EEG in Childhood Epilepsy: Initial Presentation and Long‐term Follow‐up. H. Doose. John Libby Eurotext, London, 2003, 413 pp.

Abstract

In the preface to his monograph, EEG in Childhood Epilepsy, Dr. Doose emphasizes the importance of systematic evaluation of maturation-dependent changes in the EEGs of children with epilepsy. He has accomplished this very well in this 413-page work by means of ample, excellent EEG examples, well-organized chapters, and a fine bibliography. The book in organized into seven chapters. The first three chapters illustrate normal EEG findings and genetically determined EEG patterns. Discussion focuses on whether various abnormalities or variant patterns have significance with regard to a genetic origin or epileptic potential. Chapter 4 is a brief (three-page) chapter focusing on EEG analysis and its importance in the evaluation of the complex pathogenesis of epilepsy. Chapter 5 describes the EEG findings associated with seizure disorders not usually considered “epilepsy,” neonatal seizures and febrile seizures. Chapter 6 is the centerpiece of the book. It is 166 pages long and comprises discussions of EEG in generalized, idiopathic, and lesional epilepsies, along with thorough discussions about the distinctions between and similarities among a variety of epilepsy syndromes. Chapter 7 illustrates the EEG contribution to the differential diagnosis of such entities as syncope, migraine, inflammatory disease, dysplasias, and metabolic diseases. A nice appendix provides useful tables and examples of EEGs in normal, healthy children. The bibliography includes 336 references, and the index handily refers to both text pages and figure numbers. The EEG figures are the most valuable feature of this work. Clearly a great deal of care went into their selection. The 345 figures are nicely reproduced. Most take up half a page, so they are usefully large. This work could easily serve as an atlas of EEG in children. As one would expect from EEGs accumulated over six decades, a variety of montages are used (including some not using the 10–20 system), and most examples have a limited number of channels (usually eight to 10). This is no impediment when looking at the figures because they are all well labeled with “head diagrams,” time scale, and sensitivity. Figure legends are concise and informative. In-text references to a given figure are mostly within a page or two of the actual EEG example. Particularly notable are multiple examples of serial EEGs recorded at different times ranging from young childhood through adulthood in patients with a variety of epilepsy syndromes. Family members' EEGs also are sometimes included. One might wish that more detail about the patients' medications during the EEGs also were documented to add clarity about when EEG changes are related to brain maturation versus therapeutic drug effects. The text is mostly well written and well organized. Particularly helpful are detailed discussions of the distinctions between such entities as Lennox–Gastaut syndrome, pseudo-Lennox syndrome, and myoclonic–astatic epilepsy (modestly never referred to as “Doose syndrome”). Another useful discussion focuses on differences (and similarities) between Landau–Kleffner syndrome, electrical status epilepticus during slow-wave sleep (ESES), and epilepsy of childhood with occipital paroxysms (ECOP). Hypsarrhythmia and its variants are thoroughly examined, and again the EEG examples are excellent. The line between personal opinion and consensus is not always clear from the text, but references to published works are amply cited, allowing doubtful readers to make up their own minds. At times the translation suffers from clumsy syntax, and hyphenation is occasionally odd, but these are very minor complaints. Experienced electroencephalographers will benefit from the interesting discussions about various epilepsy syndromes and the valuable bibliography. Those with limited experience in pediatric EEG will find the well-labeled examples easy to refer to and will appreciate the variety of examples for any given syndrome (as opposed to only one or two “classic” examples often shown in more comprehensive EEG texts). Neurologists who do not regularly read EEGs should find useful the details about distinctions between similar epilepsy syndromes. This volume will make an excellent addition to the collection of anyone who must interpret children's EEGs or diagnose their epilepsy syndromes.