A Clinical Guide to Epileptic Syndromes and Their Treatment

The recognition of epilepsy syndromes and attempts at their classi®cation has led to a burgeoning literature in this area. This body of research represents one of the most important advances in epileptology over the last 20 years. The addition of neuroradiological insights and, more recently, genetic discoveries have both enhanced our ability to diagnose and classify epilepsy syndromes and to understand their neurobiology. Regarding the idiopathic epilepsies, where there is no known underlying brain lesion, neuroimaging, by de®nition, is negative (but it is helpful to rule out other disorders) and genetic studies are only beginning to unravel the complexities therein. There remains a heated but productive dispute as to the best way of categorizing the patients and the recognition of what does or does not constitute a relatively speci®c syndrome. For the clinician, whether an expert in epilepsy or a general neurologist, synthesized information about this is relatively sparse. Textbooks of epileptology often tend to deal with the issue in a relatively patchy manner, re ̄ective of the usual multi-authorship problem. The standard resource has been the `Guide Bleu' [Roger et al. (eds) Epileptic syndromes in infancy, childhood and adolescence] now in its third edition. It has strengths in terms of the authority of the authorship but the detail and usefulness of chapters vary as is common in multi-author volumes. The present work is the ®rst singleauthor attempt to cover this important area. Panayiotopoulous has been an active and vigorous participant in the quest for identi®cation of epilepsy syndromes. This book represents his personal view of the area, guided by recent proposals from the International League Against Epilepsy's Commission on Classi®cation and Terminology. The book begins with a general overview of the approach to the diagnosis of epileptic seizures and epilepsy syndromes. This is a wonderful primer that residents and house of®cers in neurology should read. More seasoned consultants could also certainly bene®t. Of particular value is the summary of the appropriate use and potential abuse of the EEG. Although it remains the backbone of the investigation of epilepsy, EEG has been over shadowed by the spectacular advances in imaging. This chapter provides an authoritative and pragmatic view of the role of this still essential, but often inappropriately used, investigation. Thereafter follows eight chapters dealing predominantly with idiopathic epilepsies in the neonatal period, infancy, childhood and adolescence, as well as one chapter on the symptomatic focal epilepsies. Chapter 2 is devoted to neonatal epilepsies. There is a brief but useful description of the clinical and EEG manifestations of seizures in the neonate. A description of the relatively newly recognized epilepsy syndromes of the neonatal period is given, supplemented by an appendix of non-epileptic disorders that can be mistaken for epilepsies. Chapter 3 deals with seizures in the infantile period including febrile seizures, West syndrome and a number of rarer disorders. The discussion of febrile seizures is relatively super®cial, and this very common problem is given as much space as disorders that hitherto have only been described in small a number of cases. Chapter 4 deals with the Lennox Gastaut syndrome. The dif®culty in accurately de®ning this well-known disorder is lucidly discussed. Exactly what the Lennox Gastaut syndrome is, is a point of debate, and the problems in de®nition together with the classical descriptions of the disorder are clearly presented. Chapter 5 deals with benign childhood focal seizures, an area where Panayiotopoulous has made major personal contributions. At the end, the author presents his personal synthesis of `age-related childhood susceptibility to seizures'. Although this is presented as an hypothesis it has also been written up in more detail in previous publications and perhaps would have been better left out in this `Clinical guide'. Chapter 6 deals with the idiopathic generalized epilepsies and contains a useful, detailed description of seizure types in these syndromes, followed by a description of the wellrecognized epilepsy syndromes within this group. Thereafter follows an account of some more controversial entities, some described by Panayiotopoulous himself. It is indicated that these are not generally accepted; time will tell whether they are shown to be independent neurobiological entities. Chapter 7 describes some of the new familial focal epilepsies. This is a rapidly moving area but this chapter is fairly up to date and gives a ̄avour of these emerging entities for which the molecular basis is known in some. Chapter 8 deals with the symptomatic epilepsies such as temporal lobe epilepsies and frontal lobe epilepsies due to known or suspected lesions. The semiology of these seizures is well described and a personal view of the medical therapy of these entities is given. Surgical treatment is not discussed. Finally, in Chapter 9 the re ̄ex epilepsies, particularly photosensitive epilepsy, are described. The book is extremely well referenced. This alone provides a useful source to the literature. Good use is made of published guidelines. It compares favourably with the `Guide Bleu' in terms of content and references. It is attractively presented, with colours used to highlight aspects such as de®nitions and some controversial issues. It is well illustrated with EEGs and some images. There is understandably a bias in emphasis towards disorders that Panayiotopoulous has made a particular contribution to, and in some cases, the description of syndromes is not associated with an indication about the current acceptance of these by others, but, for the most part, the representations are fair and balanced. The volume will be useful to those who wish to look up the features of particular disorders, both from the descriptions that are well written and illustrated and the accompanying references. The book will appear more daunting to a trainee or >