A neurologist with the Royal London Hospital, O’Sullivan shares case studies of her patients with empathy and scientific rigor.

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Book review

The brain is the most important and least understood organ in the body. It gives no superficial clues as to how it works. The heart beats. The lungs inflate. But the brain sits mute, rubbery, encased in bone. Laid bare, it reveals none of its secrets. Even today, our understanding of its most basic functions is rudimentary at best.

Dr. Suzanne O’Sullivan’s new book, “Brainstorm: Detective Stories from the World of Neurology,” explores the brain’s inner workings, particularly in cases of epilepsy, a condition that can arise from a variety of causes: oxygen deprivation at birth, traumatic head injury, intracranial tumors or other causes not yet understood. A neurologist with the Royal London Hospital, O’Sullivan won acclaim with her first book, “Is it All in Your Head? True Stories of Imaginary Illness,” winning the 2016 Wellcome Book Prize. This is a terrific follow-up.

Diagnosing a neurological condition, O’Sullivan writes, is like “solving a puzzle but when you rarely have all the pieces. You are given 10 pieces of a 100-piece jigsaw and are asked to predict the final picture from just those.” In the case of epilepsy, there’s no definitive test for epilepsy and the symptoms can vary significantly.

In chapters that each tell the story of a different patient, O’Sullivan tries to solve that puzzle. Donal, for example, was a quiet man, the father of three, who worked as a janitor in a school. When his seizures struck, to his embarrassment and chagrin, he saw seven brightly colored men race across the room — cartoon dwarves. Their appearance wasn’t like a dream, but real and vivid. Donal had trouble accepting what he was seeing, imagining the dwarves were some kind of extraordinarily vivid computer projection.

By the time a patient arrives at O’Sullivan’s clinic, symptoms are long gone, leaving only stories, impressions and sometimes bruises or cuts to tell the tale. To diagnose patients, the clinic operates a monitoring ward where they’re wired up to an electroencephalogram (EEG) tracking brain-wave patterns. The patients are assigned to individual rooms and videotaped continuously for days at a time, with the goal of recording a seizure.

Comparing the physical symptoms to the corresponding EEG recording can help identify the characteristic saw-toothed brain-wave pattern that often indicates an epileptic seizure. A small electrical disturbance can spread across the brain and either stop or envelope the brain, resulting in a larger physical seizure. In Donal’s brain, the electrical discharge spread across the right side, then stopped. But that discharge — a brainstorm of sorts — caused his vivid hallucination.

O’Sullivan walks us through case studies of her patients — a ballerina who falls over while dancing; a man who sits up without warning from a deep sleep and points into the distance; a woman who bolts from the room without warning or even consciousness. Some respond to medication; others are candidates for surgery; and some have few viable options but to live with their symptoms.

O’Sullivan’s patients help to tell the history of neurology and illustrate its hopeful breakthroughs — as well as how far we have to go to understand the brain. The author candidly discusses the limitations of surgery, the side effects of medication and the limited toolbox available to neurologists. In the space between cold diagnostic data and the personal challenges facing her patients, O’Sullivan’s sympathy, compassion and understanding come through. How should O’Sullivan advise a young woman about disclosing her condition to a partner? Or a woman who doesn’t fall, but runs, when the seizure hits, down a busy street or even into traffic? What about a lawyer full of confidence, but stripped by a head injury of his cognitive ability?

Many mourn the passing of Oliver Sacks, the neurologist and best-selling author once called “the poet laureate of medicine,” who was known for his neurological case histories including “The Man Who Mistook His Wife for a Hat.” “Brainstorm” deserves a place on the same bookshelf.

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“Brainstorm: Detective Stories from the World of Neurology” by Suzanne O’Sullivan, Other Press, 352 pp., $26.95