Epileptic Disorders
MENUAicardi’s Epilepsy in Children Volume 6, issue 4, December 2004
Alexis Arzimanoglou, Renzo Guerrini, Jean Aicardi 3rd Edition. Lippincott Williams & Wilkins, 2004
The discipline of pediatric epilepsy has grown substantially in
recent years. Once a relatively static discipline devoted to
clinical descriptions of seizure types and a handful of
antiepileptic drugs, the field has grown exponentially in the
clinical and experimental domains. This rapid growth poses
difficult problems for authors of textbooks as it has become
increasingly difficult to weave the wealth of new information into
a single volume that is both comprehensive and concise. Existing
texts often espouse more modest aims and typically develop
selective themes rather than attempt to provide definitive coverage
of the field. This elusive challenge has now been ably met in the
masterful third edition of Jean Aicardi’s original work Epilepsy
in Children. Newly titled Aicardi’s Epilepsy in
Children, and written in collaboration with Alexis Arzimanoglou
and Renzo Guerrini, the newly updated version of the original text
remains undisputedly the single most authoritative treatise on
pediatric epilepsy in the literature.
The text is logically organized into 25 chapters included in
four sections covering general aspects of pediatric epilepsy,
epileptic seizures and syndromes, epileptic manifestations based on
age, cause, duration and precipitation of seizures, and medical and
surgical treatment of pediatric epilepsy. All of the chapters have
been rewritten and updated. Despite the additional two authors, the
text remains refreshingly consistent in its style, making for an
easier read and facilitating access to information. Chapter
subheadings are logically organized around important core issues in
pediatric epilepsy. Each chapter ends with a helpful summary
section that crystallizes the salient clinical issues. The text is
replete with clinical "pearls" that can be applied directly at the
bedside and clinic.
Most chapters commence with a series of paragraphs that introduce
core clinical issues from a distinctive pediatric point of view.
These paragraphs provide the developmental framework from which to
interpret subsequent material. The descriptions of seizure
semiologies and syndrome features are particularly satisfying and
reflect the vast combined clinical experience of the authors. It is
worth owning the book for these descriptions alone as they capture
the intricate and subtle differences among various seizure types
and syndrome presentations. The validity of each clinical syndrome
as a unique entity is also discussed. EEG and neuroimaging figures
are amply interspersed throughout the text. Current genetic
information is supplied in rich detail. The large number of tables
helps to organize data from the published literature. Particular
attention is given to disorders that have recently been elucidated
such as Dravet syndrome and the idiopathic partial epilepsies.
Throughout the text, tables assist in organizing information and
enhancing descriptive information. The 104 page reference
section at the end of the volume is both up‐to‐date and
encyclopedic.
The second chapter is devoted to a presentation of the systems of
classification of epileptic seizures and epilepsies. Besides
reviewing the existing ILAE classification, the authors describe
previous classification systems and newly proposed classification
systems. Strengths and weaknesses of the current system are
presented while the authors point out several important limitations
of the current classification with regard to pediatric epilepsy and
seizures. These critiques provide invaluable clinical insights from
a pediatric perspective.
The inclusion of updated material on genetic aspects of the
pediatric epilepsies is a particularly valuable addition since the
last edition. Chapter 20 is specifically devoted to this group of
disorders. Epilepsies with simple and complex inheritance patterns
are described, as are channelopathies and syndromes with
chromosomal abnormalities. Three tables help categorize this
information. The inclusion of molecular genetic information is
particularly noteworthy. Chapter 16 is devoted to a thorough review
of pediatric status epilepticus from a clinical perspective. The
various presentations of status epilepticus are reviewed including
borderland presentations with psychiatric features. The treatment
regimen presented in Table 16.2 constitutes a pragmatic approach to
the management of convulsive status epilepticus in childhood. While
some readers may take issue with one or another of the steps in the
treatment algorhythm, the overall scheme of treatment is
representative of current clinical practice.
Two other areas deserve special commendation. The book’s clinical
orientation is represented in the comprehensive descriptions of
neurological disorders associated with the pediatric epilepsies
such as metabolic and degenerative disturbances. Their inclusion
promotes the proper understanding of myoclonic and neonatal
seizures and the lesional epilepsies. Coverage of epidemiological
data concerning seizure prognosis, social adjustment and mortality
in Chapter 22 is another area of strength. Specific factors that
affect prognosis are discussed in detail.
The comprehensive clinical orientation of this book leaves little
room for flaws. I would have preferred the term "provoked" rather
than "occasional" seizures in chapter fifteen. MRI information is
spread over several chapters covering structural brain lesions and
surgical therapy; given its increasing importance for the diagnosis
and surgical management of children with epilepsy, some centralized
discussion of MRI would be welcome. These criticisms are quite
minor, however, and in no way detract from the remarkable
achievement of this single volume. It will undoubtedly become an
important resource for pediatric neurologists and epileptologists
and is wholeheartedly recommended reading for allied pediatric
disciplines involved in the care of pediatric seizure patients.