Ingmar Blümcke, Harvey B. Sarnat, Roland Coras Surgical Neuropathology of Focal Epilepsies: Textbook and Atlas John Libbey Eurotext, 2015. 157 Pages (hardcover). Price 94.99 (amazon.co.uk). ISBN: 978-2-7420-1399-9

Abstract

Surgical Neuropathology of Focal Epilepsies: Textbook and Atlas is a 157-page reference handbook written by three leaders in the field of epilepsy neuropathology, Drs. Blümcke, Sarnat and Coras. It fills a gap in the current neuropathology reference literature with a singular focus on epilepsy-associated lesions. In an effort to organize the evidence base for this diverse group of pathologies, the authors have assembled short reviews of the current literature and figures illustrating the typical microscopic findings for each entity. Of particular value to such an effort, Dr. Ingmar Blumcke brings to the text the experience of the German Neuropathology Reference Centre for Epilepsy Surgery, a European brain bank which includes an assemblage of 5603 specimens spanning a range of pathologies. The first section of the book is divided into five chapters covering different aetiologies of epilepsy including hippocampal sclerosis (HS), malformations of cortical development including focal cortical dysplasia (FCD), tumours, encephalitis and vascular lesions. The chapters on HS and FCD include summaries of the consensus classification systems for both from the International League against Epilepsy. References are listed alphabetically at the end of each topic's chapter. After these five overview chapters, the authors move on to a case-based atlas of lesions. These cases comprise 32 patients and are organized by diagnosis, with examples drawn from each of the categories outlined in the opening chapters. The case presentations include epilepsy history as well as relevant imaging findings and beautifully photographed macroscopic photos of the specimens as received and after dissection. This is followed in each case by a multi-panel figure showing the typical microscopic findings for each diagnostic entity, including histochemical and immunostains which can be useful in resolving these diagnoses. The final components of the textbook are two reference chapters. The first is an in depth presentation of the data from the European brain bank cohort. The samples included in this large series were obtained from patients with intractable epilepsy, and the data collected include clinical information such as the patients’ age, sex, age at seizure onset and localization of seizures. The data are presented in several tables, demonstrating the overall frequencies with which certain diagnoses were encountered, the average ages of onset of seizure activity, and the major categories of lesions for both adult and paediatric groups. The final section includes recommendations for processing and work-up of epilepsy specimens. This chapter includes numerous macroscopic photos detailing the handling of brain samples, from initial cut-up to techniques for freezing and processing tissue. Practising neuropathologists will also find information on immunohistochemical staining useful for the work-up of epilepsy cases. The quality of the illustrations is very good throughout the book, and the gross photographs are particularly helpful. Many light microscopic images from low magnification are provided and allow a broad overview of the architecture of the cortex or hippocampus. These images are frequently supplemented by higher magnification panels to show more detailed histopathological findings. Another major asset of this textbook is the inclusion of data from the German reference centre cohort, which allows the reader to have a better sense of the relative prevalence of specific pathologies, and their common clinical features. The structure of the book is somewhat unusual, with the first half dedicated to descriptive chapters, the next portion to case presentations and the remainder presenting reference data. Unfortunately, the book lacks an index which, given its format, would have been particularly useful for cross-referencing among these segments. However, given its short overall length, it is possible to find relevant sections simply by browsing instead. The most frequently used section of this textbook for a practising neuropathologist would likely be the case-based atlas at its centre. In this portion of the book, the high quality macroscopic and microscopic images will provide a very handy reference. The emphasis in this section on the clinical and radiological findings associated with different types of epilepsy-associated lesions certainly broadens the potential audience. In presenting the information in such a format, the authors have created an atlas that will be of interest to many clinicians with an interest in focal epilepsy. This textbook will be a good addition to the library of a practising neuropathologist who handles epilepsy cases with any frequency. Because of its broad scope and case-based approach, it will also provide a nice introduction to the topic for clinical specialists in neurology, neurosurgery or neuroradiology.