Diagnosis and Management of Epilepsy in Adults

Department of Clinical Neurological Sciences, Epilepsy and Clinical Neurophysiology, London Health Sciences Centre - University Campus, London, ON.
Canadian Medical Association Journal (Impact Factor: 5.96). 03/2003; 168(4):441-8.
Source: PubMed


This article concisely describes the more common epilepsy conditions and will enable physicians to efficiently evaluate and manage these disorders. Salient aspects of the history and examination, together with electroencephalography, will usually determine the epilepsy syndrome (category), forming the basis for any further investigation and possible antiepileptic therapy. Imaging may be required in some circumstances.

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    • "Epilepsia ILAE common side effects of lamotrigine include nystagmus and dizziness. These side effects can be reversed by dose reduction (Blume, 2003). The half-life of lamotrigine is 15–30 h. "
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    ABSTRACT: Lennox-Gastaut syndrome (LGS) is an intractable childhood-onset epileptic encephalopathy. Seizure freedom is rare in LGS. One of the hallmarks of LGS is medical intractability, with generally poor response to antiepileptic drugs (AEDs). Nevertheless, several treatment options are available that can mitigate the severity of seizures and curtail their frequency. New AEDs have been validated in randomized, controlled trials for the treatment of seizures in LGS. In some cases, nonpharmacologic options may be effective, although more data are needed to confirm efficacy outcomes. Comprehensive patient assessments are critical to achieve an optimal AED treatment regimen and minimize the potential for adverse effects.
    Epilepsia 08/2011; 52 Suppl 5(supplement 5):10-20. DOI:10.1111/j.1528-1167.2011.03178.x · 4.57 Impact Factor
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    ABSTRACT: RESUMO Introdução: Há evidências de que pessoas com alguns tipos de epilepsia podem apresentar prejuízos cognitivos, sendo que para alguns pacientes, tais déficits cognitivos podem ser mais debilitantes do que suas crises epilépticas. A disfunção do lobo frontal é relatada em adultos com epilepsia do lobo temporal, caracte-rizada pela disfunção executiva. Objetivo: Rever a literatura sobre a ocorrência de disfunção de lobo frontal em crianças e adolescentes com epilepsia do lobo temporal. Métodos: Revisão sistemática da literatura compulsada no PUBMED. Resultados: A disfunção do lobo frontal tem sido pouco estudada em crianças com epilepsia, em especial com epilepsia do lobo temporal. No único estudo sobre este assunto, demonstrou-se que há um déficit executivo, sendo que as crianças com esclerose mesial têm maiores déficits de execução/ planejamento do que aquelas com lesões neocorticais temporais ou frontais. A presença de uma disfunção do lobo frontal nos pacientes com epilepsia parcial e generalizada pode corroborar as evidências de que epilepsia e transtorno psiquiátrico são epifenômenos e não fenômenos com relação causa-efeito. Conclu-sões: Há uma escassez de artigos sobre a disfunção do lobo frontal em crianças com epilepsia do lobo tempo-ral, sendo de interesse saber se esta ocorre e se pacientes com etiologias distintas apresentam diferentes graus de comprometimento destas funções. Unitermos: epilepsia, crianças, lobo frontal, lobo temporal, transtornos psiquiátricos. ABSTRACT Frontal lobe disfunction in children and adolescents with temporal lobe epilepsy and possible correlation with psychiatric disorders Introduction: There is evidence that individuals with certain types of epilepsy may present cognitive disorders, and that these disorders can be more debilitating than seizures proper. Frontal lobe disorders are reported in adults with temporal lobe epilepsy, carachterized by executive disfunction. Rationale: Literary revision of work concerning the occurence of frontal lobe dysfunction in children and adolescents with temporal lobe epilepsy. Methods: Systematic revision of published literature in PUBMED. Results: Frontal lobe dysfunction has been poorly studied in children with epilepsy, especially in temporal lobe epilepsy. In the only study on the subject, executive deficit was demonstrated. Moreover, children with mesial sclerosis had more deficit in execution/planning than those with frontal or temporal neocortical lesions. Presence of frontal lobe dysfunction, in patients with partial and generalized epilepsy, may corroborate evidence that epilepsy and psychiatric disorders are epiphenomena and not cause-effect related phenomena. Conclusion: There are few articles on frontal lobe dysfunction in children with temporal lobe epilepsy. It would be interesting to find out if, and how much this occurs, and if patients with distinct etiologies present different levels of functional disability.
    Journal of Epilepsy and Clinical Neurophysiology 01/2005; 11(3). DOI:10.1590/S1676-26492005000300004
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    ABSTRACT: The primary purpose of this study was to evaluate the utilization pattern and seizure out-come of newer and older antiepileptic drugs in pediatric clinical practice in a tertiary care hospital setting. The study was a retrospective observational study carried out, among pedi-atric epilepsy patients who were diagnosed according to the classification of the Interna-tional League Against Epilepsy and the information was gathered with the help of a vali-dated data collection form. There was a relative male preponderance (56%) seen among epi-leptic patients. Of the total 210 patients analyzed, 110 (52.4%) were having partial seizure and 100 (47.6%) had generalized seizures. Out of 210 patients 134 (63.8%) were on mono-therapy and 76 patients (36.2%) were on polytherapy. Mean daily doses of carbamazepine were 492.69±51.8 and 320.97±42.09 in polytherapy and monotherapy respectively. The number of patients on newer anticonvulsants was much smaller. The serum levels were mo-nitored for commonly used antiepileptics like phenytoin, carbamazepine, phenobarbitone and Valproate in 43 (20.5%) patients. Among 210 patients, antiepileptic drugs were changed for 96 (45.71%) and the reasons for changing prescriptions were uncontrolled seizures (67.7%), recurrence (22.9%) and adverse effects (9.3%). A nationally based study and guidelines may bring a more rational approach for antiepileptic drug. Though most of the cases can be effectively managed with conventional antiepileptics, an increase in experience with the use of newer medications can offer an additional advantage to patients.
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