Gregory P. Lee from Medical College of Georgia has written a slim volume aimed at clinicians who see epilepsy patients, including neuropsychologists and clinical psychologists. This is the seventh volume in the Oxford Workshop Series, published in collaboration with the American Academy of Clinical Neuropsychology. Consistent with the publisher's intent, to provide “focused content,” it is written as a hybrid between a comprehensive textbook to be read in a single sitting and a reference book to be accessed as needed. It attempts to be readable yet concise, and definitely succeeds on the readable side. Overall, the style is that of a well-written textbook or an engaging lecture that covers most aspects a clinician would need to familiarize him/herself with a case at hand. The volume is divided into two parts. Part One, Medical Aspects of Epilepsy for Neuropsychologists, consists of eight chapters. Part Two, Surgical Treatment of Epilepsy, has three chapters.
Part One begins a brief introduction in Chapter 1, which includes content related to definition, epidemiology, and etiology of epilepsy, as well as the role of the neuropsychologist. Chapter 2 addresses the complex issue of the classification of epilepsy disorders. Specifically, the traditional classification (International League Against Epilepsy, 1981) is reviewed which distinguishes disorders with partial (focal) seizures from those with generalized (complex) seizures. Chapter 3 covers the ILAE's classification schema of epilepsy syndromes (International League Against Epilepsy, 1989). This system is based on clusters of signs and symptoms, such as type of seizure, etiology, and anatomy. Diagnostic tests pertinent to a diagnosis of epilepsy are reviewed in Chapter 4, with coverage of electroencephalography (EEG) patterns and structural neuroimaging techniques. Chapter 5 provides a concise and up-to-date introduction to pharmacologic treatment of epilepsy. Older and newer drugs are reviewed, up to and including lacosamide (Vimpat). Special consideration is given to antiepileptic drug use in women and children. Cognitive and behavioral effects of each drug are discussed briefly but with sufficient detail, and there also is discussion of the mechanism of action, adverse effects, and efficacy of the ketogenic diet. Neuropsychological assessment is the subject matter in Chapter 6. To this end, Dr. Lee reviews factors that contribute to cognitive problems in epilepsy, as well as potentially confounding factors such as effects of antiepileptic medication. Cognitive deficits and how they present in different types of epilepsy are discussed. Quality of life assessment, and matters such as driving issues in epilepsy, are included along with a detailed case example of preoperative neuropsychological test results in left mesial temporal lobe seizure onset. In Chapter 7, psychological and psychiatric disorders in epilepsy are discussed. Clinical presentations related to mood, anxiety, psychotic, and personality disorders are contrasted with epilepsy-specific psychological disorders such as psychoses of epilepsy, affective-somatoform disorders of epilepsy, and anticonvulsant-induced psychiatric disorders. Chapter 8, providing an overview of psychogenic nonepileptic seizures, concludes the first section about medical aspects of epilepsy for neuropsychologists.
Part Two begins with Chapter 9, and a discussion of neuropsychological assessment in the context of epilepsy surgery. There is a review of the purposes of pre- and postoperative evaluations, frequently used tests, as well as a detailed case example of neuropsychological results pre- and post anterior temporal lobectomy. In Chapter 10, other neuropsychological procedures in epilepsy surgery are described. This includes a discussion of the intracarotid amobarbital (Wada) procedure, as well as functional imaging techniques, and electrocortical stimulation mapping. Chapter 11, entitled Medical Aspects of Epilepsy Surgery begins with the interdisciplinary pre-operative evaluation process for epilepsy surgery and is followed by a review of eleven epilepsy surgical procedures, each explained with outcome findings and commonly encountered complications. A case example of independent bilateral seizure onset concludes the second part.
The book concludes with three appendices. Appendix I supplements Chapter 2 and describes seizure types not covered in the body of the text, based on the traditional classification of epileptic seizures. While many syndromes are reviewed in Chapter 3, Appendix II notes syndrome subtypes in even greater detail. Appendix III presents a detailed description of the Wada assessment procedures and rating criteria used at the Medical College of Georgia. A glossary is also provided.
Some might prefer to read Neuropsychology of Epilepsy and Epilepsy Surgery cover-to-cover. In the Preface, Dr. Lee writes “much of the material … is not intended to be read through in one sitting, but rather to serve as a reference for looking up specific information when the need arises …” However, several features were not conducive to such use. First, it does not make full use of layout to facilitate quick access. At times, the hierarchy used to structure the text is not consistent and makes it difficult to follow the line of thought. Additional tables and figures could have been added, although those included are very useful. Cross-referencing is almost entirely absent, although it would have been very helpful. For example, there is a section on magnetoencephalography in the second part of the book, but if you are reviewing diagnostic tests such as EEG or magnetic resonance imaging in the first part, there is no reference to indicate that related content is elsewhere. It would have been useful to recommend online resources. In the chapter on EEG, images are used from internet resources but these are not explicitly recommended. The reader is referred to atlases or specific textbooks, but for quick access and multimedia information about EEG and/or other aspects of epilepsy, online resources would have been more helpful. Finally, the index could be improved by including more synonyms (e.g., Doose syndrome for myoclonic-astatic epilepsy) and by covering the glossary in the index (e.g., Sturge-Weber syndrome is listed in the glossary but not in the index).
On the other hand, the book shines when it comes to clinically relevant knowledge. Many sections, such as the introduction to EEG, detailed coverage of Wada procedure, and the explanation of multiple specific surgery approaches, will be extremely useful to anybody participating in (or even listening to) interdisciplinary epilepsy rounds or consultations. Even in discussing treatment options with patients and families, this information is likely to be relevant and helpful. The chapter on antiepileptic drugs is current and includes information on cognitive side effects pertaining to most questions that arise in the context of a neuropsychological evaluation of adults and children. Psychogenic seizures are not only described and distinguished from epileptic seizures, but research on etiology and treatment is presented in a concise way. Neuropsychological assessment is discussed twice, once in general epilepsy and once related to epilepsy surgery. Evidence regarding the clinical utility of specific tests is provided in both contexts. Finally, the description of some of the rare forms of epileptic syndromes (e.g., hot water or reading epilepsy) is another clear advantage of this book.
Overall, I recommend this book for neuropsychologists who see epilepsy patients. Its use as a reference will be facilitated after an initial read of the whole book, which will also provide clinicians with a solid overview of the field. If you work in an epilepsy center, chances are you already have several textbooks that provide more in-depth coverage. However, the strength of this volume lies in its brevity. I very much liked the short, half to one-page descriptions of syndromes provided in the appendix, and found myself reaching for this book more than once during the review process to familiarize myself with a specific surgical procedure or refresh my memory of a specific seizure type.
