Book Review

The Medical Treatment of Epilepsy

Frontal Lobe Seizures and Epilepsies

N Engl J Med 1993; 328:144-145January 14, 1993

Article

The Medical Treatment of Epilepsy
Edited by Stanley R. Resor, Jr., and Henn Kutt. 734 pp., illustrated. New York, Marcel Dekker, 1992. $195. ISBN: 0-8247-8549-5

Frontal Lobe Seizures and Epilepsies
(Advances in Neurology. Vol. 57.) Edited by Patrick Chauvel, Antonio V. Delgado-Escueta, Eric Halgren, and Jean Bancaud. 750 pp., illustrated. New York, Raven Press, 1992. $95. ISBN: 0-88167-827-9

The Medical Treatment of Epilepsy belongs in the libraries of neurologists, pediatricians, and other physicians who take care of patients with epilepsy. The editors have admirably fulfilled their stated goal of providing a comprehensive guide to the medical treatment of epilepsy. Over a hundred authors, most of them recognized experts in the area, have contributed to the book. The editors have done an excellent job of maintaining a uniform style throughout the book, and there is minimal duplication among chapters.

The first section deals with general principles. It includes chapters on when to treat seizures and when and how to stop treatment with antiepileptic drugs. Other chapters deal with the problems associated with the use of antiepileptic drugs in children and the elderly. The treatment of specific types of seizures seen in the newborn and during infancy and childhood and the treatment of the partial and generalized epilepsies are dealt with in detail. There is a chapter on the management of status epilepticus and a chapter that deals with the difficult problem of patients with refractory seizures.

A major portion of this book is reserved for the discussion of specific anticonvulsant medications. It deals succinctly with the standard anticonvulsant drugs and describes the less commonly used drugs, drugs not now available in the United States, and anticonvulsant drugs that are currently under investigation. There is even a chapter detailing the use of bromides in treating patients with porphyria who have seizures. These chapters provide a vast amount of practical information on each of the antiepileptic drugs. There is also a detailed chapter on the use of the ketogenic diet in the treatment of seizures in childhood and one on the treatment of infantile spasms with ACTH and prednisone.

Although the surgical treatment of the epilepsies is beyond the scope of this book, there is a chapter on when to consider a surgical evaluation and a brief overview of the workup of patients being considered for surgery. A number of special problems in epilepsy are also addressed, including those inherent in using generic anticonvulsant drugs, the use of anticonvulsant agents during pregnancy and during surgical procedures, epilepsy and driving, and legal and regulatory issues.

In summary, there is an immense amount of practical information in this book, which encompasses virtually every aspect of the medical management of seizures. One drawback is its cost, which may prevent easy access for many who could benefit from it.

Frontal Lobe Seizures and Epilepsies, volume 57 of Advances in Neurology, is a compilation of the proceedings of a workshop on frontal-lobe seizures. The various chapters include both review articles and research papers. Among the authors are neuroscientists and internationally recognized epileptologists. There are seven sections dealing with a variety of issues with the common theme of the frontal lobe. The basic-science sections cover issues ranging from the neuroanatomy and functional organization of the frontal lobes to the neurophysiology of eye movements, models of frontal-lobe epilepsy, and neurochemical aspects of the frontal lobes.

A substantial portion of the book is devoted to clinical aspects of frontal-lobe seizures. The behavioral manifestations of seizures emanating from various regions of the frontal lobe are described in detail. One section focuses on the electrographic manifestations of frontal-lobe seizures. Several chapters deal with the role of the newer imaging techniques in the investigation of frontal-lobe epilepsies. A very informative chapter reviews the histopathological features of a large series of non-neoplastic lesions in frontal-lobe epilepsies and discusses correlations with findings on magnetic resonance imaging and positron-emission tomography.

This book is a good reference source and would be most useful to neurologists with a particular interest in epilepsy and basic scientists seeking information on clinical aspects of the frontal-lobe epilepsies. The student or neurologist in training who is seeking practical advice on the diagnosis and treatment of partial seizures is likely to find this book daunting and difficult to digest.

Masud Seyal, M.D.
University of California, Davis, Medical Center, Sacramento, CA 95817