Febrile Seizures [Anglais] [Relié]

The editors of Febrile Seizures are correct: the time has come for a new book on this topic. The last multiauthored book on the subject (Karin B. Nelson and Jonas H. Ellenberg, eds. Febrile Seizures. New York: Raven Press, 1981) was produced more than 20 years ago, and the most recent book devoted to febrile seizures (which had an entirely clinical focus) was written almost 15 years ago by a single author (Sheila Wallace. The Child with Febrile Seizures. Boston: John Wright, 1988). Febrile seizures are the most common type of seizures in childhood, occurring in about 3 percent of children in North America and in even higher proportions of children in many other populations. They are frightening occurrences for families and often lead to unnecessary evaluations and worry. They have been the focus of recent practice guidelines issued by the American Academy of Pediatrics, the Royal College of Physicians, and the British Paediatric Association. Febrile seizures generate much discussion among neurologists, pediatric neurologists, and basic scientists. Such seizures also serve as a model for researchers who seek to understand why seizures occur and what effects they have on the brain -- particularly the developing brain. This book was edited by two eminent scholars from opposite ends of the professional spectrum. Shinnar represents the clinical and epidemiologic arenas, and Baram represents the experimental arena. Together, they have taken a wonderful and ultimately cohesive approach to their material, providing a comprehensive and stimulating review of the state of the art by bringing together experts from many countries and disciplines. The book is an evidence-based presentation to its core. The first part of the book covers basic epidemiology and then explores the extensive understanding of the clinical picture that has evolved in recent decades, summarizing key studies from around the world, including those that deal with the evidence that febrile seizures frequently recur, especially among certain children (the very young, children who attend day-care centers, and those with a family history of febrile seizures). The authors then discuss the outcome of febrile seizures -- both the normal cognitive development that is generally expected and the variability in the related risk of epilepsy. There is careful consideration of the possible relation between febrile seizures and temporal-lobe epilepsy. This thoughtful analysis demonstrates that follow-up studies in children with febrile seizures do not show an increased incidence of temporal-lobe epilepsy. Subsequent chapters blend the clinical and the experimental, dealing with both the question of whether prolonged febrile seizures may cause acute neuronal injury and experimental approaches to examining the neurobiology of febrile seizures and their effects. These sections successfully explore a wide range of fascinating material with great sensitivity to critical aspects of experimental design (e.g., the developmental age of the animal under study and methods of creation and control of the febrile seizures). The authors also provide an extensive discussion of physiology, with attention to the heightened susceptibility of the developing brain to provoked seizures, the putative role of the interleukin-1 system in producing febrile seizures, the physiology of the limbic system, and the basic electrophysiology of febrile seizures. These segments of the book provide a portal into this world for clinicians who are involved in the care of children with febrile seizures, forcing them to recognize the complexity of the process that they routinely treat. The book then returns to the clinic, with an excellent discussion of genetics and thorough chapters on evaluation and management, including recommendations for dealing with parents. These chapters present much of the background that informed the recently issued practice guidelines. Finally, Drs. Shinnar and Baram summarize the information from both human research and basic science in two succinct chapters, in which they offer provocative challenges for the future. The editors have succeeded admirably in providing a comprehensive review of the current state of the art. They have also provided a sense of the direction in which the field is headed, in both the clinical and experimental domains. They have chosen thoughtful, conscientious, and compelling authors. The chapters are well organized and fully referenced. This is a book that will be a welcome addition to the library of every pediatric neurologist, every epileptologist, and every researcher working on experimental models of epilepsy. It is essential that these researchers know about the clinical conditions they are modeling. Anyone entering this field should begin with this book. It provides a platform for the wealth of diverse and fascinating information about febrile seizures and adds a crucial perspective to a vast array of data that will help new researchers to see the fascinating questions ahead and to avoid potential pitfalls. Eileen P.G. Vining, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

"... useful to clinicians who want to update their knowledge of basic research relevant to febrile seizures and current management strategies."