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Review Essays of Academic, Professional & Technical Books in the Humanities & Sciences


The Treatment of Epilepsy, 2nd Edition, edited by S. D. Shorvon, Emilio Perucca, David Fish & Edwin Dodson (Blackwell Publishing) Epilepsy is a common and important neurological condition, and its treatment has become increasingly complex in recent years. In contrast to many existing large volumes on epilepsy, where the coverage of the biology and phenomenology of the condition dominates, The Treatment of Epilepsy concentrates on the clinical treatment and day-to-day management of epilepsy.

The first edition was published in 1996 and has become a standard text in the field. Since then, the science of epilepsy has advanced remarkably, and this second edition has been fully revised to reflect these advances as they relate to treatment. While the primary purpose of the book has not changed, new material has been added, with 28 new chapters, 108 contributors from 19 countries, and 2 new editors. As before, the goal is to provide a systematic survey of the whole field of contemporary treatment. Medical and surgical therapies are both covered in depth, as are the principles of treatment in different clinical contexts. A deliberately international perspective is taken, and account taken of the changing social and cultural aspects of modern epilepsy practice.

Advances in therapy fall into four main themes, and these four themes run through The Treatment of Epilepsy. Perhaps of greatest importance has been the rise of molecular ge­netics – a tidal wave that has swept across all of medicine and which has left few areas of clinical therapeutics dry, and certainly not that of epilepsy. The impact on clinical practice is only just beginning to be realized. Molecular genetics has lead to – and will surely lead to more – designer drugs, treatment predicated on new molecular targets, and therapies designed to interfere with specific molecular processes. Similarly, the understanding of the genetic and molecular basis of drug responsiveness may result in matching patient genetic profiles to specific therapies with greater predictive accuracy. The second major change in epilepsy therapeutics since the publication of the first edition has been the consolidation into clinical practice of a range of novel antiepileptic drugs, and the gathering of more substantial and well-evidenced information about the established medicaments. This development too is covered in this second edition, where eight more chapters have been added, devoted to new individual drugs. The scientific quality of drug evaluation has also greatly improved in the past decade, and this improvement is reflected in the book. The use of clinical protocols for therapy, with a strong emphasis on hard evidence rather than on clinical anecdote, is a welcome change, and one covered in the text. The third major change in epilepsy management through this period has been a contextual change, with more attention being paid to patient-centered issues, to individuality, to patient preference and to the individual clinical circumstances in which epilepsy manifests. The final thematic change in this edition is the attempt to integrate more closely the investigatory advances in epilepsy – which have had their greatest impact on surgical rather than medical therapy – with the specific modes of surgical therapy. Although the advances in investigatory technique have been less dramatic than in previous decades, and many techniques are still research-focused, the utility of individual techniques needs to be clearly defined and backed up with an evidence base. The Treatment of Epilepsy con­centrates on this theme.

The editorship of this volume has also changed: Fritz Dreifuss, a top-notch epileptologist and a founding editor of the first edition, died on 18 October 1997 and David Thomas also stepped down as editor. Emilio Perucca and Ed Dodson have both joined the editorship, both renowned international figures in epilepsy, and bring new perspectives from different continents and different specialities. In addition, over half of the 108 contributors to this edition are also new.

The underpinnings of the book, though, remain unscathed by the passage of time. The primary objective is unchanged – to provide a systematic review of the whole field of contemporary therapy in epilepsy. The emphasis is, as before, on a text that provides practical information, useful for the clinician but comprehensive, accurate and concise. The contributors examine the evidential basis of both conventional and experimental therapies, and cover all therapeutic options. As in the first edition, summary tables have been used to present information, especially in relation to drug therapy in an easily digested form. It remains the basic purpose of the book to guide clinical practice and rational therapy, and to be a source of reference for clinicians at every level.

The spirit of internationalism which was strongly emphasized in the first edition is also the central plank of the second. The spirit of the International League Against Epilepsy (ILAE) remains central to this book. The foreword to this volume was written by the current President of the ILAE, Giuliano Avanzini, himself a highly distinguished epileptologist and clinician scientist.

The Treatment of Epilepsy is a reference work with a strong practical bias, aiming to guide clinical practice and rational therapy in the difficult decisions involved in successful therapy. This is the definitive text and a source of reference and assistance for neurologists and neurosurgeons, other clinicians and trainees at all levels who treat patients with epilepsy.

Over 800 pages, 63 chapters and over 80 contributors, all of outstanding international status, makes this the definitive book on the subject. – Journal of Neurological Sciences.  


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