Epilepsy: contemporary perspectives on evaluation and treatment

To describe the classification of seizures and epilepsies and discuss the medical and surgical treatment options.

The correct classification of types of seizures is necessary for appropriate evaluation and treatment. A neurologic examination can include electroencephalography and magnetic resonance imaging (MRI). MRI has been shown to be diagnostically superior to computed tomography in detecting epileptogenic lesions. With varying degrees of sensitivity and specificity, MRI may identify the underlying pathologic features associated with symptomatic partial epilepsy. Carbamazepine, phenytoin, and valproate sodium are the preferred medical treatments because of their relatively low neurotoxicity. Despite appropriate use of these medications, less than 50% of all patients with epilepsy are rendered free of seizures and experience no antiepileptic drug toxicity. Medically refractory seizures are often physically disabling and may be associated with an alteration in neurocognitive performance and psychosocial debilitation. Treatment options include the antiepileptic drugs felbamate and gabapentin, which have recently been approved in the United States. Surgical resection of epileptic brain tissue remains the most efficacious treatment for patients with intractable partial epilepsy.

Recent developments in neurodiagnostic studies and treatment strategies have substantially altered the management of patients with epilepsy. Challenging problems include the management of a single seizure, pregnancy and epilepsy, the timing of withdrawal of antiepileptic drug therapy, driving and epilepsy, and the use of alcohol in patients with seizures. The therapeutic goals are to render the patient seizure free and allow the patient to become a productive and participating member of society.