Estimates of the prevalence of epilepsy -- which is defined as two or more unprovoked seizures or a condition for which antiepileptic medications have been used, in either case within the past five years -- range from 0.5 to 1 percent of the population. Thus, at present, approximately 2 million persons in the United States have epilepsy. The incidence of epilepsy rises first gradually and then more rapidly after the third decade of life as the causes of symptomatic seizures, such as stroke and brain tumors, become more common. An exception to this trend of steady increase is the first decade of life and, in particular, the first year -- a year in which the incidence of new cases of epilepsy matches that seen in the oldest members of the population. Not only is epilepsy common in childhood, it is also different from epilepsy in adults. True to the dictum often voiced by pediatric practitioners that "children are not just small adults," most childhood cases of epilepsy are not miniature versions of their adult counterparts. Although it is true that most types of epilepsy in adults are often seen in children, the converse is not true. In children, dysgenetic lesions of the brain, specific pediatric epilepsy syndromes (including age-related and genetic syndromes), and factors related to pregnancy, labor, and delivery figure prominently and express themselves differently. Since the first chromosomal localization of the gene for an epilepsy syndrome -- benign familial neonatal convulsions -- was established by linkage analysis 15 years ago, the genetic underpinnings of several more types of epilepsy have been described and understood. The rapid advances in our understanding of these disorders, particularly in the areas of pathogenesis, genetics, and pharmacology, make the arrival of an excellent new textbook dedicated to the diagnosis and management of pediatric epilepsy such as Epilepsy in Children particularly welcome. Although this textbook includes several chapters that discuss the basic science underlying certain aspects of epileptology, its main focus is clinical epilepsy. Reflecting the fact that, even at specialized epilepsy centers, a considerable fraction of referred patients do not actually have epileptic seizures but, rather, symptoms that mimic epilepsy, the first chapter that deals with clinical aspects discusses diagnoses that may not formally belong to the field of neurology or epilepsy. These include vasovagal and convulsive syncope, cardiac arrhythmias, breath-holding spells, hyperexplexia or "stiff baby syndrome," night terrors, and infantile shuddering spells. All are treated briefly and clearly. The core chapters are arranged by age of onset -- a logical approach. Almost all chapters end with a sidebar-style box that includes a summary of key points from the chapter. In some instances this device is useful, but in others the summaries are too abbreviated to be of practical use. The chapter on antiepileptic drugs gives a good, practical review of both older and newer agents. The chapter on the genetics of childhood epilepsy is a concise treatment of those types of epilepsy in which a genetic basis has been either definitely identified or strongly suspected. Diagnostic techniques and special therapeutic approaches are also covered. Epilepsy in Children has both the advantages and the disadvantages of a relatively brief (500-page) book. Because the chapters are not unduly long, the book lends itself to a fairly complete and rapid review of various topics. Certain very complex topics, such as metabolic and neurodegenerative disorders associated with epilepsy, have necessarily been treated in a substantially abbreviated fashion and essentially serve as introductions to subjects that the reader may have to pursue in more depth elsewhere. The level of detail presented is probably ideal for practicing pediatricians, neurologists, and most pediatric neurologists, but specialists in the field of pediatric epileptology and others seeking more detailed information may need to consult a supplementary book. Unlike some multiauthored textbooks with a distinctly North American or European point of view, Epilepsy in Children includes an impressive array of authors from the Americas, Europe, Japan, and Australia. An appreciation describes how one of the editors, Dr. Sheila Wallace, was diagnosed with and succumbed to glioblastoma multiforme during the completion of the book. It will clearly stand as a worthy tribute to her memory. Mark H. Libenson, M.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.
Review
'Overall, this book feels comfortable and looks good. It is nicely produced and well illustrated...I read this book with great enjoyment. I learnt a lot. You will too.' Lancet; 'This volume will benefit paediatricians, psychologists, psychiatrists, pharmacologists and pathologists.' Biosis
See all Editorial Reviews
