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Women and Epilepsy

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    Women and Epilepsy. By tim betts and pam crawford. (Pp 84, gratis from the British Epilepsy Association). Published by Martin Dunitz, London, 1998. ISBN 1-85317-680-X.

    In a small accessible and easily digestible volume, the authors address a clinically important field. Faced with slim evidence on which to base clinical recommendations, they acknowledge that their very useful management advice “has often had to be based on practical clinical experience rather than the results of clinical trials or formal research . . .” This disclaimer seems to have allowed them to mix evidence and opinion, limit references, and confuse the reader regarding the level of evidence. A pity, as the authors, with special expertise in this important area, have made a good start in putting together different aspects of the care of the woman with epilepsy in a practical book that is of direct interest and relevance to neurologists, obstetricians, general practitioners, nurse specialists, and trainees.

    Moving on from the general to the particular, the text, although expansive in parts, glosses over some important points. Examples include (a) which oral vitamin K preparations are considered safe in pregnancy (phytomenadione), (b) differential efficacy of various antiepileptic drugs in different syndromes versus side effect and teratogenicity profile, (c) more information on the limitation of available evidence to support the statement “no monotherapy human abnormality reported” with certain new antiepileptic drugs in pregnancy, (d) the need to consider osteoporosis prevention well before the menopause (and not only with enzyme inducing drugs such as valproate has also been implicated), (e) discussion of differences (and available formulations) between synthetic and natural progesterone, (f) stages of pregnancy when various malformations are detectable on scanning, and (g) time to closure of the neural tube (different from the 21-56 days they quote as the “most sensitive time of the fetus to the induction of malformations by exogenous agents.”).

    Despite these comments (made with an eye on the next edition) I would recommend this book to all those involved in the care of women with epilepsy.

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