syndromes and Their Treatment implements the new
diagnostic scheme and serves as a test of its usefulness. The
educational value of the ILAE scheme book is their detailed
review of seizure types and epilepsy syndromes based on associated clinical findings. Many clinicians could benefit from
the detailed descriptions of uncommon epilepsy syndromes
and seizure types. As an example, the text and ILAE scheme
help clinicians distinguish focal motor seizures associated
with bilateral limb shaking from generalized tonic-clonic seizures.
Although the text concentrates on the definition and characterization of epileptic syndromes, the introductory chapter
points out some of the proposed changes in terminology in
the ILAE scheme. These include substitution of “focal” for
“partial” seizures (though, we wonder how often clinicians
actually err in thinking the term partial might imply “part
of” a seizure?). In addition, “cryptogenic” becomes “probably
symptomatic,” “convulsion” is replaced by “generalized
tonic-clonic seizure.” The author, who is a former member
of the ILAE Task Force, candidly discusses and illustrates
several disadvantages and shortcomings of the proposed
ILAE scheme. Confusion is one of the most common, characteristic, and disabling feature of partial-onset seizures, and
yet the new classification drops “altered awareness” as a defining feature. The author acknowledges the importance of
confusion as a sign of seizures by often using the term “complex” to describe focal seizures, for example, “complex” focal
seizures. At other points, however, the author insists on a
literal application of the ILAE scheme. He, suggests, for example, that benign childhood epilepsy with centrotemporal
spikes and early-onset benign childhood occipital epilepsy do
not fulfill the diagnostic criteria for “epilepsy,” because they
280
Annals of Neurology
Vol 54
No 2
August 2003
are not truly “chronic” and instead should be classified under
the unwieldy category “conditions with epileptic seizures that
do not require the diagnosis of epilepsy.”
Definitions for many epilepsy syndromes are evolving. It
has been shown recently, for example, that the syndrome in
the ILAE classification of “mesial temporal lobe epilepsy with
hippocampal sclerosis” is also often associated with gliosis
and atrophy in the amygdala and parahippocampus (Bernasconi N, et al. Brain 2003;126:462). The text inaccurately
refers to the syndrome as “hippocampal” epilepsy. The text
includes several syndromes that are neither commonly accepted by clinicians nor recognized by the ILAE as a syndrome, for example, Jeavon’s syndrome for eyelid myoclonia
with absences.
The new ILAE classification does not significantly influence seizure therapy: treatments are divided into standard
lists of anticonvulsants available for the generalized versus
“focal” epilepsies. Surgical treatments and outcomes are discussed in some detail; however, treatments such as vagal
nerve stimulators are mentioned only in passing as an “expensive and probably worthless exercise.”
Both the ILAE scheme and Dr Panayiotopoulos show an
unfortunate and unhelpful fondness for eponyms, rather
than more informative descriptive titles. For example, Dr
Panayiotopoulos promotes his own name as an eponym for a
syndrome of “early-onset benign childhood seizures with occipital spikes.” He adds the Russian neurologist Kozhevnikov’s name to two epilepsy syndromes, even though the name
does not further define epilepsia partialis continua and
weighs us down with double eponyms for Rasmussen’s syndrome (referred to as Kozhevnikov–Rasmussen’s or
Kozhevnikov type 2 syndrome). A Clinical Guide to Epileptic
Syndromes and Their Treatment has several errors. For tiagabine, the author notes that “visual field defects, although not
yet confirmed, may be a reality because of its mechanism of
action which is similar to vigabatrin,” even though objective
evidence demonstrates no effects of tiagabine on vision
(Krauss et al. J Neurol Neurosurg Psychiatr 2003;74:339).
Sidebars (in multiple colors) sometimes contain fragmented
or repeated comments.
A Clinical Guide to Epileptic Syndromes and Their Treatment is useful for helping neurologists recognize and classify
both common and uncommon seizure types and epilepsy
syndromes. Dr Panayiotopoulos’s review demonstrates the
heuristic value of the proposed ILAE diagnostic scheme.
Overall, however, our impression is that the ILAE scheme is
unlikely to markedly improve the precision of clinical diagnosis; most important, seizure types and epilepsy syndromes
are classified adequately in the current ILAE scheme. It
seems likely that the new proposed classification system will
serve a useful purpose as a transitional tool which points out
diagnostic pitfalls or limitations with the current system. A
more definitive classification will evolve more slowly as the
genetic and neuronal causes of epilepsy become understood.
Gregory L. Krauss, MD, and Saurabh R. Sinha, MD, PhD
Baltimore, MD
DOI: 10.1002/ana.10666
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