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Book Review   |    
Psychiatric Comorbidity in Epilepsy: Basic Mechanisms, Diagnosis, and Treatment
Kenneth R. Alper, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 1999;11:113-113.
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Edited by Harry W. McConnell, and Peter J. Snyder. , Washington, DC, American Psychiatric Press, 1998, 427 pages, ISBN 0-88048-853-0, $54.00

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This volume addresses the psychiatric evaluation and management of patients with epilepsy. It includes basic background information on neurologic aspects—such as the classification of the epilepsies and antiepileptic pharmacotherapy—to provide a context for more psychiatrically focused topics—such as psychosis, mood disorders, nonepileptic seizures, and the behavioral effects of antiepileptic drugs. The result is a practical, useful overview of the neuropsychiatry of epilepsy that also extends to a more theoretical, speculative treatment of the pathophysiology of behavioral disorders in epilepsy.

Some familiar names and their associated topics appear: Michael Trimble on the psychoses of epilepsy, Mary Robertson on mood disorders, and John Gates on nonepileptic seizures. There are also strong contributions by authors less well known to this reviewer. A theoretical discussion on the pathophysiology of behavioral disorders in epilepsy and a chapter on sleep constitute valuable additions to the volume.

More than one-third of the book is given over to two chapters that deal with psychopharmacological aspects of the treatment of behavioral disorders in epilepsy and the behavioral effects of antiepileptic drugs. These sections are admirably detailed and fill an important gap in the available literature. Here some minor criticisms can be offered. For example, in this reviewer's opinion the utility of prompt neuroleptic intervention in acute postictal psychosis is underestimated and the risks of treatment are overestimated. I also disagree with the relatively large weight assigned to postmarketing surveillance relative to phase III data in assessing the seizure threshold—lowering risks of psychotropic drugs. Certain recommendations that relatively discourage the use of fluvoxamine or buspirone in epilepsy patients appear to be based to a great extent on medicolegal aspects of an unevenly applied British standard for issuing warnings. These are, however, relatively minor points, and it is likely that all of us who treat significant numbers of epilepsy patients neuropsychiatrically have certain preferences and beliefs that have been formed in a somewhat arbitrary manner because of the absence of double-blinded studies on large numbers of patients relating to all of the psychopharmacologic issues that are encountered in clinical epilepsy.

Overall, this is a valuable book that I now frequently refer to and would recommend to neurologists and psychiatrists with an interest in the neuropsychiatry of epilepsy.

Dr. Alper is Assistant Professor of Psychiatry and Neurology, New York University School of Medicine, New York, NY.




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