The British Journal of Psychiatry (2000) 177: 473-474
© 2000 The Royal College of Psychiatrists
Epilepsy and Mental Retardation
John A. Corbett, Professor of Developmental Psychiatry
Lee Castle Hospital, Wolverley, Kidderminster, Worcestershire DY10
3PP
EDITED BY SIDNEY CROWN and ALAN LEE
Edited by Matti
Sillanpää, Lennart
Gram, Svein I. Johannessen & Torbjörn
Tomson. Stroud: Wrightson Biomedical. 1999. 212 pp. £39.00 (hb). ISBN
1-871816-416
Epilepsy is one of the most common secondary disabilities in people with
mental retardation, the prevalence increasing with the severity of the
intellectual disability. About 50% of those with profound learning disability
and between 10 and 20% of those with mild disability have suffered from
seizures at some time in life. Epilepsy is thus an important indicator of
underlying cerebral dysfunction. Until recently, only the tip of this iceberg
had been on view to most psychiatrists, but now that the majority of people
with learning disability are living in the community, generic services are
challenged to meet their needs.
This book is particularly welcome in providing the up-to-date knowledge
required by both primary care and specialist teams, and it is one of the first
comprehensive multi-author texts on the subject. The majority of the
contributors are from Scandinavia, and there are useful descriptions of
services in these countries which make it clear that if tertiary disability is
to be minimised, community care must be accompanied by specialist backup from
multi-disciplinary teams who have the neuropsychiatric skills to provide not
merely assessments, but also long-term monitoring and support.
The opening chapter, on epidemiology, gives a useful up-to-date review of
the literature, noting the relative lack of total population studies,
especially of those with mild learning disability. The detailed descriptions
of epilepsy in Angelman's, fragile X and Down's syndrome provide useful models
for consideration of the possible underlying mechanisms (the last of these
also has a separate chapter devoted to it).
The chapters on new anticonvulsants and the role of surgery in the
treatment of intractable seizures will be of particular interest to the
clinician, and it is gratifying to learn that learning disability is no longer
a contraindication to surgery. Intellectual deterioration is also no longer to
be regarded as an inevitable consequence of chronic epilepsy, but, as Stephen
Brown points out in his excellent review of the topic, it does present as a
major problem in a minority. It would have been helpful to have had a fuller
review of the educational difficulties affecting people with epilepsy,
although these are alluded to in the chapters on services. This book can be
recommended as an authoritative text for both clinicians and researchers.
