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Pediatric epilepsy: diagnosis and therapy, 2nd edition
  1. RICHARD O ROBINSON

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    Pediatric epilepsy: diagnosis and therapy, 2nd edition. Edited byjohn m pellock, w edwin dodson, and blaise f d bourgeois (Pp 688, US$150.00). Published by Demos Medical Publishing, New York, 2001. ISBN 1-888799-30-7.

    The most useful part of this book is an account of each of the anticonvulsant drugs. Concisely summarised is the evidence for efficacy, or lack of it, of each. Included is a section on epilepsy surgery.

    It is approached by a section on general principles, which is a miscellany including (oddly) status epilepticus but also treatment decisions, anticonvulsant profiles, dosage considerations, pharmacokinetics and some treatment decisions. These two sections comprise the “therapy” of the title.

    Preceding that is a section on epilepsy syndromes, including a discussion on epilepsy classification and epidemiology and the place for EEG and neuroimaging—the “diagnosis” part of the title. Introducing these sections are chapters on cellular mechanisms, consequences of seizures, and genetic influences.

    The preface suggests that the book is intended as a practical guide and reference for clinicians and investigators. The contributors are generally the names to be expected in the different fields, drawn largely from north America (none from Europe). Does it succeed? Not as well as it might.

    As a practical guide it does not deal with the investigation of many epilepsy situations, such as the encephalopathic epilepsies of infancy—nor with rational drug strategies in partial and generalised epilepsies.

    It is curiously lacking in many management issues such as “pseudo” seizures, “subclinical” seizures or transient cognitive impairment, or the implications of the abnormal EEG in autism—a particularly hot topic at the moment. It is silent on the question of life expectancy and the phenomenon of sudden unexpected death—issues which the clinician will be asked about. The management of status epilepticus is well described, but there is nothing about outcome—again a question uppermost in parents' minds. The section on quality of life is theoretical and research oriented. How to approach constraints in lifestyle and what may be done to ameliorate them is void.

    The section on adolescents' needs, transitional clinics, and organisation of epilepsy clinics in general would have been welcome.

    Vagal nerve stimulation, mentioned as a major new development in the preface, gets about two and a half column inches in the section on Lennox-Gastaut syndrome.

    The book shows signs of lack of editorial grip. Sections on Landau-Kleffner syndrome or pyknolepsy are found in several places, all saying more or less the same thing. Although I suspect a subsidiary aim was to link basic and clinical sciences, there is no cross referencing between the two (or between any other chapters for that matter).

    A major text in this subject deserves to do well, but I am afraid that in this instance the discriminating buyer will look elsewhere.

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