Epilepsy in Clinical Practice: A Case Study Approach

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Accomplished medical teachers often bundle medical knowledge with interesting case studies. In Epilepsy in Clinical Practice: A Case Study Approach, Andrew Wilner, MD, FACP, has managed to adapt this traditionally oral teaching method to a book format. In doing so, he has created a distinctive learning experience for clinicians, which bridges the gap between textbooks and clinical practice by merging theoretical concepts with practical management decisions. Both an epileptologist and skilled writer whose previous contributions have addressed other unmet educational needs, Wilner uses 12 case studies as a platform for updating the reader about the latest diagnostic and therapeutic advances in the field of epilepsy. The case studies pertain to the following central issues: the first seizure, intractable epilepsy, stopping antiepileptic medications, seizures and medications, epilepsy and pregnancy, rash, epilepsy and psychiatric disorders, epilepsy in the elderly, seizures and alcohol, generalized convulsive status epilepticus, nonepileptic seizures, and alternative therapy. Each case is followed by a series of thought-provoking questions that often anticipate the questions the physician caring for the patient would ask or be puzzled by. Answers to each question are then provided and supported by data where appropriate. Detailed but succinct explanations based on Wilner's experience, on generally accepted practice, and on useful resources are provided after the case studies. Primary care physicians as well as neurologists will be drawn to the cases because they frequently encounter patients with similar problems. Further, the questions and answers will help generalists understand the diagnostic and therapeutic challenges faced by specialists when treating patients with epilepsy and vice versa. While the diagnostic evaluation and selection of therapy are emphasized, the individualized, empathetic approach that Wilner espouses and the level of detail in the case descriptions reinforce the importance of the history and a compassionate attitude. A large number of helpful resources, 31 in all, follow the case studies. These include contact information for epilepsy organizations in the United States and abroad, a glossary, home safety checklist, and treatment protocol for generalized status epilepticus. These resources alone make a valuable contribution. A comprehensive index concludes the book. Epilepsy in Clinical Practice: A Case Study Approach breaks ground with a unique approach to medical education and will likely be emulated in other therapeutic areas. It should not only be read by medicine and neurology residents, primary care physicians, emergency room physicians, nurses, and neurologists, but it should be consulted before turning to more traditional neurology and epilepsy textbooks because it will help the reader use didactic information more efficiently. It will assist medical educators, who will use these cases as teaching tools. Above all it will enable clinicians to more effectively care for their patients with epilepsy. -- Steven C. Schachter, MD, is Vice President of the Harvard Clinical Research Institute and an Associate Professor of Neurology at Harvard Medical School, Boston, Massachusetts. More than 2 million Americans suffer from seizures. Each year, almost 200,000 people experience a seizure for the first time and approximately 100,000 require hospital admissions. The majority of these patients receive care from primary care physicians and general neurologists. Epilepsy in Clinical Practice: A Case Study Approach highlights dramatic diagnostic and therapeutic advances that impact upon the medical care of patients with epilepsy. Computerized imaging studies, new and improved medications, refined brain surgery techniques, increased experience with the ketogenic diet, and the Food and Drug Administration approval of the vagal nerve stimulator have elevated the state of the art. Medical decision making has correspondingly increased in complexity. This book lends clarity and confidence to the practical management of patients with seizures. For easy accessibility to key information, the book is organized into two sections. Management approaches to epilepsy are reviewed through a series of case studies that present the most common problems seen in clinical practice. This is followed by extensive appendices that include tables, charts, and checklists, web sites for physicians and patients, state driving regulations, summer camps for children with epilepsy, local affiliates of the Epilepsy Foundation, contact telephone numbers for pharmaceutical companies, and numerous other resources.