Dr. Filley's first edition of “The Behavioral Neurology of White Matter” was published in 2001, and since then there has been an explosion in research on white matter disease. In 2001, there were 178 articles with white matter in the title. In 2011, there were 652. In retrospect, it is probably fair to say that the first edition of this book heralded this explosion of research. In the second edition, I believe we have an authoritative and indispensable classic on the topic of white matter function and disease.
This book is divided into three sections. The first section reviews the history of white matter study and the techniques used to evaluate white matter disease. The second section reviews the diseases of white matter. The third section reviews the neurobehavioral manifestations of the diseases.
Filley's main thesis is that white matter deserves a different kind of attention than it currently gets in clinical and research settings. On p. 294 he states, “One of the strongest motivations for this book is in fact the desire to point out white matter plays a crucial role in the distributed neural networks that are now recognized to mediate all aspects of cognitive and emotional function.” Indeed, he has done a masterful job of making this case in the second edition of his book. While many chapters in the book can serve as pure reference for specific diseases or syndromes, the brilliance of the book is in the development of its thesis from beginning to end, with Part III synthesizing and producing insights that are best appreciated after reading the first two parts. In an era in which brief communications, rapid dissemination, and capsule summaries dominate clinical and scientific practice, the reader will experience through Dr. Filley's second edition the now rare experience of thoughtful, thorough, and rewarding scientific and creative exploration of an emerging field of neuroscience. Because the book is written by a single author, the writing style is consistent across chapters, making it a very easy read.
There is something for everyone in this book. Professionals who have traditionally emphasized the role of the cerebral cortex will be pleased by the excellent integration of white matter and gray matter pathology in the description of traditional neurobehavioral syndromes. Those with an interest in white matter disease will find one of the most comprehensive reviews of white matter diseases and neurobehavioral syndromes ever written. Both developmental and acquired diseases are reviewed. Those studying for board certification in clinical neuropsychology will find one-stop shopping for a review of white matter disorders.
The book does an excellent job distinguishing between diseases of the white matter versus behavioral syndromes involving white matter dysfunction. Are you curious about whether your patient's syndrome can involve white matter dysfunction? Do you have a patient with a rare white matter disorder, and you are wondering what to expect? Do you want stimulating perspectives on a burgeoning field of research to help focus your thinking? This book contains a comprehensive review of the common and the rare neurobehavioral syndromes and diseases, and will almost certainly meet your needs.
The reader should pay close attention to Dr. Filley's proposal of “white matter dementia.” In this section, he provides an in-depth review of the cognitive and psychiatric profile of white matter disease and how it is distinct from subcortical dementias and cortical dementias. Subcortical dementias usually have an extrapyramidal disorder associated with them, while, while a predominantly white matter disease does not. Cortical dementias usually have language and/or memory storage disorders, while white matter dementia does not. And, of course, white matter dementia has attention, executive, and mental speed deficits as well as psychiatric disturbance as core features. There is clear recognition of the problem of proposing a new dementia syndrome, but the rationale for white matter dementia centers on the need for organizing principles to understand our surroundings: it is clear that white matter has a distinct function, and our research and clinical application of knowledge will be more efficient and effective if we employ the notion of white matter dementia.
In addition to the expected reviews of methods of white matter investigation, anatomy, and physical disease, there is a standout chapter on neuropsychiatric dysfunction involving white matter disease. This chapter touches on important aspects of behavior with the emphasis away from the psychiatric/organic distinction but on the neurobiological underpinnings of psychiatric syndromes. The topics include both common psychiatric diagnoses as well as behavioral syndromes that are frequently correlated with white matter dysfunction.
I think one of the most important contributions of this text is its organized and systematic approach to teaching us about the structure and function of white matter. Dr. Filley provides us with many empirically based rules to apply clinically to the understanding of our patients with white matter disease. Equally important is that he provides clear direction for future research into white matter disease. How much white matter damage is required for cognitive impairment? What is the organization of human white matter, and what are the mechanisms of normal and abnormal function? How much of white matter structure and function is genetic, and how can we treat white matter disease? Dr. Filley is optimistic about the treatment prognosis for white matter disease, especially when compared to gray matter neurodegenerative conditions that are irreversible. The fact that axons can remyelinate is central to the optimism about the prognosis of white matter disease.
If you are neuropsychologist like me, with some familiarity with white matter structure and function based on occasional readings of journal articles and the usual teachings in graduate school, The Behavioral Neurology of White Matter, 2 ndEdition, will certainly broaden your perspective and introduce you to new ways of thinking about the “other half” of the brain.
