Paediatric Neurology

Rob Forsyth, Richard Newton, eds. Paediatric Neurology. Oxford: Oxford University Press; 2012 (633 pages) ISBN 978-0-19-960363-3.

This volume “Paediatric Neurology” is one of the 10 Oxford Specialist Handbooks in Paediatrics. It was written by an “orchestra” of 10 contributors under the “conductors” Rob Forsyth (Newcastle) and Richard Newton (Manchester). It is an expanded and modified second edition taking into account suggestions for improvements of the first 2007 edition. In their modest attitude, the editors again “ask to tell us how it can be improved.” Therefore, I dare to draw attention to some rather minor options for amendments, realizing that considerations of text reductions, addenda, and semantics is a very difficult editorial balance.

The general aim of the editors is to provide a combination of practical advice on clinical approach, and “at a glance” oversights and aides-memoire to topic areas. The handbook has the format of a pocket book (10 × 18 cm) and is thus predestined to be a daily companion for trainees and experienced clinicians. The style of the text is precise and compact, often in appropriate “telegram” manner, and reads very well. The clinical experience and teaching commitments of the editors are felt in and between the lines, often topped with a sense of fine humor. The print of the main text is acceptable, but is too small in some figures and tables, at least for an old reviewer, even with adjusted glasses. Overall, the book includes many helpful tables (about etiologies and differential diagnoses) and figures (e.g., innervations, neuroradiological anatomy).

The book is divided into seven chapters: (1) Clinical approach, (2) Neurodiagnostic tools, (3) Signs and symptoms, (4) Specific conditions, (5) Consultations with other services, (6) Emergencies, and (7) Pharmacopeia.

In chapter 1 (Clinical approach), I valued many practical hints, also paying attention to special circumstances (the dying child), the description of gait “gestalts,” the pattern recognition approach to (for example) gait difficulties and weakness. The two pages on Synthesis (which reflects the clinical art of synthesizing historical and clinical findings into a meaningful differential diagnosis and a targeted investigational plan) reflect important remarks. I have missed a description of the head-impulse test, an easy bedside test to check vestibulo-ocular reflex function.

Chapter 2 (Neurodiagnostic tools) provides good explanations of the various magnetic resonance imaging (MRI) techniques and detailed tables about nerve conduction velocities. I have missed a sentence about the use of muscle MRI which is being increasingly used and can be quite helpful in the differential diagnosis of neuromuscular disorders. Are the practical hints for skin and muscle biopsy relevant in this context? Are there still indications for a nerve biopsy?

Chapter 3 is devoted to a Sign and symptom approach, and covers many areas as headache, head shape abnormalities, toe waling, etc. There are very useful descriptions on brain development, malformation syndromes recognizable by MRI, white matter abnormalities, and unexpected findings on MRI, but these neuroimaging hints are unexpectedly placed among signs and symptoms.

Chapter 4 covers Specific conditions on 160 pages, providing a wealth of information. I wonder whether the text on spina bifida and related disorders could be clarified in a next edition. In my mind, the practical distinction and their relevance between open neural tube defects and closed spinal dysraphism should be clearer. Closed defects are not really “associated,” they are embryologically quite different and—in contrast to open defects—are not influenced by folic acid supplementation.

It was an excellent idea to present chapter 5 on Consultations with other services, covering almost all pediatric subdisciplines. The renal consultations cover topics as hypertensive encephalopathy, hemolytic-uremic syndromes, and posterior reversible encephalopathy syndromes.

Chapter 6 is devoted to Emergencies (including trauma, coma, status epilepticus, and acute ataxia). Chapter 7 (Pharmacopeia) discusses medications often used in pediatric neurology, acute sedation protocols, and interactions of antiepileptic drugs. The index is very detailed.

Despite some minor criticism mentioned above, I greatly enjoyed reviewing this book. It includes a wealth of information, and the spirit of practical approach and clinical experience is well appreciated. I can recommend this handbook as a companion.