The field of pediatric neurology is extraordinarily wide. It includes material from general pediatrics and adult neurology, genetics and dysmorphology, metabolism and biochemistry, intensive care and neurosurgery, and neonatology. In addition, it must incorporate the areas of physical, psychological, and language development and their underlying brain correlates as well as child neuropsychiatry. This list is not exhaustive, but it may give some sense of the challenges faced by the author of a textbook on the field. In fact, such textbooks are rather numerous -- surely a tribute to the academic zeal of pediatric neurologists.
This new textbook is multiauthored but has been given a strong unitary structure by editor Ronald David, the author of an earlier textbook, Pediatric Neurology for the Clinician (Norwalk, Conn.: Appleton and Lange, 1992). This book is also intended for clinicians, to "reside on [their] desk, rather than [their] bookshelf." The book has three sections: tools for diagnosis (with extensive descriptions of the neurologic examination of infants and children and the major imaging and electrophysiologic tools), descriptions of diseases and disorders, and approaches to common problems. Throughout the book there are well-organized diagnostic tables, boxes of "pearls and perils" of varying degrees of pithiness, boxes entitled "Consider Consultation When...," and annotated bibliographies in each chapter; there is also a complete bibliography. The book includes references through 1995, with a smattering from 1996.
The standard of the book is uniformly high. Several chapters provide superb and probably unrivaled coverage of material, especially those on neoplastic disease by Michael Cohen and Patricia Duffner, cerebral palsy by Barry Russman, epilepsy by Gregory Holmes and Carl Stafstrom, and neurocutaneous syndromes by Daniel Stowens. Notable also are articles by experienced and thoughtful clinicians on headache, movement disorders, and dyspraxia (which is often ignored in textbooks).
Inevitably, the book is uneven. Some chapters approach the subject by providing an initial overview or system that is extremely useful for the student or clinician; ideally, it conveys the structure of the author's knowledge. The chapters on inborn errors of metabolism (including neurodegenerative disorders) contain a wealth of material, but they lack such a framework for a diagnostic approach to this very complex group of disorders. They are organized according to an anatomical-pathological classification that gives the clinician little guidance. There is, for example, an exhaustive description of mitochondrial disorders, but with little to organize or systematize them.
The textbook cannot be used as a definitive or encyclopedic source: much is covered, indeed, but I found serious gaps. Using the book for reference in the course of a few weeks' clinical work, I was unable to find mention of several entities: fetal alcohol syndrome, neuroaxonal dystrophy, Sanfilippo's syndrome (or its enzymatic equivalents), myelopathy, XYY syndrome, and Rasmussen's encephalitis. Only cursorily mentioned were acute disseminated encephalomyelitis, complicated migraine, multiple sclerosis, systemic lupus erythematosus, Angelman's syndrome, sickle-cell cerebral infarction, and congenital or infantile nystagmus. Guillain-Barre syndrome and Wilson's disease each had only a short entry. The description of African trypanosomiasis, by contrast, claimed nearly two columns. New syndromes -- for example, cyclosporine toxicity, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, and glucose transport protein deficiency -- are included. The new anticonvulsant agents are discussed; fosphenytoin is mentioned. The neurologic complications of high-intensity regimens, always a major source of consultations, are well covered.
The chapters on functional disorders (dyspraxia, learning disabilities, speech disorders, and hyperactivity) are commendable. However, I had the sense that they failed to add up to a satisfying overall approach to the child with developmental disabilities and to possible underlying diagnoses. In particular, the focus on hyperactivity without more than glancing consideration of familial psychopathology seems outdated.
In summary, this is a rich and important textbook and joins the first rank of pediatric neurology textbooks. It is as up to date as possible. It contains a great deal of excellent material, much of which is probably unequaled elsewhere. It is presented in a very attractive and readable fashion. The book cannot be considered a complete or encyclopedic source for pediatric neurology because of its unevenness and omissions in coverage. Nevertheless, it strongly deserves to be read and used by training and practicing pediatric neurologists, developmentalists, and pediatricians.
Reviewed by G. Robert DeLong, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
