[Medical treatment of epilepsy: hidden dimensions]

Treatment with antiepileptic drugs (AED) increases the chance of seizure control in patients with epilepsy. This control is best achieved with AED monotherapy in the early stages of the disease. In up to 28% of the remaining patients, complete seizure control is obtained with AED combination therapy. In our own retrospective studies, levetiracetam proved to be the most effective drug in add-on treatment of focal epilepsies. Seizure control for at least 6 months was seen in 22.8% of patients, and reduction of seizure frequency by more than 50% was achieved in 58.8%. One must however consider that up to 50% of all seizures are not recognized by the patients. This is especially the case in complex partial seizures and in seizures during sleep. Seizure control (as recognized by the patient) allows better social reintegration, e.g. by obtaining a driving license. In addition to AED therapy other epilepsy-related symptoms such as depression need diagnosis and treatment. Of all patients with epilepsy, 30-50% suffer from depression, but about 50% of these are not willing to start antidepressant drug therapy.