Epilepsy: A Comprehensive Textbook (3-volume set)
Jerome Engel,Timothy A. Pedley,Jean Aicardi,Marc A. Dichter,Solomon Moshé,Emilio Perucca,Michael Trimble | 2007-09-28 00:00:00 | Lippincott Williams & Wilkins | 3056 | Epilepsy
Written and edited by world-renowned authorities, this three-volume work is, to quote a reviewer, "the definitive textbook about seizures and epilepsy". This Second Edition is thoroughly updated and gives you a complete print and multimedia package: the three-volume set plus access to an integrated content Website.
More than 300 chapters cover the spectrum of biology, physiology, and clinical information, from molecular biology to public health concerns in developing countries. Included are detailed discussions of seizure types and epilepsy syndromes; relationships between physiology and clinical events; psychiatric and medical comorbidity; conditions that could be mistaken for epilepsy; and an increasing range of pharmacologic, surgical, and alternative therapies, including vagus nerve stimulation and deep brain stimulation. This edition describes many new antiepileptic drugs, major advances in surgical treatment, and state-of-the-art neuroimaging, EEG, and other technologies for diagnosis and seizure prediction.
A companion Website offers instant access to the complete, fully searchable text, plus an image bank of additional figures, video footage, and annual updates to selected chapters.
Reviews
As a patient and student, I found this book very useful in understanding the physiology and treatment of my disease. I found the book to be generally accessible. However, this book is not for the layperson and generally requires a basic background in nervous system and neuron physiological terms which is not included. The textbook is structured as a summary reference. Specific points in the study of epilepsy are discussed with summaries of relevant current and past research. Each topic is covered with a high degree of specificity and depth. I read this series to understand the principle cellular and anatomical elements in epilepsy, the genetics of epilepsy, and mechanisms of drugs which are used to treat epilepsy. As one with generalized epilepsy, I focused on the parts of the book which were relevant to my particular condition. I realize this perspective doesn't show the whole of the book, but the depth of the text and the vast number of topics covered can hardly be conveyed by a general review.
For example, within the volume appear detailed analyses of historical views, demographics, and neural foundations of epileptic disorders. In neuronal foundation of various epileptic disorders, the text begins with an overview of cellular mechanisms and then moves into specific sections within the brain which were critical to generating epileptic seizures.
I found two areas of particular interest: the discussion of ion channels (particularly calcium channels) and the structure of the thalamus. These areas were of critical interest to me as they play a critical role in the genesis of generalized epileptic seizures and the medications controlling them.
Ion Channels:
An incredible depth in explaining the role of potassium, calcium, and sodium voltage-gated protein channels have in generating fits and the relationship these channels have to current and future anti-epileptic medication. The information here is several primary sections: the role of channels in the "burster" cells, the synchronization of neuronal firing patterns, and control of neurotransmitter release. The explanation of the role of calcium channels in particular interested me, as medications that treat my condition have been shown to effect calcium currents (for example by blocking T-type calcium currents). Within each section are general overviews of the structure, functional properties, and overall role of the ion channels. The text then discusses the role of each ion channel type in the integration and propagation of signals. Flow charts, activity plots from specific experiments (effects on membrane potential for example) and basic diagrams are included to explain concepts when needed. Some imported graphs from cited experiments I found to be difficult to interpret, and several flowcharts illustrated the complexity of the system but were nonetheless difficult to analyze. I found overall, however, that the text and images correlated well and provided enhanced understanding of the complex elements introduced in the text.
Brain Structures:
For a typical chapter in this section, the text develops the initial discussion of cellular elements, discussing larger structures and their role in seizures. The structure most critical to me was the thalamus. The text begins with a basic history of the study of the thalamus in relation to epilepsy, noting that in early studies, simultaneous discharge in large areas of the neocortex gave rise to the hypothesis that the thalamus and surrounding structures formed a sort of "centrencephalic pacemaker" which synchronized and drove these rhythms.
Following this basic introduction, structural anatomy of the associated brain region is introduced. For the thalamus, three structures within this body were discussed concerning their ability to regulate low-frequency rhythms: the thalamic relay nuclei, the surrounding GABAergic thalamic reticular nucleus, and the neocortex.
The connections between the brain region and surrounding structures are discussed in detail and specific characteristics of the tissues present are explored, referring cellular elements previously discussed. For the thalamus, neurons in nearly all of the three identified areas are characterized by a high amplitude, low threshold calcium spike which has been shown to play a critical role in regulating low frequency rhythms.
The text then analyzes the indicators and elements of the disorder in relation to the structure and properties of cells and brain region. In the thalamus, one area noted was the 3-4Hz spike wave activity which characterizes generalized absence epilepsy. The text analyzes the relationship between triggers (such as sleep deprivation and rapid sleep-waking state transition) and their associated responses (ictogenesis) with respect to the normal functioning of the structure (the generation of sleep spindles). Included in this section is a discussion of the generation of animal models to study these phenomena.
These structural elements and associated cellular characteristics are integrated to isolate the key structures involved in seizure generation. The lateral sensory relay nuclei, the midline thalamic nuclei (both of which control spike wave discharge generation), and the anterior and mediodorsal thalamic nuclei (which may be involved in convulsions) are all explained in detail.
Control of these elements is then discussed. For generalized epilepsy, I found it interesting that many drugs, such as ethosuximide, which have little effect on other forms of epilepsy show efficacy in generalized absence because they block the T-type calcium currents critical to this type of epilepsy.
Included in every section are references from current and past literature forming a clear picture of the current state of knowledge for each topic. Limitations of the text's knowledge are conveyed positively as each topic contain the present theories and future directions of research derived from them. Many of the chapters of the book discussing particular phenomena reference several other prior discussions providing an efficient logical progression from one topic to the next (as seen in the discussion of the chapters above).
Overall, I would highly recommend this text to anyone with an interest in studying epileptic disorders. The detail and structure of the book fit its function. It is not easily accessible, but is worth the time and effort in reading it.
Reviews
There are so many aspects of modern epilepsy research and clinical practice that make a summary virtually impossible. Attempts have been made in the past and several excellent books are available. What is remarkable in this new text is the breadth of knowledge that was assembled, the superb and provocative writing of true experts in the field and the electronic version that allows for easy search strategies. The book is divided in three main volumes subdivided in chapters further split in sections. More than a compendium, this is an encyclopedia of current and past knowledge, with practical clinical examples, critical description of diagnostic criteria, summary of basic mechanisms, and illustrations either ad hoc or borrowed from previous work.
The book as a whole reads well, the chapters are clearly organized so that one does not need to read every word to learn the message. One minor point that may be addressed in reruns (especially in online versions) is the lack of color in many figures. For example, the chapter on field potentials provides "historic" depiction of seminal experiments that are hard to understand in a grey scale format. Along the same lines, the book would greatly benefit from more illustrative neuropathology, and the MRI reproductions lack sometimes in quality.
The editors have to be complimented for a major effort that will help those in the field understand what's hot and what's not in current understanding of this multifactorial disease. The novice will be fascinated by the depth of this textbook, and the non-epileptologist will find a unique source of searchable information. Cross references to diseases associated with seizure disorders, including psychiatric co-morbidities, make this a must for everyone looking for up to date knowledge in human neurological diseases associated with abnormal cortical and sub-cortical function.
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