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Quality of life in epilepsy: beyond seizure counts in assessment and treatment

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    Quality of life in epilepsy: beyond seizure counts in assessment and treatment. Edited by gus a baker and ann jacoby. (Pp 316, £38.00). Published by Harwood Academic Publishers, Amsterdam, 2000. ISBN 90 5823 121 6.

    The issue of quality of life in epilepsy has developed enormously over the past 10 years. Although this is still rather belated in relation to other conditions where the issue has been around for much longer, there is a healthy debate ongoing about what indeed is quality of life and it is likely that no answer to this question will ever be forthcoming. Nevertheless, in terms of health outcome research, there is a place for quality of life measurement.

    Epilepsy, perhaps more than many other medical disorder, is associated with profound deleterious psychological and sociological consequences that are not always directly related to the actual disease process. Instead, severe disability results from the fear that an epileptic seizure might occur at some time in the future and from the negative public image associated with the diagnosis itself. People with epilepsy, who may be perfectly normal apart from the fact that epileptic seizures occur or might occur from time to time, are commonly subjected to limitations on their daily activities ostensibly to protect them or others from injury or even death. Seizures can occur without warning, which fosters a sense of insecurity that affects social development. Opportunities for satisfying interpersonal relationships are further compromised when seizures begin in childhood and parents adopt an overprotective attitude that prevents the acquisition of skills required for a full independent life. All these introduce disabilities, which potentially threaten the quality of life of people with epilepsy.

    In the past decade, instruments to measure quantitatively the health related quality of life in epilepsy have been developed. Consequently, today in most major epilepsy centres, effectiveness of treatment is no longer measured only by frequency of seizures. The impact that treatment has had on the patients' perception of improvement and their predicament and vital capacity to live independent fulfilling lives are important considerations.

    This book, edited by two of the leading workers in this field, is a good review of what is going on in the field of measurement of quality of life. It is comprehensive, encompassing almost every aspect of this domain. An excellent review of currently available quality of life measures is one of the highlights of the book. Chapters covering quality of life issues for children, adolescents, and older people with epilepsy as well as people with learning disabilities and epilepsy are also present. This book would no doubt enhance the library of any person with an interest in measuring outcome in epilepsy.

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