Bullets and Brains Book Review

Despite the word order in the title, "Bullets and Brains" is of much more interest for those who care about brains than those who care about bullets. In fact, only the first two articles are about bullets, involving the shooting of Representative Gabrielle Giffords and traumatic brain injury from wartime. The book is a collection of weekly columns on neurological topics of interest, prepared for medscape.com and WebMD. Dr. Wilner is not just a writer and reporter, but an experienced, hands-on physician. He has credentials in Internal Medicine, General Neurology and Epilepsy as a subspecialty. His writing speaks directly to professionals, without the glaring errors demonstrated by those who don't truly understand their subject.

The writing style is clear and not overly technical. At times, it could even be called ironic or witty. Medical professionals are the main target audience, but inquisitive patients will also find the book interesting. We occasionally see the writer in the article, much as Alfred Hitchcock appeared in bit parts in his movies. For example, Dr. Wilner sparred with a professional boxer, who fortunately chose not to strike back. I got the impression that, had it been a true fight, the book would not have proceeded past this chapter on page 13. He also provides several interesting articles on his charitable physician trips to needy locations in the Philippines and, in a very different environment, on his struggles with a new electronic medical record. However, most of the columns are reportage. Topics of interest are dealt with piecemeal, with no attempt to connect one chapter/column to the next, except for occasional updates. There are section groupings, but no index. It is a testimony to Dr. Wilner's selection process that articles written as early as 2009 still sound current and accurate. About 30% are updated, but a few more would benefit from updates, such as the description of multiple sclerosis drugs, for which there has been a recent explosion of choices.

The best way to tell whether you should read this book is to see if you are interested in the answers to the following questions. Is meningitis vaccine worth it? Does EEG predict chronic traumatic encephalopathy (p. 76)? Should a patent foramen ovale be repaired after a stroke (p.115)? Does chronic cerebrovascular venous insufficiency play a role in multiple sclerosis? Does angioplasty help (p. 160)? How often do seizures occur in the first week after stroke (p. 204)? Which is better: carotid endarterectomy or stenting (p. 222)? What is the unexpected toxicity of ezogabine (Potiga, p. 231)? Which is superior for the ambulance treatment of status epilepticus: intravenous lorazepam or intramuscular midazolam (p. 258)? And my personal favorite - how can a vampire bat unobtrusively suck your blood for up to 30 minutes without your being aware (p.62)? These are just a few examples.

The book is a snapshot in time of a blog, convenient in paperback and electronic editions available on Amazon.com. But printed matter does not capture the third dimension of reader response and immediate updates. For those, the reader will have to search for the original articles and responses on medscape.com/neurology. Readers' comments and reviews are available at: bulletsandbrains.net . Despite that limitation, the book is an entertaining and educational read for anyone interested in neurology and in epilepsy. It is written by someone who knows his stuff and knows how to make it entertaining.

Disclosure: I was interviewed for two of the chapters in the book, one of which involved a product for which I have a financial interest. The author invited me to provide this uncompensated review. I have no business or personal relationship with the author.

by Robert S. Fisher MD, PhD
Past-Editor-in-Chief, epilepsy.com
Last Reviewed: 1/22/2014