Neuropathology of Focal Epilepsies: An Atlas

Neuropathology of Focal Epilepsies: An Atlas . Lahl, R., Villagran, T., and Teixeira, W. . John Libbey & Co. Ltd. , London , 2003 , 316 pp . As neurosurgical intervention for medically intractable epilepsy has become popular, previously unknown or less well known pathological entities came to light. However, major (neuro)pathology textbooks do not allot enough pages to describe fully the histologic features characteristic of individual epilepsy-related disorders. Thus Neuropathology of Focal Epilepsies: An Atlas may nicely fill the niche. The book is divided into 15 chapters. The first five chapters are short, each covering introduction, epidemiology, historical overview of epilepsy surgery, methods of specimen processing, and clinicopathologic data on their cases. The next two chapters occupy the bulk of the book, covering temporal lobe epilepsy (Chapter VI) and extratemporal epilepsy (Chapter VII). Chapters VIII through XIV include clinical data on different disease groups, postoperative outcome, surgical complications, and summary table of patients. Finally, references shown in Chapter XV are comprehensive and up to date. The subject headings included in the two largest chapters (Chapters VI and VII) are arranged in a unique but somewhat confusing way. For instance, tumors and hippocampal sclerosis are listed under Chapter VI (temporal lobe epilepsy), and other disorders including malformation, inflammatory lesions, trauma, and ischemic lesions are shown in Chapter VII (extratemporal epilepsy). Assignment of these disorders to either temporal or extratemporal epilepsy is arbitrary and thus somewhat misleading, as individual pathological entities are not limited specifically to any particular type of epilepsy. The authors of the book frequently refer to “microdysgenesis,” which is a rather controversial term that invited an immediate, rather harsh rebuttal from two scholars on the publication of the original article on microdysgenesis. The same histologic features specified in “microdysgenesis” also are present in nonepileptic brains, and the significance of microdysgenesis in epilepsy is, at best, questionable. Furthermore, the authors of the current book added four more questionable histologic features to the category of microdysgenesis (Table 19), including duplication of the hippocampal granular layer. The latter also is observed in the nonepileptic hippocampus, depending on the angle and level of hippocampal sectioning, as the granular layer is part of the highly undulating dentate fascia. The term dysembryoplasticneuroepithelialtumor (DNT) was created for an intracortical, often multinodular tumor with no significant involvement of the subcortical white matter. Figures depicted as DNTs in the book (Figs. 50 and 160.3.1–160.3.4), however, display tumors predominantly located in the white matter, which may mislead readers, as they do not represent classic DNTs, as originally defined. A specific clinical feature of DNTs different from other gliomas is supposed to be their consistently nonaggressive behavior without recurrences. However, we now know that DNTs can be highly aggressive, as rightly indicated by the authors of the book, consequently losing their major unique characteristic feature. The reviewer personally believes that DNTs represent intracortical gliomas in an early stage with trapped preexisting neurons, and that the most common form of so-called DNT is an oligodendroglioma. Oligodendrogliomas, indeed, have been known to be highly epileptogenic compared with other gliomas. With the exception of somewhat controversial areas referred to earlier, this book possesses many attractive features. The book is more than a typical atlas composed of gross, microscopic, and imaging photographs only. Most chapters have introductory comments, detailed descriptions on each disorder, and appropriate clinical data drawn from their own cases. Further, the book contains many tables that are tastefully created with a pleasant background color. Color photographs are of superb quality, often showing pertinent special stains including immunohistochemistry. Black-and-white line drawings are crisp. In addition, abundant imaging photographs reveal a short clinical history, followed by figures demonstrating gross as well as histologic features. The book should be a valuable addition to the library of practicing pathologists, but more important, it also should be on the must-have book list for general epileptologists who are interested in the clinicopathologic aspects of epilepsy-related disorders.