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Childhood Epilepsies and Brain Development. Edited by A Nehlig, J Motte, S L Moshé, P Plouin. (Pp 311; hardback: £59.) John Libbey, 1999. ISBN 0 86196 578 7 .
The challenge of the developmental epilepsies is multifaceted. As clinicians, we have all spent time trying to control the anxiety we feel because of our impotence in the face of intractable epilepsy. The mainspring of our concern is usually not the paroxysmal events themselves but the quite unpredictable cognitive impairment which may accompany these events. Despite great strides being made in our understanding of epilepsy in recent years, we are still profoundly ignorant of the crucial relationship between seizure disorder and learning disability. Defining the pathogenetic mechanism of cognitive impairment and developing possible preventions or treatments for these children with epilepsy is of paramount importance to scientists and clinicians alike and is probably thechallenge for those studying and treating developmental epilepsies.
This volume is compiled from the proceedings of a meeting held in Alsace in 1997 that brought together clinicians and scientists involved in the diagnosis, treatment and research of childhood epilepsies. The theme of the meeting was the inter-relationship between brain development, epilepsy and learning disability, and the conference was an important stepping stone in establishing a dialogue between the different disciplines.
Age related mechanisms involved in the development of seizures and “windows” of vulnerability for developing chronic epilepsy are closely considered. A fascinating multiauthor chapter on neuronal migration disorders, suggesting that neocortical structural abnormalities, due to developmental disturbances, are often the cause of treatment resistant seizure activity is followed by several chapters discussing laboratory details of producing an animal model with neuronal migration disorder and refractory epilepsy. Some of the scientific detail is rather heavy going for the clinician, but the message, of course, is that since clinical studies are technically limited in the analysis of the cellular mechanisms underlying hyperexcitability, rat models of cortical dysplasia are invaluable.
This, in fact, is the pattern of the volume, where we are treated to some excellent clinical chapters (for example, those on the malignant epilepsies, or the effects of asphyxia on the developing brain), which are then followed by scientific chapters attempting to characterise the molecular neurobiology underlying some of our observations.
The clinician will discover some gems in this book, but he will also need to plough through a swathe of scientific information, the relevance and interpretation of which is not always immediately obvious. In some sections the conversation between scientist and clinician is stilted, but there are some passages where the dialogue sparkles (for example, chapters 3, 5, 11, and 21). One is left with a feeling that trying to get on the same wavelength and trying to speak the same language, though challenging, benefits all of us, and of course it is the child with epilepsy and cognitive impairment who will be the ultimate beneficiary of the exercise.
Such multidisciplinary conferences and the volumes they spawn are clearly one of the ways forward in unravelling the complex developmental epilepsies.