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Comprehensive care for people with epilepsy. Current problems in epilepsy, volume 16
  1. David Chadwick

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    Edited by Margarete Pfäfflin, Robert T Fraser, Rupprecht Thorbecke, Ulrich Specht, and Peter Wolf (Pp 375, £60.00). Published by John Libbey, London, 2001. ISBN 0-86196-610-4

    Epilepsy is beyond question a condition with unique psychosocial consequences for which any package of care needs to acknowledge the wider effects of the condition rather than simply addressing the clinical issues. Advocating programmes of comprehensive care for epilepsy is therefore rather like advocating motherhood and apple pie. One is rather doubtful that reading this book gets one much further than this statement.

    The book is the product of a number of presentations at the 10th Bethel Cleveland Symposium held in Bielefeld in 1999.

    After some discussions of the need for comprehensive care, there is a large number of chapters that try to define what the definition might comprise. There is no obvious consensus. There are considerable contributions on a variety of alternative therapies including psychotherapeutic and cognitive behaviour therapies. Many chapters acknowledge the difficulties of quantifying the outcomes of these interventions. Other chapters simply suggest that trying to measure outcomes is meaningless! There is then an interesting methodological section about potential tools for measuring outcomes of comprehensive programmes, but little or nothing in the way of hard data is produced. Finally, at the end of the book (chapter 36) one stumbles across a paper from Bielefeld that includes in the title “results from a controlled, prospective study”. At last, this cynical evidence based reviewer thought that he had found a nugget of hard data, only to be left completely uncertain as to whether the three groups in this study were selected by randomisation or by other means!

    Who would be helped by reading this book? It would be totally unrewarding for anyone who didn’st have a specialist interest in epilepsy, yet anyone with a specialist interest in epilepsy would be aware of many of the issues raised in the book and be able to read work by the contributors in rather more satisfactory peer reviewed format elsewhere. For a young researcher coming to the field for the first time, it may provide a useful general overview. The second subheading in the preface asks why this volume has been considered necessary. I am not sure that the question has been answered.

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