Principles and Practice of Child Neurology in Infancy

Colin Kennedy, ed. Principles and Practice of Child Neurology in Infancy. London: MacKeith Press; 2012 (384 pages). ISBN 978-1-908316-35-6. USD 49.50.

Some background information is essential to understand the scope and primary intention of this book and to avoid false expectations. This information is briefly outlined by the editor in the preface.

A study published in 2006[1] has drawn attention to overinvestigation, overdiagnosis, and overtreatment of neurologic disease, especially in infancy, in the Republics of Kazakhstan and Moldovia and in the Russian Federation. This situation is likely to be extrapolated to other CIS (Commonwealth of Independent States, the former Soviet Union) and further states. Subsequently, an enthusiastic Kazakh working group sought contact to specialist societies and was attempting to change the local situation regarding medical training and providing care. Kazakh authorities, the European office of the World Health Organization, and other bodies supported the idea, and the European Commission further backed the idea with a grant toward improving maternal and child health in Kazakhstan. This explains the focus on the infant period (which at times appears artificial). At that time Colin Kennedy was president of the European Pediatric Neurology Society. He was instrumental and deserves credit for having recruited authors for an “information booklet,” which finally turned out to be a 360-page book with 39 contributors. Needless to say, this was undoubtedly a very challenging task: select (and persuade?) authors, define content, and consider the needs of the potential addressees living in different countries with very different health care systems and facilities. I understand that the input (and coauthorship) of colleagues from CIS states was sought, but this is not reflected in the list of contributors (there is just one coauthor from Armenia and one from Ukraine).

The book is structured in two parts: The first part, “Principles of Child Neurology in Infancy,” deals with more general topics, presented in 12 chapters, with emphasis on terms, definitions, carer involvement, professional (team) working, prevention, drug and nonpharmacologic treatment, clinical assessment, and use of additional investigations. At the beginning of every chapter (this applies to the second part as well), important information is provided in highlighted boxes, summarizing some “Key messages,” “Common errors,” and “When to worry.” To give an idea, some are mentioned: First do no harm; discard imprecise terms; avoid separating the child and parents; inform and talk to parents; every child has a right to a family life; institutionalization can have severe detrimental consequences for child development. These (and other) messages may sound self-evident for colleagues having had the privilege of a “modern pediatric training,” but they are very appropriate in this context. The choice and emphasis of additional investigations may be difficult in this context, assuming different local facilities in various countries and specific institutions. A sentence about the option of genetic testing would perhaps have been appropriate. The chapter on imaging was very informative and precise, but without a single figure perhaps beyond imagination. The high prevalence of incidental findings are mentioned among the key messages, but these are not listed, explained, or illustrated.

The second part, “Settings in Clinical Practice,” is symptom based and includes 13 chapters covering such topics as neonatal encephalopathy; neonatal seizures; postneonatal epileptic seizures; nonepileptic paroxysmal disorders; macrocephaly, including hydrocephalus; microcephaly, including congenital infections; the floppy infant; and cerebral palsy. The chapters are clearly and uniformly structured (including definitions, clinical approach, and management), and many include tables and algorithms, but apart from a handful of electroencephalographic tracings and neuroimaging figures, no illustrations are provided. These chapters present helpful information. Sometimes the question arises about the relevance and balance in this context (10 pages on stroke) and whether the colleagues have access to facilities such as pediatric intensive care units or tools such as video-electroencephalography and blood chemistry (“always measure ammonia in acute encephalopathy”).

This reviewer has limitations, undoubtedly. I am looking at this volume from a resource-rich setting with almost unlimited access to investigations. Although after several visits I have some idea about the pediatric/pediatric neurology situation in parts of Armenia, where (outside Arabkir hospital) I was confronted with many myths, I know too little about the general (educational) needs in other areas.

I wish the book wide distribution. I hope it will be widely accessible in terms of language (translations planned?) and affordable costs. Providing information is essential but does not necessarily achieve a change in attitude, remove common myths, improve clinical competence, or result in an insight that lifelong learning is essential.

• Reference

• 1 Duke T, Keshishiyan E, Kuttumuratova A , et al. Quality of hospital care for children in Kazakhstan, Republic of Moldova, and Russia: systematic observational assessment. Lancet 2006; 367 (9514) 919-925