Psychiatric Issues in Epilepsy: A Practical Guide to Diagnosis and Treatment

Albert Einstein College of Medicine, Bronx, NY. Provides a practical approach offering access to clinical information on diagnosis and management, discussions on quality-of-life issues, case studies, and summary tables. Addresses the link between depression and seizure disorders, the use of psychotropic drugs, and more. DNLM: Epilepsy--complications.

During the past few years, a number of books have been published examining the psychiatric issues related to epilepsy. These issues appear to be a respectable subject again in neurologic circles, in part because a new generation of neurologists and epileptologists has embraced a wider scope of concern than its predecessors.

Apart from the occasional author from a Latin American country, every contributor to this book comes from the United States -- an ironic turn of events, given that American epileptologists since the time of William G. Lennox had vigorously avoided discussing psychiatric issues related to epilepsy, which have been very much a European area of interest. No reasons for this reversal of bias are given by the editors.

That epilepsy and psychiatric illness are closely intertwined is reinforced not only by recent epidemiologic studies but also by the fascinating rediscovery that the suppression of seizures can bring with it the development of quite severe psychopathology. This fact emphasizes the obvious but usually ignored distinction between seizures and epilepsy: the former is merely a sign of the latter. Epilepsy should be viewed as an ongoing process.

The book covers these topics as well as the neuropsychological aspects of epilepsy and traditional syndromes ranging from depressive disorders to anxiety and psychosis. Controversial topics such as the interictal personality syndrome of temporal-lobe epilepsy, the relation between epilepsy and aggression, and the psychiatric consequences of temporal lobectomy have been included. These topics are often ignored in traditional textbooks on epilepsy, yet knowledge of them is essential not only to clinical practice but also to a full understanding of epilepsy syndromes.

As in any book of this type, the individual chapters vary in usefulness and accessibility. Nonpsychiatrists may find the chapter on psychiatric evaluation for the nonpsychiatrist useful, although the authors neglect to recommend inquiring about key symptoms of the interictal syndrome. The description of neuropsychological evaluation makes no reference to Wada testing, and the book hardly touches on the management of one of the most important syndromes found in clinical practice, postictal psychosis. Nevertheless, the individual chapters contain excellent reviews of the literature, and some of them are remarkably comprehensive.

I hope this book will be well received by neurologists and epileptologists in the United States, since it reinforces the close relation between psychiatric illness and epilepsy and the need for a renewed understanding of this intimacy, which was deeply embedded in the European literature of the 19th and early 20th centuries.

Michael R. Trimble, M.D.
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