John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the

Aicardi’s Epilepsy in Children Volume 6, issue 4, December 2004

Author
Miami, USA
  • Page(s) : 297-8
  • Published in: 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.