Book Review


Epilepsy Surgery: Case Studies and Commentaries, by Kost Elisevich and Brien J. Smith, Lippincott Williams & Wilkins Publishers, 2002 0

This book consists of a series of case reports on the theme of the surgical management of epilepsy with added brief literature reviews on a number of associated topics. Since 10% or more of epilepsy patients could potentially benefit from this form of treatment, it is an important subject. Appropriately, the principal authors include both a neurosurgeon and a neurologist who work together in one epilepsy surgery program. The text at less than 250 pages, considerably shorter than its multi-authored predecessors, covers a lot of territory, but suffers somewhat from being less than comprehensive. Nonetheless, it is an easier read than the larger tomes. Resective epilepsy surgery is the main focus while corpus callosotomy, multiple subpial transection, stereotaxic lesionectomy, and vagus nerve stimulation all receive brief mention. Thirteen cases are based on the location of the resected focus (6 temporal, 3 frontal, 3 parietal, 1 occipital) and five on the etiology of the focal epilepsy (trauma, postmeningitic, perinatal ischemia, schizencephaly, hypothalamic hamartoma). The last three cases are presented in a format similar to that of an epilepsy case conference or epilepsy rounds where invited contributors from three other epilepsy centers in New Haven, USA; London, Ontario, Canada; and Cleveland, USA give their assessments of the diagnosis, investigation, and management of the patients.

The localizing and lateralizing features of clinical signs and symptoms are appropriately addressed as are selected pathologies that can cause epilepsy including the concept of dual pathology. Surprisingly, dysembryoplastic neuroepithelial tumor, an increasingly familiar cause of focal epilepsy, is not mentioned. Single photon emission computed tomography (SPECT) receives extensive attention in contrast to limited reference to positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), which do not appear to have been in use at the author's institution. Similarly, this appears to explain the preference for invasive telemetry recordings using subdural rather than depth electrodes or a combination in several of the case presentations. Postoperative complications involving memory, visual fields, and cranial nerves are discussed (contralateral allodynia following a parietal lobe resection is an unusual one) but the cases presented reveal a certain amount of selection bias in that all had a favorable seizure outcome—except the hypothalamic hamartoma, which was only biopsied. A more balanced approach would have demonstrated the reasons why epilepsy surgery fails to improve seizures or causes unforeseen complications in some patients and why seizure control does not always equate to improved quality of life. Further, there is no discussion of psychiatric, clinical psychological, or social issues despite at least two of the patients experiencing psychosis and exacerbation of panic disorder following surgery.

Information presented is reasonably well referenced and generally accurate. There are only a few statements with which the discerning reader might take issue. Not everyone would agree that “single heterotopic white matter neurons” in the temporal lobe indicate cortical dysplasia of clinical significance or with the contention that the occurrence of language transference to the nondominant hemisphere “may not extend much beyond two years of age.”

This book will appeal primarily to clinicians who are training in an epilepsy surgery program most of whom will be familiar with the case-centered approach to learning. Of particular interest to this group, as well as to other readers, is the approach used by experienced epileptologists in analyzing and discussing complex cases. The text provides a taste of many issues surrounding the surgical management of epilepsy but to appreciate the full flavor of this fascinating subject one will be obliged to look elsewhere.