First published in 2001. Routledge is an imprint of Taylor & Francis, an informa company.
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Svein I. Johannessen is Director of Research at the National Center for Epilepsy, Sandvika, Norway, Torbjorn Tomson is a Consultant Neurologist at the Karolinska Hospital, Stockholm, Sweden. Matti Sillanpaa is Professor of Paediatric Neurology at the University of Turku, Finland. Birthe Pedersen is a Consultant Neurologist in Aalborg, Denmark.From The New England Journal of Medicine:
Clinicians continue to grapple with the problem of epilepsy, while molecular and genetic research on seizures has had hardly any influence on the day-to-day practice of neurologists. Physicians are still concerned about the safety of routine exercise regimens for their patients with epilepsy, about the prevention of burns and drowning, about the risk of death, and about ways to deal sensibly with the question of allowing these patients to drive. These concerns are as encompassing for physicians as they are for patients. Unfortunately, there are often no simple solutions, and advances in the basic science of epilepsy are a long way from providing the key to mitigating daily risks. Some of the current mainstays of therapy were developed decades ago or, in the case of phenobarbital, more than a century ago. For the most part, we do not yet have antiseizure medications or treatments that are specific to seizures according to type, cause, or clinical syndrome. Even the process of developing epilepsy treatments is not specific to the cause of the condition. For example, the initial evaluation of a potential antiseizure compound involves empirical testing in standard animal models of seizures and, eventually, evaluation with respect to safety and efficacy in patients with intractable epilepsy. It is not yet possible to fine-tune this process with the use of clinical surrogate markers for epileptic potential or with a full understanding of the important membrane and transcriptional mechanisms. It is always of interest, therefore, to study "the big picture": the epidemiologic features and consequences of epilepsy. Looking at risks of the disease provides a unique perspective on the disease itself. For example, if we could understand which patients with epilepsy become depressed and which of them are at risk for suicide, we might find insights into new aspects of epilepsy itself and learn how to prevent such outcomes. Medical Risks in Epilepsy is written from the perspective of European neurologists, primarily from Nordic countries. They are especially qualified to discuss this topic, since many of them are clinical researchers with expertise in the epidemiologic assessment of epilepsy. In fact, for non-European neurologists interested in medical epidemiology, much of the data cited in this book may provoke a bit of jealousy at the wealth of population information accessible in countries where medical care is "socialized." Medical Risks in Epilepsy is a comprehensive review of the risks associated with epilepsy, with emphasis on sudden unexpected death, on standardized mortality ratios comparing persons with epilepsy and the general population, on proportional mortality according to cause of death, and on the risks of suicide and accidental injuries. Nearly every chapter includes a discussion of most of these subjects, and thus the perspective of several experts in each area is provided. But this is one of the difficulties with the book: a lack of unified conclusions that could have been avoided with more careful editing. For example, the authors of separate chapters frankly differ as to whether the incidence of suicide among patients with epilepsy is greater than that in the general population. Nevertheless, several interpretations of the meaning of data from epidemiologic studies may be worth exploring, particularly when the studies cited are from varied, although overwhelmingly westernized, populations. The opening chapter, one of the most useful in the book, sets the stage with a lucid discussion of how risk assessments are performed. The strengths and weaknesses of randomized clinical trials as compared with observational epidemiologic studies are discussed. Several clear and provocative points emerge from the discussions in subsequent chapters; for example, it becomes clear that epilepsy is associated with a higher than expected mortality and that more deaths occur within a few years after diagnosis than later in the course of the disease. Mortality is also greater when the cause of epilepsy is known (as in symptomatic epilepsy) than when it is not. The authors indicate that sudden unexpected death in epilepsy is not rare among patients with frequent seizures, but frank discussions with patients about sudden death probably are rare. Accidents are more likely to be a cause of death in persons with epilepsy than they are in the general population, but studies regarding the relative risk of suicide among persons with epilepsy do not consistently show an increased risk. Several chapters provide useful guidance on simple safety measures, including ways to arrange a bathroom, a kitchen, and other areas of the home to minimize the risk of injury. It is refreshing to see safety measures carefully outlined in a book that is intended for physicians. In fact, these chapters broaden the target audience of the book to include nurses and allied health professionals. The list of safety precautions is somewhat more restrictive than that provided for consumers by the Epilepsy Foundation, but it is more comprehensive and detailed in its advice for patients who wish to take part in particular sports activities, including bungee jumping (which is "best avoided"). It must be noted that whereas there is one general chapter about the risk of traffic accidents in epilepsy, there are two chapters that refer to regulatory issues specific to Nordic countries, which (although interesting) are less broadly useful. The book progresses from a discussion of the risks associated with epilepsy as revealed by epidemiologic studies to advice on how to minimize these risks in concrete, practical ways. For this, the authors should be lauded. Their comprehensive and prescriptive discussion of the risks associated with epilepsy will be of value to physicians, nurses, and therapists who work with patients with epilepsy. Cynthia L. Harden, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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Book Description Wrightson Biomedical Pub Ltd, Hamshire Gu32 3Pn, United Kingdom, 2002. Pictorial Cover. Book Condition: Fine. Like new hardcover. 146 pp. Can be shipped in USA. Bookseller Inventory # 2139