A Clinical Guide to Epileptic Syndromes and Their Treatment, 2nd ed.

C.P. Panayiotopoulos, ed. London, UK: Springer-Verlag; 2007, 578 pages, 100 illustrations, $99.00.

The syndromic classification of epileptic seizures has been evolving for more than a quarter century. Piggy-backed onto major advances in neurophysiology and neuroimaging, the current nomenclature of specific clinical epilepsy syndromes now supersedes earlier seizure classifications based exclusively on seizure types. The practice of epilepsy has thus joined mainstream medicine through its newfound ability to link the signs and symptoms of epilepsy with specific underlying disorders. It is no longer sufficient to formulate the diagnosis as a grand mal seizure in a patient who may be having seizures in the context of the Lennox-Gastaut or Ohtahara syndrome. Syndromic classification thus provides useful information that is easily communicated and leads to improved diagnostic work-up and more successful treatment.

The first edition of A Clinical Guide to Epileptic Syndromes and Their Treatment appeared 5 years ago. As a single-authored text, this volume had the distinct advantage of a uniform volume written by a senior well-respected epileptologist, who could provide a clear perspective on the subject. Because the author systematized the existing knowledge of epilepsy classification and presented it in a readable format, this volume was well received and highly successful. A particular strength of the first edition was its inclusion of the syndrome guidelines established by the International League Against Epilepsy (ILAE). The volume was both comprehensive and handy and, at the same time, a “one-stop shop” for information about epileptic disorders.

The second edition seeks to build on the success of the first. Systematically incorporating the most recent updates in syndromic classification adopted by the 2006 ILAE taskforce, the latest volume is brimming with current information. The format is, for the most part, evidence-based and is replete with references that are refreshingly up-to-date and extracted from leading journals. This is a good thing because the reader can effectively use the text for rapid access to original studies. For example, although chapter 6, which deals with electroencephalography (EEG) and brain imaging, has 67 references, the oldest reference was published in 1998 and there are numerous citations from 2006 and 2007. No lag from authorship to publication here.

The volume is neatly organized into 18 sections. As the preface states, the opening chapters cover general issues, including comprehensive descriptions of seizure types, their classification, and the application of neurodiagnostic procedures and principles of treatment. These chapters are particularly important for readers unfamiliar with the overall clinical presentation of the epilepsies and their diagnostic evaluation. Omitting these topics was a certain pitfall that has been avoided. Basic techniques used in the evaluation of patients with of epilepsy, including anatomic and functional neuroimaging, are also included. The discussion of the relative value of EEG and its problems is particularly valuable.

Subsequent chapters are devoted to the meat of the book, the epilepsy syndromes. These are presented in age-based chronologic order, beginning with syndromes in the neonate and infant and continuing through syndromes in adults. Complete coverage of reflex seizures and reflex epilepsies in chapter 16 is particularly welcome. Chapter 17 covers a group of disorders that are associated with epileptic seizures. The chapter gives excellent coverage of these disorders but makes no pretenses at being comprehensive. For example, coverage of important disorders with epilepsy such as the Wolf-Hirschhorn syndrome or Rett syndrome is lacking. This is unfortunate because these conditions and other disorders have an important relationship with epilepsy and are the subject of widespread clinical interest.

The graphic design and quality of the figures in this book contribute significantly to its readability. Blue and red colors are used effectively to emphasize organizational boundaries and highlight essential information. In every chapter, key points are presented in blue boxes labeled “Useful Reminder,” “Diagnostic Tips,” “Important Note,” etc. The eye is drawn to these highlighted regions, and the reader is often rewarded by a clinical pearl reflecting the observations of an experienced clinician. There are copious illustrations throughout the book, which are very clear and helpful. They are labeled correctly and amplify the text. The sequential illustrations on pages 32–33 of a generalized tonic clonic seizure are especially noteworthy. The EEG tracings are salient, and whenever appropriate are correlated with neuroimaging findings. All of the tables are helpfully organized.

Should this volume end up on the neuroradiologist's shelf? If the population served by the neuroradiology department includes a high proportion of individuals with epilepsy, the answer is “yes.” If the epilepsy population includes a significant number of children, then A Clinical Guide to Epileptic Syndromes and Their Treatment may just be the 1 book to own. As a single-authored comprehensive state-of-the-art clearly organized volume loaded with useful clinically oriented tips, it is hard to beat. It is also difficult to find very many faults with this work. One comes away with the definite impression that considerable thought went into improving the first edition. Although other books address the subject of epilepsy syndromes, this volume is a stand-out. It is remarkably user-friendly yet provides near-perfect coverage of a difficult subject.

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