Book Review

Paediatric Neurology

N Engl J Med 1998; 338:480February 12, 1998

Article

Paediatric Neurology
Third edition. Edited by Edward M. Brett. 924 pp., illustrated. New York, Churchill Livingstone, 1997. $240. ISBN: 0-443-05200-X

The practice of pediatric neurology is substantially different on either side of the Atlantic Ocean and somewhat different on either side of the English Channel. The publication of this very “British” textbook provides an opportunity to review these differences and their significance.

Edward Brett and his colleagues at the Great Ormond Street Hospital for Children have produced seminal methodologic contributions to the neurologic examination of infants. Their procedures have integrated the “tonus” maturation of André-Thomas, the empathic examination of Ronald MacKeith, the “liberated motricity” of Albert Grenier and Claudine Amiel-Tison, the clinical approach of Richmond Paine, and their own research on parameters for estimating maturity. This syncretic clinical tool deserves to be correlated with the new imaging methods.

Modern molecular genetics has already transformed the professional life of pediatric neurologists. Brett and his colleagues have produced superb chapters that teach the clinician how to use the molecular genetic approach to clinical problems. It is a precious contribution at a time when too many publications in this field are mainly inventories, generating as much confusion as help.

The chapters on psychology and neuropsychology present the available tests clearly and also provide well-balanced discussions of the nature–nurture and the neurobiology–psychodynamics debates, still so popular in the Latin countries. The book covers the whole field of clinical pediatric neurology comprehensively, including excellent sections on neuropathology by Brian Harding. The topics of several paragraphs and chapters are favorites of Great Ormond Street, including bottom-shuffling, involuntary movements, the algorithm for a diagnosis of lysosomal disorders, Sandifer's syndrome, opsoclonus–myoclonus (dancing eye), and Brian Neville's positive but cautious views about surgery for the treatment of epilepsy.

Because of the symptom-free interval between the time lesions occur during brain development and the time clinical signs appear, a neurologic prognosis is difficult in early life. It is, however, crucially needed, especially in countries of Western Europe where abortion is accepted for medical reasons until the last weeks of pregnancy. Throughout the book, issues related to prognosis, ethics, and social aspects are carefully scrutinized and will be especially useful for European pediatric neurologists who are involved in ethical decisions about active discontinuation of fetal and newborn life.

In the majority of pediatric neurology services in Europe, pediatric neurologists are not only consultants but are also responsible for the entire care of their patients. This promotes the integration of medicine of the nervous system with the whole care of the child. Brett and his coauthors cover these aspects well.

In comparison with the United States and France, it seems that the United Kingdom has somewhat lower levels of mortality and morbidity in several fields, despite the fact that the British spend a rather modest amount of money for health care. Several chapters, including those on cerebral palsy and perinatal medicine, and the spirit of the whole book show concern about public health, prevention of illness, and the strategic use of laboratory examinations, all of which could reflect the lower health care costs in the United Kingdom.

This textbook is not only a source of information, it also demonstrates a teaching method and pathway. Even though it is multiauthored, it has the homogeneity of a book by a single author. It contains excellent paragraphs introducing the history of important concepts and paying due tribute to authors who gave so many ideas to others but who are underrepresented in the literature, such as the late Paul Sandifer. Many excellent general sources, from Queen Victoria to George Bernard Shaw, are quoted when they are useful for making important points; true culture is not forbidden in academic medicine. Every pediatric neurologist will wish to have a copy of this original, superb, and comprehensive textbook.

Philippe Evrard, M.D.
Hôpital Robert-Debré, F-75019 Paris, France