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Intractable Focal Epilepsy
edited by John M. Oxbury, PhD, Charles E. Polkey, MD, and Michael
Duchowny, MD, 910 pp, $225, London, England, WB Saunders, 2000.
Arch Neurol. 2002;59:319-320.
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The title needs to be addressed by nature of the words chosen. Intractable focal epilepsy has been defined operationally
for adults as
the situation in which seizure control has yet to be achieved
more than 2 years after the initiation of treatment with optimal doses of
at least three of phenobarbitone, phenytoin, carbamazepine, sodium valproate,
and lamotrigine, either individually or in combination.
For children, it is noted that the 2-year rule is not always applicable
if they are "clinically deteriorating." The editors refer to Penfield and
Jasper's 1954 definition of focal epilepsy in which the seizures begin with
"a neuronal discharge in the vicinity of a demonstrably abnormal focus." Classification
schemes developed by the International League Against Epilepsy (ILAE) have
proposed the terms partial and more recently, localization related, to replace the older term focal. The editors, however, chose to use the term focal because they believed it . . . [Full Text of this Article]
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