Aicardi's Diseases of the Nervous System in Childhood

Arzimanoglou A, O'Hare A, Johnston MV, Ouvrier R, eds. Aicardi's Diseases of the Nervous System in Childhood. 4th ed. London: Mac Keith Press; 2018: 1496. ISBN: 9781909962804

Weighing in at nearly 8 pounds and 3.5 inches tall, the most recent (4th) edition of Aicardi's Diseases of the Nervous System in Childhood (edited by A Arzimanoglou, A O'Hare, MV Johnston, R Ouvrier), is a heavyweight indeed! It is a 1,496-page book which comprises a huge and systematic compendium covering the entire spectrum of pediatric neurological disorders. The first two editions, written predominantly by Prof. Jean Aicardi, represented a tour de force, the accumulated wisdom a lifetime of professional engagement with children who have neurological diseases. When the 3rd edition appeared in 2009, something was lost and gained. We lost the unique perspective and keen observations of a single-acknowledged genius but gained insights by extending those of Prof. Aicardi's with those of other experts.

As this book review is intended for a pediatric epilepsy audience, my comments will focus on that section of the volume. However, first I want to highlight some nonepilepsy chapters that I found exceptionally clear and well written. Specifically, the chapters on fetal and neonatal neurology and brain development were written beautifully, with clear illustrations and diagrams that clarify the complicated molecular and cellular processes by which conjunction of sperm and egg ultimately results in the complexity and beauty of the developed brain. And of course, this developmental information is pivotal to our understanding of seizures and epilepsy in the young patient.

The epilepsy section is comprehensive, to say the least, comprising 139 pages, with no fewer than 1,200 references. All the major topics of pediatric epilepsy are covered, including mechanisms, etiology (including a good coverage of the burgeoning list of genetic mutations that give rise to epilepsy), pathology, semiology (the presentation of epilepsy syndromes by age of onset is very helpful), and treatment. Yet, this section also has some disappointing deficiencies. My main concern is the dearth of updated references. Most of the references throughout the chapter appear to be simply copied forward from older editions of the textbook (the majority are from the 80s and 90s). Classification is discussed extensively, but the authors could have focused more on the currently revised classification scheme and less on the schemes from the 80s and 90s. While acknowledging the foundational aspects of earlier classification schemes and older references, current readers expect discussion of the most up-to-date classification schemes and controversies surrounding them. The coverage of mechanisms is far too cursory and does not include a discussion of the critical developmental mechanisms in the developing brain that predispose a child to seizures and epilepsy; again, the references are largely from the 90s and much knowledge about mechanisms has been gained since then. Curiously, while carbamazepine is included in the tables and text, oxcarbazepine, arguably among the most often prescribed antiseizure medications, is not (whereas newer and less commonly prescribed agents such as perampanel are included).

The authors of the epilepsy section are to be congratulated for their comprehensive coverage of all aspects of seizures and epilepsy in children, including an especially useful discussion of seizure mimics. Indeed, this section could be book unto itself! However, the references and citations should have been comprehensively updated and revised, in keeping with modern viewpoints.

In summary, I do recommend this book as a comprehensive treatise on child neurology and disorders of the developing nervous system. Overall, the 4th edition stays true to Aicardi's vision, with an emphasis on clinical findings in a format and readable style accessible to the clinician. It is a fitting tribute to the vision and genius of Jean Aicardi, and with tighter editing, should continue to be an important resource for the child neurologist and epileptologist.