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The treatment of epilepsy
  1. M Jackson

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    Edited by Simon Shorvon, David Fish, W Edwin Dodson, Emilio Perucca. Published by Blackwell Publishing Ltd, 2004, £150.00 (hardcover), pp 952. ISBN 0-63206-046-8

    This is a text that ought to be read by all physicians who treat people with epilepsy. It may appear dauntingly large on first acquaintance, but it is well written, full of practical advice, and gives the reader helpful details about the drugs that most of us use on a daily basis.

    The first section contains chapters on the clinical and epidemiological aspects of epilepsy and the clinical pharmacology of antiepileptic drugs. The second section is on the management of epilepsy, including: newly diagnosed epilepsy, status epilepticus, epilepsy in remission, reproductive aspects of epilepsy, and the management of special groups such as learning disabled people. The third section is devoted to individual antiepileptic drugs introduced by a thoughtful assessment of the evidence upon which we have to make choices of antiepileptic therapy and practical advice on the changing of antiepileptic drugs. The final section is about epilepsy surgery with details of the necessary investigations, assessments, and surgical procedures.

    If this all sounds like too much detail for the general neurologist I would beg to disagree. You may not want to read the introductory chapter on historical aspects of the treatment of epilepsy (but you will miss out on a fascinating account of drug development if you don’t) or you may feel you do not need to read the chapter on mechanisms of antiepileptic drug action (though you would be wise to do so for this is one of the best chapters on the subject that you could hope to find), but the sections on the principles of medical treatment and antiepileptic drugs should be of interest to all who have patients with epilepsy.

    Chapters such as that on the treatment of epilepsy in general medical conditions will be particularly useful to neurologists working in hospitals with renal and liver units. The section on the individual drugs contains all details that you need but can’t remember when you are rung up and asked about those side effects and drug interactions (which you should know and can’t find in the BNF). For anyone unfamiliar with epilepsy surgery this section is an excellent summary of the subject.

    There are only one or two weak points: as in most multi-author texts there is some overlap, e.g. in the description of seizure models in two adjacent chapters, and I was puzzled why there was no chapter on the treatment of the idiopathic generalised epilepsies as there was in the first edition. It would be useful to have had more practical advice for special circumstances such as foreign travel and the management of patients unable to take oral medication, but these are minor quibbles. My advice would be: get a copy and keep it by your desk at work, you won’t regret it.