Complex Partial Seizures in Adults

Many disorders can mimic complex partial seizure (CPS), and clinicians must be careful to make an accurate diagnosis. Complex partial seizures must be distinguished from generalized-onset seizures (such as absence seizures), which require a different treatment regimen. Treatment of CPS should begin with monotherapy with a standard antiepileptic drug (AED), such as phenytoin or carbamazepine. Increasing evidence indicates that the newer AEDs, such as lamotrigine, topiramate, and possibly gabapentin, are effective as monotherapy. These AEDs may prove to be as effective as the standard AEDs but with fewer adverse effects. All the newer AEDs have significant efficacy when used as add-on treatments, and they may have fewer adverse effects than standard AEDs used in combination. Surgery for epilepsy should be considered in any patient in whom adequate trials of AEDs have failed. The vagus nerve stimulator, a new nonpharmacologic treatment, is a reasonable option in patients in whom AED treatment has failed. Randomized clinical trials comparing older and newer AEDs in the treatment of CPS are needed.