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Benign Childhood Partial Seizures and Related Epileptic Syndromes. By Panayiotopoulos CP. (Pp 360, hardback; £60.00.) London: John Libbey, 1999. ISBN 0 86196 577 9
The recycled ingredients of texts that disseminate evidence-based medicine, although essential, sometimes acquire the bland heaviness of the worst school dinners. How stimulating, then, to read a book so full of zest that boldly admits to being a highly personalised and opinionated account of a field in which the author is an acknowledged expert. Rather than dwell on the areas of consensus, Panayiotopoulos tells us in the opening pages that he “often has to argue against generally applauded statements” about epilepsy, and contends that “differential diagnosis is seldom undertaken for epilepsies”. Throughout the book, the image persists of the author as a lone figure fighting against the philistinism of an establishment that does not perform EEG after a single seizure or always tries sodium valproate first. There are glimpses of personal battles won or lost in this symposium or that classifying committee. He presents a rich and illuminating account of his good fight against “textbook recommendations on drug treatment and management, which perpetuate inappropriate generalisations”, supporting his arguments with 44 references to his own work and nearly 800 other references, ranging from antiquity through to many from the 1990s.
The 360 pages are divided into five easily digestible sections: general aspects; Rolandic seizures and centrotemporal spikes; occipital seizures and related epileptic syndromes (including his eponymous syndrome); occipital seizures versus migraine; and other childhood partial seizure syndromes. Different chapters are written to serve different purposes and a couple are an inspection at greater magnification of the material covered in a preceding chapter. Although this makes for some repetition, it helps to make the book a useful source for different types of reader. Less common syndromes such as epilepsy with continuous spikes and waves during slow sleep, acquired epileptic aphasia, benign affective seizures, and others are also well covered. Views other than those of the author are, for the most part, fairly represented, although he never leaves the reader in doubt about what he thinks. Opinions are sometimes presented as facts (for example, “the visual hallucinations of migraine . . .cannot last for [only] seconds”).
Panayiotopoulos is both clinician and neurophysiologist and can examine both of the elements that make up the electro–clinical syndromes of epilepsy with astonishing attention to detail. Did you know—for example, that fortification spectra were so named by Herschel in 1866 because they resembled not the castellated appearance of battlements but the star patterned pentagonal shape of earthworks projecting from fortifications and known as bastions? Similar precision in detailed clinical observation is used to underpin distinctions between different epilepsy syndromes (or, in that particular example, a “purposely overemphasised” argument that the visual phenomena of migraine are quite different from those of occipital seizures). Some genetic and molecular biological information is presented but the prime purpose of the book is to refine the definition of the clinical syndromes (on which genetic study currently depends).
This book is never dull. Nor is it a storm in a teacup. Although he is a well known “splitter” of syndromes, his overall thesis is that these entities are manifestations of a common childhood seizure susceptibility syndrome that affects 2–4% of all children and 25% of children with seizures. Reading this book has already forced me to think in greater depth about several patients I have seen in the last week, and may affect my view of their treatment and prognosis. I recommend it to all clinicians, neurophysiologists, and perhaps to geneticists who see children with the many varieties of epilepsies and migraine. It should provoke its readers into a more precise form of observation-based medicine.
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