Brain, Vol. 126, No. 11, 2567-2568,
November 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg281
Book Review |
A CLINICAL GUIDE TO EPILEPTIC SYNDROMES AND THEIR TREATMENT
Department of Clinical Neurophysiology, Western General Hospital, Edinburgh, UK
A CLINICAL GUIDE TO EPILEPTIC SYNDROMES AND THEIR TREATMENT
By C. P. Panayiotopoulos
2002. Chipping Norton: Bladon Medical Publishing
Price: £39.95. ISBN 1-904218-23-72.
In 1981 the International League Against Epilepsy (ILAE) put forward a new classification of epilepsy and seizures that has been the mainstay for clinicians working in the field for more than 20 years. The classification was revised in 1989 and again more recently in 2001 by the ILAE Task Force. The new classification takes into account the emphasis that has emerged over the past decade on the concept of epilepsy syndromes. This clinically useful idea recognises that certain clinical and electrophysiological patterns in the presentation of epilepsy may have several different causes (e.g. West’s syndrome), but that each syndrome tends often to be age-dependent and may require sometimes specific investigation and management. Epilepsy syndromes are of particular importance to paediatric neurologists, where age dominates the clinical presentation of a variety of epileptic disorders, and indeed the same patient may shift from syndrome to syndrome as they mature. The new classification has also removed some of the terminology of the 1981 scheme, and has replaced these with simpler (usually more old fashioned) terms, which for many clinicians will seem a very sensible move.
This relatively small but comprehensive and concise book uses the new ILAE classification to describe the important clinical features, aetiologies, investigation and treatment of all the common and many uncommon epilepsy syndromes likely to be encountered by adult and paediatric neurologists. For a neurologist who trained in the 1970s, it is particularly refreshing to see the re-emergence of previously discarded terms such as ‘focal’ (to replace ‘partial’) and ‘idiopathic’ (to replace ‘primary’). The author has maintained the use of ‘complex’ and ‘simple’ in conjunction with focal seizures with and without alteration of awareness, though this is not strictly part of the new classification. Thankfully, the clumsy term ‘localisation-related’ has been discarded. The scope of the book is wide and covers the range of epilepsies seen from birth to adulthood.
The opening chapter covers the above changes in classification and then deals in a very practical way with the problems of making an accurate diagnosis and the use of investigations, particularly EEG and brain imaging. I particularly enjoyed the section on the use and misuse of the EEG, which offers very sensible and experienced advice. A short piece on how to write a clinically useful EEG report is especially well done, and should be compulsory reading for trainees in clinical neurophysiology. I must confess to sharing the author’s view (not held by all in the field) that EEG examination should be regarded as a routine requirement in the assessment of patients with suspected epilepsy. The author also is a strong advocate for the inclusion of video recording during any routine EEG investigation. With advances in digital compression and storage technology, this is becoming increasingly possible at little or no extra cost, and is likely to become the norm in many EEG departments over the current decade. There is however scanty mention of the problems in the accurate diagnosis and management of patients with non-epileptic attack disorders. This area, although clinically common, is possibly out with the scope of this book, but might have received a little more space.
Chapters on neonatal, childhood and adult epilepsies are written in a clear, concise and authoritative style, with well-organized sections on clinical and EEG features, aetiologies, investigations and management. Many of the recommendations are evidence-based, but the author (often using the first person) offers his own opinion and advice based on experience. This is a welcome approach and is not over used. Anti-epileptic drug treatment is covered in outline only in individual sections, but there is a separate useful section giving more details about individual drugs later in the book which is both helpful and up to date. Relatively little detail is given to the selection of patients for surgical treatment of epilepsy, and the problems of this whole area. Surgical management is largely out of the scope of the book, and clinicians requiring more information on this will need to consult more specialized texts.
The book, although comprehensive in its scope, is relatively compact, and selling at just under £40, offers excellent value for money. The 851 references are printed together at the end of the book rather than after individual chapters, and there is a well-organized index section. Apart from the limitations noted above, my only reservations about this otherwise excellent and informative book relate to the technical publishing details. High quality glossy paper is used and the book has a sound attractive hard back. However, probably in order to maintain compactness and possibly cost, the overall text size has been made uncomfortably just slightly too small for the presbyopic reader, making frequent adjustments of reading distance necessary. One other aspect that may irritate some readers is the excessive use of different coloured texts. Some pages have three different colours of print, which I found both unnecessary and distracting. Illustrations—mainly of EEG records and brain imaging—are of generally high quality and are well-annotated in detail underneath, which helps to emphasise their message for the reader.
Overall, this is an excellent, up to date book covering a very wide spectrum of clinical epilepsies from the neonatal period to adult life. It is both readable and concise, offers very sound advice on diagnosis, use of investigations and medical management, and yet manages to remain accessible in size and cost for most busy clinicians. Neurologists in the adult and paediatric sectors and Clinical Neurophysiologists involved in the diagnosis and management of epilepsy will all find it fascinating reading and a useful modern reference text covering common and uncommon epilepsy problems. There are not many books that a busy clinician will want to read from cover to cover whilst preparing a review—this is one of them.
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