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Childhood Epilepsies and Brain Development
  1. RICHARD E APPLETON

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    Childhood Epilepsies and Brain Development. Edited by astrid nehlig, jacques motte, solomon l moshe, and perrine plouin.(Pp 311, £59.00). Published by John Libbey, London, 1999. ISBN 0–86196–578–7.

    Childhood Epilepsies and Brain Development is the fruit of a symposium held in 1997 to try and bridge the chasm between those working in the clinic or at the bedside and those in the laboratory. Both groups must collaborate and communicate to improve the management of children (and older patients) with epilepsy.

    The book is essentially a collection of monographs of heterogeneous content and style and the result, perhaps not surprisingly, is that some of the component parts are better than the sum. The clinically oriented section will clearly be of particular interest to those who treat children and their families. The chapters on infantile spasms and Lennox-Gastaut syndrome are informative and provide some new but speculative insights into the pathogenesis of spasms. However, it was surprising that severe myoclonic epilepsy of infancy did not merit a specific chapter in view of the unique electroclinical evolution and natural history of this syndrome. The crucial issue of the cognitive and behavioural sequelae of early and frequent seizures on the immature brain, which is probably of most concern to both clinicians and families, is succinctly addressed in two chapters—although a clear and consistent cause and effect relation remains to be established. The chapters covering basic neurophysiology, neuropharmacology, and neuropathology, are erudite and fascinating but at times are barely comprehensible. Further work is needed, including answering the fundamental question—why does the first seizure occur—before the clinician and basic scientist are able to talk the same language—for the benefit of the patient with epilepsy.

    The concept of Childhood Epilepsies and Brain Development is innovative and commendable and although some of the monographs are interesting and informative, the overall impression is that the individual parts (the chapters) are better than the whole (the book). The lack of an index is a strange omission, perhaps reflecting a prolonged editorial atypical absence, and although this militates against it becoming a well thumbed reference text, the book is an erudite addition to the mossy fibre-like sprouting of the epileptological literature.

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