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The most up-to-date reference on the topic, Epilepsy analyzes the most relevant research developments in parallel clinical issues impacting modern therapeutic regimens-defining the scientific basis of current clinical practices and posing a set of challenging questions and considerations that may impact the future of clinical epilepsy research and investigation.
- Sales Rank: #6352622 in Books
- Brand: Brand:
- Published on: 2004-04-23
- Original language: English
- Number of items: 1
- Dimensions: 10.00" h x 7.00" w x 1.25" l, 2.36 pounds
- Binding: Hardcover
- 532 pages
- Used Book in Good Condition
From The New England Journal of Medicine
Progress in epilepsy research during the past several decades has advanced our understanding of the disease and greatly expanded our choice of treatments. Research in molecular and cellular biology has improved our understanding of the pathologic changes that ensue during a latent period, eventually giving rise to seizures. This understanding, in turn, has served as the basis for the development of effective therapies. Despite exciting scientific discoveries, however, there is a disconnect between bench research and clinical practice. For the most part, the clinical-practice aspect remains largely empirical in the general neurology community. There is no question that the types of therapeutic options for epilepsy have increased during the past several decades. However, epilepsy is a very heterogeneous disorder; its variants share only one fundamental cellular similarity -- neuronal hyperexcitability -- and hypersynchrony. Thus, treatment has to be tailored to the specific epilepsy syndrome and type of seizure. For that reason, effective seizure management requires an understanding of pathogenesis and mechanisms of the various epilepsy syndromes and seizure types, and Epilepsy: Scientific Foundations of Clinical Practice is a much-needed textbook. It attempts to integrate data regarding the most relevant developments in research with those regarding clinical issues that have a direct effect on therapeutics. The book achieves this goal by reviewing current therapies and discussing new areas of research and treatment. Much of what is discussed provides a good review for not only the epilepsy community but also for general neurologists. As is desirable in any book about treatment, this one begins with a discussion of basic anatomical and functional substrates of the genesis of seizures, mechanisms of drug resistance, and status epilepticus. From there, the book delves into various treatments and diagnostic tests. Since at least 16 antiepileptic drugs are available in the United States, choosing one is not straightforward. Not all drugs are equal for all seizure types and epilepsy syndromes. In addition, epilepsy is a chronic disease, often coexisting with other illnesses. The various cytochrome P-450 enzyme systems make it challenging to understand drug interactions. This book provides a concise, mechanistic review of the drugs, summarizing their metabolic pathways and their effects on the hepatic enzyme systems. In addition, for patients whose epilepsy is difficult to control with drugs, surgery is now often considered, owing to advances in structural and functional neuroimaging that have improved both the selection of patients and the clinical outcomes. In the area of neuroimaging, the book provides a good update, with a particularly excellent discussion of the means of enhancing visualization by magnetic resonance imaging. The book also offers the medical community a glimpse of treatment methods on the horizon, such as nonsurgical ablation techniques and deep-brain stimulation. Perhaps the most exciting discussion in the book concerns the future of epilepsy research and treatment. Clinicians and researchers in the field have long recognized that since current medical treatment is limited to preventing seizures from recurring, drugs for treating such conditions are more aptly called anticonvulsant or antiepileptic agents. However, such drugs do very little to prevent the development of epilepsy. An ambitious goal undertaken by epilepsy researchers in the past decade has been to pursue a cure for the disease. The final chapter, by Philip Schwartzkroin, eloquently summarizes the current status of epilepsy research and identifies challenges for the future. Although such goals may have seemed far-reaching a decade ago, the findings and ideas presented here make the concept of antiepileptogenesis appear to be an attainable goal. Teresa Tran, M.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
Libraries that serve medical professionals should have this book. Any university library supporting programs in medicine should also have this book.this book fills a niche unfilled by other books in its specificity towards epilepsy research.
Most helpful customer reviews
0 of 0 people found the following review helpful.
Must Read Cutting Edge Scientific Thinking About Epilepsy
By Dr. T
I am a physician with a personal interest in epilepsy. (I am neither a primary care provider nor a neurologist)
There is much new thinking about epilepsy and many new treatment options available. This book nicely lays out much of that material. Neurologists as well as primary care providers will find this book useful. For primary care providers that treat epilepsy, it will be useful to be aware of the latest thinking. This will benefit their patients in getting them to the best treatment options sooner. For neurologists that read this book, they will come away with a more systematic way of thinking about the scientific basis of epilepsy. Most of the material is likely too specialized for the lay public to get much out of it but there may be exceptions. Those with some technical or health care background and education and a strong personal interest may find some chapters intriguing.
I found the following chapters to be particularly useful and helpful for me:
1) Chapter 2 (receptors and pathophysiology)
2) Chapter 4 (genetics of epilepsy, mutations in ion (sodium, etc) channel components)
3) Chapter 5 "Targets of Antiepileptic Drugs" is particularly brilliant in its explication of how understanding drug mechanism of action at specific targets can help a physician to make an educated choice regarding the potentially best anticonvulsant for a particular patient
4) Chapters 8 and 9 contain a marvelous explanation of interactions of various anticonvulsants and theoretical approaches to minimizing toxicity and idiosyncratic reactions. These may be the most useful chapters in the entire book.
5) Chapter 14 gives a lucid description of the Ketogenic Diet and some of the effects of diet in general on epilepsy
6) Chapters 17 and 18 deal with neurosteroids and neuroendocrine issues including catemenial epilepsy and the effects of stress on seizures
7) Chapter 19 on "sleep and epilepsy" is interesting
8) Chapter 20 on psychopathology in epilepsy I also found fascinating
9) The final chapter on "Arresting Epileptogenesis" was a nice way to point the reader's attention to possible future therapy modalities
I intend to read all of the above mentioned chapters at least a second time.
The other chapters which I have not specifically mentioned above are also very good, including outstanding descriptions of various imaging and diagnostic procedures, surgical options, special treatments, vagal nerve stimulators, and even experimental modes that are not yet ready for clinical application.
For the money, this book is an outstanding bargain. In fact I bought a second copy and donated it to my institution's medical library. Few medical texts are worth reading cover to cover. This book is truly an exception. Most of the chapters held my interest to the last word. In fact, I was "snarfing" up the information just like a hungry puppy dog eats its food.
I highly recommend it for any physician who wants to understand current thinking regarding scientific theory underlying the modern treatment of epilepsy. It increased my level of understanding by at least an order of magnitude.
3 of 4 people found the following review helpful.
FROM ONE OF THE AUTHORS AND CO-EDITOR
By Jose E. Cavazos
The co-editors of this medical textbook, Drs. Rho (UC-Irvine), Sankar (UCLA) and myself (UTHSCSA) are among the few clinician-scientists in the field of epilepsy. The textbook aims to bridge the gap between scientific developments in research laboratory (bench) with the insights obtained at the bedside caring for thousands of patients with epilepsy. The textbook is unique in many aspects, including: 1) the selection of contributing authors, who are young investigators or at mid-career, and 2) the provocative nature of their discussion. Authors were asked to describe the scientific foundation of their area of expertise, but also to provide educated insights about potential future developments. The book is divided in six sections: I) Scientific Foundations (3 chapters), II)Antiepileptic Drugs (5 chapters), III) Epilepsy Surgery (3 chapters), IV) Alternative Therapies (5 chapters), V) Other Modulators of the Epileptic State (3 chapters), and VI) The Future of Epilepsy Therapy (5 chapters). Advances in epilepsy have come from many fields in anatomy, biophysics, genetics, molecular biology, neuroscience, pharmacology, etc. We are hoping that this book will educate physicians, health care providers, and investigators increasing their Scientific Foundations to improve Clinical Practice in Epilepsy.
Jose E. Cavazos, MD PhD
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