Epilepsy and Mental Retardation. 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.