Epilepsy

Abstract

The accurate diagnosis and classification of seizures is critical in informing prognosis and determining appropriate antiseizure treatments for patients with epilepsy. The electroencephalogram is the gold standard for diagnosis. Obtaining a thorough history, performing a careful physical examination, and selecting appropriate diagnostic studies are also essential in determining the underlying seizure etiology. The authors provide clinical pearls and pitfalls in the diagnosis and management of epilepsy.

Keywords

seizure - epilepsy - convulsion - antiseizure drug - electroencephalogram

• References

• 1 Krumholz A, Wiebe S, Gronseth G , et al; Quality Standards Subcommittee of the American Academy of Neurology; American Epilepsy Society. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2007; 69 (21) 1996-2007
• 2 Sazgar M, Carlen PL, Wennberg R. Panic attack semiology in right temporal lobe epilepsy. Epileptic Disord 2003; 5 (2) 93-100
• 3 Alemayehu S, Bergey GK, Barry E , et al. Panic attacks as ictal manifestations of parietal lobe seizures. Epilepsia 1995; 36 (8) 824-830
• 4 Williamson PD, Spencer DD, Spencer SS, Novelly RA, Mattson RH. Complex partial seizures of frontal lobe origin. Ann Neurol 1985; 18 (4) 497-504
• 5 Theodore WH, Porter RJ, Albert P , et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology 1994; 44 (8) 1403-1407
• 6 Ng SK, Brust JC, Hauser WA, Susser M. Illicit drug use and the risk of new-onset seizures. Am J Epidemiol 1990; 132 (1) 47-57
• 7 Spiller HA, Ryan ML, Weston RG, Jansen J. Clinical experience with and analytical confirmation of “bath salts” and “legal highs” (synthetic cathinones) in the United States. Clin Toxicol (Phila) 2011; 49 (6) 499-505
• 8 Striano S, Coppola A, del Gaudio L, Striano P. Reflex seizures and reflex epilepsies: old models for understanding mechanisms of epileptogenesis. Epilepsy Res 2012; 100 (1–2) 1-11
• 9 Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976; 295 (19) 1029-1033
• 10 French JA, Williamson PD, Thadani VM , et al. Characteristics of medial temporal lobe epilepsy: I. Results of history and physical examination. Ann Neurol 1993; 34 (6) 774-780
• 11 Smith SJ. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry 2005; 76 (Suppl. 02) ii2-ii7
• 12 Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology 2006; 66 (11) 1730-1731
• 13 LaFrance Jr WC. Psychogenic nonepileptic seizures. Curr Opin Neurol 2008; 21 (2) 195-201
• 14 Annegers JF, Shirts SB, Hauser WA, Kurland LT. Risk of recurrence after an initial unprovoked seizure. Epilepsia 1986; 27 (1) 43-50
• 15 Macdonald RL, Kelly KM. Antiepileptic drug mechanisms of action. Epilepsia 1995; 36 (Suppl. 02) S2-S12
• 16 Lynch BA, Lambeng N, Nocka K , et al. The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci U S A 2004; 101 (26) 9861-9866
• 17 French JA, Gazzola DM. Antiepileptic drug treatment: new drugs and new strategies. Continuum (Minneap Minn) 2013; 19 (3 Epilepsy): 643-655
• 18 Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000; 342 (5) 314-319
• 19 Kwan P, Arzimanoglou A, Berg AT , et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2010; 51 (6) 1069-1077
• 20 Sperling MR, O'Connor MJ, Saykin AJ, Plummer C. Temporal lobectomy for refractory epilepsy. JAMA 1996; 276 (6) 470-475
• 21 Wiebe S, Blume WT, Girvin JP, Eliasziw M ; Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001; 345 (5) 311-318
• 22 Engel Jr J. Update on surgical treatment of the epilepsies. Summary of the Second International Palm Desert Conference on the Surgical Treatment of the Epilepsies (1992). Neurology 1993; 43 (8) 1612-1617
• 23 Drane DL, Loring DW, Voets NL , et al. Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia 2015; 56 (1) 101-113
• 24 Kossoff EH, Ritzl EK, Politsky JM , et al. Effect of an external responsive neurostimulator on seizures and electrographic discharges during subdural electrode monitoring. Epilepsia 2004; 45 (12) 1560-1567
• 25 Heck CN, King-Stephens D, Massey AD , et al. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia 2014; 55 (3) 432-441
• 26 Morris III GL, Mueller WM. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01-E05. Neurology 1999; 53 (8) 1731-1735
• 27 Felton EA, Cervenka MC. Dietary therapy is the best option for refractory nonsurgical epilepsy. Epilepsia 2015; 56 (9) 1325-1329
• 28 Klepper J, Diefenbach S, Kohlschütter A, Voit T. Effects of the ketogenic diet in the glucose transporter 1 deficiency syndrome. Prostaglandins Leukot Essent Fatty Acids 2004; 70 (3) 321-327
• 29 Cervenka MC, Kossoff EH. Dietary treatment of intractable epilepsy. Continuum (Minneap Minn) 2013; 19 (3 Epilepsy): 756-766
• 30 Kossoff EH. International consensus statement on clinical implementation of the ketogenic diet: agreement, flexibility, and controversy. Epilepsia 2008; 49 (Suppl. 08) 11-13
• 31 Krumholz A, Wiebe S, Gronseth GS , et al. Evidence-based guideline: management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015; 84 (16) 1705-1713
• 32 Jirsch J, Siddiqi M, Smyth P, Maximova K. Bias in counseling of seizure patients following a transient impairment of consciousness: differential adherence to driver fitness guidelines. Seizure 2015; 30: 21-25
• 33 Zupanc ML. Antiepileptic drugs and hormonal contraceptives in adolescent women with epilepsy. Neurology 2006; 66 (6) (Suppl. 03) S37-S45
• 34 Gidal BE. Antiepileptic drug formulation and treatment in the elderly: biopharmaceutical considerations. Int Rev Neurobiol 2007; 81: 299-311
• 35 Devinsky O. Sudden, unexpected death in epilepsy. N Engl J Med 2011; 365 (19) 1801-1811