Book Review

Epileptic Seizures and Syndromes with Some of Their Theoretical Implications

N Engl J Med 1995; 333:603-604August 31, 1995

Article

Epileptic Seizures and Syndromes with Some of Their Theoretical Implications
Edited by Peter Wolf. 678 pp. London, John Libbey, 1995. £65. ISBN: 0-86196-430-6

At first glance, this book seems to be drowning in a sea of minutiae. There is an entire page devoted to the semantic differences between “idiopathic” and “cryptogenic” epilepsy. But it soon becomes apparent that the attention to detail in this book is necessary for an understanding of the epilepsies.

Before there can be any meaningful discussion of the pathophysiology and treatment of a disease, everyone must be speaking the same language. In 1985, the International League against Epilepsy proposed an international classification of the epilepsies and epileptic syndromes. Peter Wolf updates and expands this classification and relates these syndromes to possible underlying pathophysiology. The resulting book should be invaluable to epileptologists, geneticists, and anyone with a research or clinical interest in epilepsy.

After an introductory section discussing the advantages and disadvantages of the international classification, the remaining sections of the book explore each of the major categories of epileptic syndromes. The first two deal with the idiopathic epilepsies, both generalized and focal, with an emphasis on known genetic aspects. The next two sections describe the symptomatic epilepsies, including those with known causes and those with suspected but hidden causes (“cryptogenic” epilepsies). Pertinent epileptogenic models are reviewed in relation to the symptomatic syndromes, particularly temporal-lobe epilepsy. Finally, the book explores the “syndromes” of intractable epilepsy and “pseudoepileptic” seizures, and their relations with some of the epileptic syndromes described earlier.

The author does a nice job with the idiopathic epileptic syndromes, perhaps because many of these are already well defined. There is useful clarification of many common syndromes and new information on some syndromes not well known in the English literature. The discussion of symptomatic epilepsies is not as informative and often asks more questions than it answers. This may be because these epilepsies are more heterogeneous than the idiopathic epilepsies and do not lend themselves as easily to classification according to syndrome. The final discussions on intractable and hysterical epilepsy are limited in scope and may be intended to explore areas where there is need for future research and dialogue.

This book is an ambitious undertaking and usually succeeds. Occasionally it does get bogged down in minutiae, since some of its separately classified syndromes may actually be variants of others. However, rigorous definitions of clinical syndromes are usually necessary to the discovery of any common underlying pathophysiology, and this book makes meaningful contributions to that goal.

I would make two minor changes: a more extensive index, and a separate listing of all the contributing authors with their affiliations. As the chapters are numerous and relatively short, it is possible, and often necessary, to skim relevant chapters instead of the index. However, in order to appreciate the breadth of international contribution one must read all 66 chapter headings. Despite these shortcomings, this book covers most of the important epileptic syndromes successfully in one encyclopedic volume. It should become an important reference for both clinical and basic scientists seeking a better understanding of the epilepsies.

Elizabeth Barry, M.D.
University of Maryland Hospital, Baltimore, MD 21201