Epilepsy management. Issues in medical and surgical treatment

After a single seizure, about 40% of patients have recurrence. The main features correlating with recurrence are cause, seizure type, EEG findings, family history of seizures and, possibly, the presence of a prior febrile seizure, Todd's paresis, and other abnormal neurologic findings. A number of medications are available for treatment. Withdrawal from medication is successful in 60% to 70% of patients. Several factors favor successful drug taper. These include a seizure-free status for at least 2 years during drug therapy, a single type of seizure (partial or generalized), young age at seizure onset, and an epilepsy syndrome with a tendency to remit. Surgery can be considered in certain patients with surgically remediable syndromes. Candidates typically have seizures that impair consciousness, that cause falling with injury, that have adverse psychosocial or social effects, and that persist after trials of three appropriate medications. A multidisciplinary evaluation should take place at a surgery center with experience and documented success. Favorable results from surgery can be expected in a large proportion of patients.