Media Watch
1
For personal use. Only reproduce with permission from The Lancet Publishing Group. Delirium in Old Age Edited by Lindesay J, Rockwood K, and MacDonald A Oxford University Press, 2002 £55, 226 pp ISBN 0 19 263275 2 Sharon K Inouye reminds us of the importance of delirium on the first page of this new book: “delirium represents the most frequent complication of hospitalisation for the older population”. Astonishingly, excluding conference proceedings, there have been only three textbooks on delirium (McNichol’s The Treatment of Delirium Tremens and Related States; Lipowski’s Delirium: Acute Confusional States; Miller’s Delirium Advances in Research & Clinical Practice). Delirium in Old Age is based on a little-known work published in 1990. This edition has been completely rewritten and updated, thanks in no small part to the contribution of Kenneth Rockwood. The significance of delirium to the practising neurologist cannot be overestimated. The syndrome complicates the recovery of at least a quarter of stroke patients and co-occurs in over half of patients with dementia. Furthermore, the mortality rate can reach 50% in the first 6 months of onset. Yet delirium has been widely ignored scientifically and is commonly overlooked clinically—two points the authors press home repeatedly. For example, delirium is identified by nursing staff in less than one in three true cases and when dementia is also present, delirium is missed 90% of the time. The editors have attempted to address these problems and their possible solutions by providing a comprehensive yet concise overview of every feature of delirium. Overall, they have been remarkably successful. Delirium in Old Age is logically divided into 11 chapters covering clinical features, epidemiology, causes, management, and prevention of delirium. The best chapters are those on epidemiology (which also cover prognosis) and the well-balanced chapter on management. Sections on the importance of the family and education strategies are particularly innovative. Perhaps the least satisfactory chapter concerns the neuropathophysiology of delirium. This is not because it is poorly written but because so few of the observations have actually been tested in patients. In addition, none of the important studies examining the hypothalamus–pituitary–adrenal axis (stress hormones) in delirium have been quoted. There are several other omissions in other chapters. There is almost nothing about the use of the EEG in delirium and little on the clinically important overlap of Lewy-body dementia and delirium. However, the above criticisms should not deter clinicians from buying this excellent volume. Neither should the title, which incorrectly suggests that the book is restricted to a discussion of delirium in old age. In reality, the book strikes a perfect balance between authority and brevity and is currently the most up-to-date text on delirium (in any age group) available. It should be compulsory reading for anyone who deals with vulnerable hospitalised patients. Alex Mitchell THE LANCET Neurology Vol 2 May 2003 http://neurology.thelancet.com 321 Media watch A Clinical Guide to Epileptic Syndromes and their Treatment Chrysostomos P Panayiotopoulous Bladon Medical Publishing, 2002 £39·95, 278 pp ISBN 1 904218 23 72 Advances in the understanding of epilepsy have been made owing to improved classification of the epileptic syndromes, new diagnostic methods, and new treatments. More new antiepileptic drugs have appeared in the past 20 years than the previous 70 years. Neurologists, paediatricians, and general physicians all have to come to terms with this knowledge. This book succesfully shows that “epilepsy” is of a group of disorders of differing aetiologies and that diagnosis depends on knowledge of the different syndromes and their clinical and laboratory manifestations. As the author states, “this is the first book to be based on the new diagnostic scheme of the ILAE (International League Against Epilepsy)”. This scheme is divided into seizure phenomenology and type, syndrome and aetiology of epilepsy, and impairment. The book clarifies this intrinsically difficult classification and terminology and deals very well with epilepsy at different life stages. The sections on benign childhood syndromes, epileptic encephalopathies, and familial focal epilepsies are particularly well written and of great clinical benefit. The symptomatic epilepsies have been presented according to their lobe of origin. The largest chapter is on idiopathic generalised epilepsy (IGE). IGE disorders comprise a third of all epilepsy syndromes and are genetically determined; some, such as juvenile myoclonic epilepsy, require lifelong treatment. The author emphasises that drugs, such as carbamazepine, used to treat focal epilepsy can increase seizure frequency in IGE. The final chapter is a comprehensive account of reflex epilepsies including photosensitive epilepsy and the much rarer scotosensitivity, in which seizures are induced by the elimination of light. The author says “video EEG should be made routine practice”, but this would add greatly to the cost of treatment, particularly in less developed countries. This bias is seen again in the statement that “hippocampal epilepsy is the commonest form of focal epilepsy”. This does not take into account cysticercosis in tropical regions. In the one and a half line discussion of clinical practice in less developed countries, there is no mention that about 70% of patients in these countries receive inappropriate or no treatment. The book’s format and use of MRI and EEG are pleasing. The author is not averse to stating his own opinion, which together, with a sprinkling of clinical vignettes, makes good reading. I recommend this book, the only one of its kind, to epileptologists, electrophysiologists, EEG technicians, neur- ologists, paediatricians, and even general physicians. Nadir E Bharucha
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Transcript of Media Watch
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Delirium in Old AgeEdited by Lindesay J, Rockwood K, andMacDonald A Oxford University Press, 2002 £55, 226 ppISBN 0 19 263275 2
Sharon K Inouye reminds us of theimportance of delirium on the first page of this new book:“delirium represents the most frequent complication ofhospitalisation for the older population”. Astonishingly,excluding conference proceedings, there have been onlythree textbooks on delirium (McNichol’s The Treatment ofDelirium Tremens and Related States; Lipowski’s Delirium:Acute Confusional States; Miller’s Delirium Advances inResearch & Clinical Practice).
Delirium in Old Age is based on a little-known workpublished in 1990. This edition has been completelyrewritten and updated, thanks in no small part to thecontribution of Kenneth Rockwood.
The significance of delirium to the practising neurologistcannot be overestimated. The syndrome complicates therecovery of at least a quarter of stroke patients and co-occursin over half of patients with dementia. Furthermore, themortality rate can reach 50% in the first 6 months of onset.Yet delirium has been widely ignored scientifically and iscommonly overlooked clinically—two points the authorspress home repeatedly. For example, delirium is identifiedby nursing staff in less than one in three true cases and whendementia is also present, delirium is missed 90% of the time.
The editors have attempted to address these problems andtheir possible solutions by providing a comprehensive yetconcise overview of every feature of delirium. Overall, theyhave been remarkably successful.
Delirium in Old Age is logically divided into 11 chapterscovering clinical features, epidemiology, causes,management, and prevention of delirium. The best chaptersare those on epidemiology (which also cover prognosis) andthe well-balanced chapter on management. Sections on theimportance of the family and education strategies areparticularly innovative. Perhaps the least satisfactory chapterconcerns the neuropathophysiology of delirium. This is notbecause it is poorly written but because so few of theobservations have actually been tested in patients. Inaddition, none of the important studies examining thehypothalamus–pituitary–adrenal axis (stress hormones) indelirium have been quoted.
There are several other omissions in other chapters.There is almost nothing about the use of the EEG in deliriumand little on the clinically important overlap of Lewy-bodydementia and delirium.
However, the above criticisms should not deter cliniciansfrom buying this excellent volume. Neither should the title,which incorrectly suggests that the book is restricted to adiscussion of delirium in old age. In reality, the book strikesa perfect balance between authority and brevity and iscurrently the most up-to-date text on delirium (in any agegroup) available. It should be compulsory reading foranyone who deals with vulnerable hospitalised patients.Alex Mitchell
THE LANCET Neurology Vol 2 May 2003 http://neurology.thelancet.com 321
Media watch
A Clinical Guide to Epileptic Syndromes andtheir TreatmentChrysostomos P PanayiotopoulousBladon Medical Publishing, 2002£39·95, 278 ppISBN 1 904218 23 72
Advances in the understanding of epilepsy have been madeowing to improved classification of the epileptic syndromes,new diagnostic methods, and new treatments. More newantiepileptic drugs have appeared in the past 20 years than theprevious 70 years. Neurologists, paediatricians, and generalphysicians all have to come to terms with this knowledge.
This book succesfully shows that “epilepsy” is of a group ofdisorders of differing aetiologies and that diagnosis dependson knowledge of the different syndromes and their clinical andlaboratory manifestations. As the author states, “this is the firstbook to be based on the new diagnostic scheme of the ILAE(International League Against Epilepsy)”. This scheme isdivided into seizure phenomenology and type, syndrome andaetiology of epilepsy, and impairment. The book clarifies thisintrinsically difficult classification and terminology and dealsvery well with epilepsy at different life stages. The sections onbenign childhood syndromes, epileptic encephalopathies, andfamilial focal epilepsies are particularly well written and ofgreat clinical benefit. The symptomatic epilepsies have beenpresented according to their lobe of origin.
The largest chapter is on idiopathic generalised epilepsy(IGE). IGE disorders comprise a third of all epilepsysyndromes and are genetically determined; some, such asjuvenile myoclonic epilepsy, require lifelong treatment. Theauthor emphasises that drugs, such as carbamazepine, usedto treat focal epilepsy can increase seizure frequency in IGE.
The final chapter is a comprehensive account of reflexepilepsies including photosensitive epilepsy and the muchrarer scotosensitivity, in which seizures are induced by theelimination of light.
The author says “video EEG should be made routinepractice”, but this would add greatly to the cost of treatment,particularly in less developed countries. This bias is seenagain in the statement that “hippocampal epilepsy is thecommonest form of focal epilepsy”. This does not take intoaccount cysticercosis in tropical regions. In the one and a halfline discussion of clinical practice in less developed countries,there is no mention that about 70% of patients in thesecountries receive inappropriate or no treatment.
The book’s format and use of MRI and EEG are pleasing.The author is not averse to stating his own opinion, whichtogether, with a sprinkling of clinical vignettes, makes goodreading.
I recommend this book, the only one of its kind, toepileptologists, electrophysiologists, EEG technicians, neur-ologists, paediatricians, and even general physicians.Nadir E Bharucha
