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Epilepsy in children ed 2. By Jean Aicardi New York Raven 1994 555 pp illustrated $95

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Epilepsy i n Children, ed 2
B y Jean Aicardi
New York, Raueq I994
555 pp, illustrated, $95.00
Coming 7 years after the first edition, Jean Aicardi has once
again provided clinicians with an interest in pediatric epilepsy
a masterful account of the field. All the previous chapters
have been revised, and reflective of new developments in
the field, new information is provided on epilepsy surgery
and neuroimaging. However, the basic format remains similar, with a heavy emphasis on epileptic syndromes.
D r Aicardi is legendary both in his home country, France,
and internationally for his skills in eliciting the important
points in the neurological history, noting key features of the
neurological examination, and synthesizing these findings
into a diagnosis. These clinical skills, coupled with his years
of closely following patients, make him a clinician’s clinician.
The strength of Epilepsy in Children is the incorporation of
Dr Aicardi’s personal experiences from a lifetime of caring
for children with epilepsy. While there are excellent discussions of clinical features and prognosis of all the pediatric
epilepsy syndromes, the work on the myoclonic epilepsies
is particularly useful, considering the controversy that still
surrounds the classification of these disorders. Despite the
personal nature of the book, extensive references are provided.
Weaknesses of the book are few and, while mildly irritating, are not major flaws. The section on medical management
could be improved by discussing the pharmacokinetic profiles, starting and maintenance doses, dose-dependent and
idiosyncratic side effects, and recommended blood monitoring studies for each antiepileptic drug separately. US readers
looking for information o n felbamate and gabapentin will be
disappointed, although there are discussions of drugs not yet
released in the States, such as vigabatrin. Compared with
several of the other recently released books on epilepsy, the
number of figures are few. The size of the book and the
print style lead to rapid fatigue. The index is skimpy, making
it difficult to find subject matter quickly.
This book should be of interest to anyone with an interest
in childhood epilepsy. It is the type of book from which
everyone from a medical student rotating on neurology to a
full professor of child neurology can learn.
Gregovy L. Holmes. M D
Boston, M A
Infectious Diseases of the Central Nervous System:
Contemporary Neurology Series, Vol41
Edited by Kenneth L. Tyler and Joseph B. Martin
Philade&hia, FA Davis, 1993
379 pp. illustrated, $85.00
Drs Tyler and Martin and a dozen and a half coauthors have
produced a highly useful short work on infectious diseases
of the central nervous system. The book is divided about
equally between viral and nonviral disorders and covers all
major categories of infectious disease afflicting the nervous
system, including the retroviruses, slow viruses, and spongiform encephalopathies. The editors have entirely (and, in my
opinion, wisely) ignored the subject of the chronic fatigue
syndrome. There is a separate chapter on antibiotic and antifungal management; less complex issues of therapy for viral
and parasitic infections are dealt with in appropriate chapters.
Following some chapters, the editors provide brief commentaries on controversial issues such as brain biopsy in the
management of suspected herpes simplex encephalitis, management of Lyme disease, and neurosyphilis in the human
immunodeficiency virus-infected patient. A similar comment on postpoliomyelitis syndromes would have been welcome, as would a more extensive discussion of this topic.
While this work is not as comprehensive as the recent
monograph by Scheld, Whitley, and Durack (Infectionsof the
Central Newous System), with which it shares several coauthors, it is written from the standpoint and perspective of
a neurologist and will serve admirably as a primary reference
work for neurologists, as well as internists and pediatricians.
James W. Schmidky. M D
Pharmacological Approaches to the Treatment of
Chronic Pain: New Concepts and Critical Issues.
Progress i n Pain Research and Management, Vol 1
Edited by Howard L. Fields and John C. Liebeskind
Seattle. IASP, I994
312 pp, illutrated, $55.00
Gary Bennett, writing in this volume, crystallizes current
thinking in the pain field: “. . . pain is not just a symptom
demanding our compassion; it can be an aggressive disease
that damages the nervous system.” Chronic pain continues
to be a significant clinical problem: we are unable to treat
many patients suffering from it, despite a relative explosion
in research in the past 5 to 10 years. This research has begun
to uncover alterations in the peripheral and central nervous
system that arise from damage to pain pathways, and that
may result in chronic pain.
PhamacologicalApproachesto the Treatment of Pain is a wonderful contribution to the pain literature. The 17 chapters
are written by top researchers in the field. The book summarizes the underlying pathophysiology of chronic pain and the
pharmacological approaches to treatment. Excluding the introductory chapter, there are 10 chapters that describe the
scientific basis for neuropathic pain states including sympathetically maintained pain and six chapters that describe the
basis for using specific pharmacological agents. Some of these
chapters revisit known pharmacological treatments in light of
new discoveries, for example, peripheral opioid receptors
and the use of opioids that act peripherally. Other chapters
describe new therapeutic agents, for example, N - m e t h y h aspartate antagonists that may prove useful in the treatment
of hyperalgesia and the inhibition of neural plasticity, which
may hinder the development of the “chronic pain state.”
There are many publications on pain, but what makes this
book different is that it contains a collection of chapters focusing on a biological approach to the way we all should
think about the basis of pain in our patients. This has direct
implications for the pharmacological treatments we prescribe
for patients with chronic pain. For anyone who has anything
to do with the evaluation and treatment of pain patients,
reading this book will undoubtedly make the practice of pain
456 Copyright 0 1994 by the American Neurological Association
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aicardi, york, illustrated, rave, children, 555, jean, 1994, new, epilepsy
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