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The incidence of epilepsy rises sharply over the age of 60 and with an ever-increasing elderly population, it is becoming an area of increasing clinical and social importance. The limitations of current knowledge, especially in relation to treatment and directions for future clinical research, are considered in a valuable penultimate chapter of this book, that would have been well placed at the beginning.
The book is divided into five sections: epidemiology; pathophysiology of aging and relation to seizures; diagnosis; medical treatment; and future directions. The epidemiology is becoming increasingly understood and is well summarised. There is a very good chapter on pathological processes in elderly people causing seizures and an excellent theoretical and practical guide to falls in elderly persons. In many chapters the book tends to stray a little from its title and considers more general problems of epilepsy with relatively little that is specific to elderly people. This probably reflects the paucity of published information. It is, however, taken to extremes in detailed chapters on alteration of renal and glucose homeostasis in elderly persons, which really only contain passing references to epilepsy. Chapters on the differentiation of pathological changes of EEG and MRI in elderly people from age related variants are highlights in the diagnosis section. There are two chapters devoted to status epilepticus in elderly people. They contain valuable information but conflict in various aspects partly because they use different classifications. The treatment section has a strong emphasis on pharmacokinetics. Treatment is considered on a drug by drug basis, including established and newer drugs, essentially from an American perspective. More space is given to felbamate (not available in the United Kingdom) than to any other new drug. None of the (admittedly few) comparative trials of drugs in elderly people is mentioned and nowhere are guidelines for treatment suggested.
This book is easy to read and has some very useful chapters, but is patchy, which is perhaps inevitable, given the current state of knowledge.