Epilepsy Board Review

Moder PN, Gupta PK, Sirsi D. Epilepsy Board Review. New York, NY: Demos Medical Publishing; 2017 (200 pp). ISBN 978-1-4939-6772-8

This comprehensive epilepsy review book contains questions that cover a broad range of topics in epilepsy including pediatrics, epidemiology, psychological and socioeconomic issues, neurogenetics, and inpatient/outpatient evaluation and management. I particularly enjoyed the chapter on basic electroencephalography (EEG), and also appreciated the emphasis on genetics and the surgical evaluation and management of epilepsy. The literature references cited in the explanations are appropriately selected and provide a sound basis for further review and learning. One area for improvement would be the quality of the images, as several are difficult to appreciate. For example, the magnetic resonance imaging (MRI) scan in question 6 of Chapter 3 claims to demonstrate increased fluid-attenuated inversion recovery (FLAIR) signal in left parieto-occipital region and right frontal region, supposedly depicting features of tuberous sclerosis; however, neither subependymal nodules nor cortical tubers are easy to discern on this image. Also, question 40 in Chapter 3 shows an MRI scan that purportedly demonstrates increased FLAIR signal in bilateral hippocampi and the left insula, but these findings are challenging to make out.

Although many explanations are comprehensive, some lack clarity regarding key learning points or allow for ambiguity in interpretation. For example, question 20 in Chapter 1 concerns West syndrome; the explanation does not focus on the EEG characteristics one would expect in an epilepsy review book and it does not adequately emphasize the appropriate and accepted treatments (i.e., steroids and vigabatrin). Rather, all treatments are lumped together as if each is equally weighted with regard to efficacy; further, there is no mention of the ketogenic diet as a treatment option. Another example is question 22 in Chapter 1, which focuses on early myoclonic encephalopathy (EME). The explanation states, “neuroimaging is normal at onset, but progressive atrophy can be noted.” This statement is not entirely accurate since EME can have multiple etiologies, including brain malformation, in which case the initial MRI would not be normal. However, in general, these discrepancies are infrequent and the occasional lack of clarity is outweighed by repetition of the content in other chapters.

As a pediatric neurologist, I was particularly pleased to find that pediatric topics are well represented, spanning the age range from the neonatal period to adolescence. Both familiar and uncommon pediatric epilepsy syndromes are included, such as tuberous sclerosis, infantile spasms, Sturge–Weber syndrome, and Zellweger syndrome. There are some awkwardly worded questions; for example, question 13 of Chapter 1 is about a 19-year-old boy with absence seizures; obviously, the authors meant to say that the boy is 9 years old. Similarly, some questions are oddly placed, for example, a question about the diagnosis of a rare congenital syndrome is placed in the chapter on seizure treatment rather than in the chapter on diagnosis of seizures and epilepsy (question 107 in Chapter 4).

In summary, I found this review book to be a very useful and valuable study tool. The questions are sufficiently challenging and the explanations provided are typically succinct yet informative. I will continue to use this book as a platform for learning and certainly recommend it to other epilepsy trainees.