Book Review

Behavioral Neurology

N Engl J Med 1994; 330:1464-1465May 19, 1994

Article

Behavioral Neurology
(100 Maxims in Neurology. Vol. 1.) By Orrin Devinsky. 384 pp., illustrated. St. Louis, Mosby-Year Book, 1993. $35.95. ISBN: 0-8016-7280-5

This book is the first in a series entitled 100 Maxims in Neurology, which is intended to provide clinically useful information, much of which is often not available in standard textbooks, to the practitioner. The series editor, Roger Porter, M.D., intends to provide this information in a format akin to clinical rounds. The series thus represents a unique approach to the study of neurology.

The field of behavioral neurology lends itself well to this format. For example, the physician must tailor the assessment of mental status to the individual patient in the course of the neurologic examination, rather than use a standardized battery of measures with all patients. It is this kind of clinical acumen that is difficult to portray in a textbook format and that this series attempts to capture. Devinsky has succeeded in synthesizing basic neuroscience material with clinical skill in his discussion of the diagnosis and treatment of behavioral disorders. The result is a very readable and interesting book, divided into 17 chapters, each of which addresses a set of maxims on a topic, yielding a total of 100 maxims. The discussion of each maxim is a few pages long, with adequate references for further exploration.

As would be expected in a book with this format, the discussion of some of the topics is somewhat superficial. For example, the section on the treatment of dementia includes only generalizations about various subtypes of dementia and provides relatively little insight into the clinical techniques used to distinguish among them. In addition, the author uses imprecise terminology in his discussion of forms of memory. He refers to short-term memory as the recall of information over a period lasting from minutes to a day. For most cognitive neuroscientists, there is a more precise definition of short-term memory, which overlaps with what the author has chosen to call immediate memory. Nevertheless, many of the discussions are useful and accurate, especially those of the behavioral manifestations of seizure disorders, with which the author is very familiar.

The strength of the book is its attempt to base clinical observations on the structural and functional organization of the brain. The author frequently refers to the functional organization of the cerebral cortex and its underlying patterns of connectivity. This approach gives the reader a framework for understanding behavior in terms of underlying structure and function rather than memorizing a collection of strange syndromes. It also reinforces the series editor's claim that behavioral signs have localizing properties comparable to the physical findings obtained during the general neurologic examination.

In general, this is an enjoyable, informative collection of useful information. It should be valuable to the medical student, house officer in neurology or psychiatry, and practicing clinician with an interest in behavior. Although it is somewhat difficult to use as a reference, its complete index allows the reader to locate topics of interest. The author and series editor are to be commended for their new approach to the study of neurology.

Ronald C. Petersen, Ph.D., M.D.
Mayo Clinic, Rochester, MN 55905