Book Review

The Surgical Management of Epilepsy

N Engl J Med 1994; 330:1836June 23, 1994

Article

The Surgical Management of Epilepsy
Edited by Allen R. Wyler and Bruce P. Hermann. 277 pp., illustrated. Boston, Butterworth-Heinemann, 1993. $75. ISBN: 0-7506-9416-5

This book is about a highly specialized treatment, the excision of the epileptogenic focus in patients with epilepsy intractable to management with drugs. About 5000 patients in the United States are candidates for this operation each year.

During the past decade, the surgical treatment of intractable epilepsy has gained widespread acceptance. There are now many comprehensive centers for the surgical treatment of epilepsy, staffed by multidisciplinary teams of neurologists, neurosurgeons, psychiatrists, physiatrists, psychologists, social workers, pediatricians, and vocational and physical therapists. The growth in this field stems from long years of experience by a few pioneering centers and from knowledge, much of it recently gained, of the efficacy of surgery. The expanding interest in this field on the part of investigators and clinicians has generated a lively debate about the treatment of intractable epilepsy.

This book comprehensively considers the evaluation and medical and surgical treatment of patients with intractable epilepsy, including pharmacologic management of the disorder, criteria for determining its intractability to drug treatment, evaluation of suitability for surgery, the kind of data needed to decide among the various types of operations, and the outcome of surgery. The Surgical Management of Epilepsy, consequently, is a superb road map for a group planning to establish a new center.

The successful treatment of patients with intractable seizures is time-consuming and complex, and it requires considerable judgment, experience, and knowledge from multiple disciplines to achieve optimal results. Although only neurosurgeons and neurologists who are subspecialists in epilepsy are likely to read the book from cover to cover, a number of the chapters discuss specific clinical problems encountered by all physicians who treat patients with epilepsy. The discussion of when to consider surgical treatment (when medical treatment has failed) is a valuable reference for the general neurologist who must decide when to refer the patient for possible surgical treatment. The descriptions of the technical aspects of the surgery are quite exhaustive and thus provide details that are invaluable -- indeed, necessary -- for neurosurgeons and neurologists who devote their practice to patients with epilepsy. The chapters on outcome, which include discussions of the incidence of postoperative seizures, the risk of postoperative neurologic impairment, and vocational and psychiatric status after surgery, will be of particular interest and value to general neurologists, psychiatrists, and allied health professionals.

The division of the book into short chapters on highly specialized subjects makes finding discussions of specific issues very easy and increases its value to busy residents. It has been meticulously edited. Although numerous authors contributed, the duplication of topics is minimal, and every important topic is covered.

Byron Young, M.D.
University of Kentucky, Lexington, KY 40536