Epilepsy resident survival guide: Difference between revisions

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==Do's==
==Do's==


*Adults with an unprovoked first [[seizure]] should be informed that their risk of recurrence is higher within the first 2 years.<ref name="KrumholzWiebe20152">{{cite journal|last1=Krumholz|first1=A.|last2=Wiebe|first2=S.|last3=Gronseth|first3=G. S.|last4=Gloss|first4=D. S.|last5=Sanchez|first5=A. M.|last6=Kabir|first6=A. A.|last7=Liferidge|first7=A. T.|last8=Martello|first8=J. P.|last9=Kanner|first9=A. M.|last10=Shinnar|first10=S.|last11=Hopp|first11=J. L.|last12=French|first12=J. A.|title=Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society|journal=Neurology|volume=84|issue=16|year=2015|pages=1705–1713|issn=0028-3878|doi=10.1212/WNL.0000000000001487}}</ref>
*Adults with an unprovoked first [[seizure]] should be informed that their [[Risk-benefit analysis|risk]] of [[Recurrence quantification analysis|recurrence]] is higher within the first 2 years.<ref name="KrumholzWiebe2015" />
*Treat with immediate [[antiepileptic]] [[therapy]] from the first unprovoked [[seizure]], since it has been seen that it reduces recurrences, as compared with the delay of [[treatment]] pending a second [[seizure]]. This may not improve [[quality of life]].<ref name="KrumholzWiebe2015">{{cite journal|last1=Krumholz|first1=A.|last2=Wiebe|first2=S.|last3=Gronseth|first3=G. S.|last4=Gloss|first4=D. S.|last5=Sanchez|first5=A. M.|last6=Kabir|first6=A. A.|last7=Liferidge|first7=A. T.|last8=Martello|first8=J. P.|last9=Kanner|first9=A. M.|last10=Shinnar|first10=S.|last11=Hopp|first11=J. L.|last12=French|first12=J. A.|title=Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society|journal=Neurology|volume=84|issue=16|year=2015|pages=1705–1713|issn=0028-3878|doi=10.1212/WNL.0000000000001487}}</ref>
*Treat with immediate [[antiepileptic]] [[therapy]] from the first unprovoked [[seizure]] in adults, since it has been seen that it reduces recurrences, as compared with the  delay of [[treatment]] pending a second [[seizure]]. This may not improve [[quality of life]].<ref name="KrumholzWiebe2015">{{cite journal|last1=Krumholz|first1=A.|last2=Wiebe|first2=S.|last3=Gronseth|first3=G. S.|last4=Gloss|first4=D. S.|last5=Sanchez|first5=A. M.|last6=Kabir|first6=A. A.|last7=Liferidge|first7=A. T.|last8=Martello|first8=J. P.|last9=Kanner|first9=A. M.|last10=Shinnar|first10=S.|last11=Hopp|first11=J. L.|last12=French|first12=J. A.|title=Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society|journal=Neurology|volume=84|issue=16|year=2015|pages=1705–1713|issn=0028-3878|doi=10.1212/WNL.0000000000001487}}</ref> [[Risk-benefit analysis|Benefits and risks]] of [[psychological]] and [[Adverse effect (medicine)|medical side effects]] of [[AED]] should be evaluated when treating [[children]] with an unprovoked first [[seizure]].<ref name="HirtzBerg2003">{{cite journal|last1=Hirtz|first1=D.|last2=Berg|first2=A.|last3=Bettis|first3=D.|last4=Camfield|first4=C.|last5=Camfield|first5=P.|last6=Crumrine|first6=P.|last7=Gaillard|first7=W. D.|last8=Schneider|first8=S.|last9=Shinnar|first9=S.|title=Practice parameter: Treatment of the child with a first unprovoked seizure: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society|journal=Neurology|volume=60|issue=2|year=2003|pages=166–175|issn=0028-3878|doi=10.1212/01.WNL.0000033622.27961.B6}}</ref>
*Use [[Gabapentin]] in patients aged ≥60 years with new-onset [[Focal Epilepsy|focal epilepsy]], as it is as effective and better tolerated than other [[drugs]].<ref name="KannerAshman2018">{{cite journal|last1=Kanner|first1=Andres M.|last2=Ashman|first2=Eric|last3=Gloss|first3=David|last4=Harden|first4=Cynthia|last5=Bourgeois|first5=Blaise|last6=Bautista|first6=Jocelyn F.|last7=Abou-Khalil|first7=Bassel|last8=Burakgazi-Dalkilic|first8=Evren|last9=Llanas Park|first9=Esmeralda|last10=Stern|first10=John|last11=Hirtz|first11=Deborah|last12=Nespeca|first12=Mark|last13=Gidal|first13=Barry|last14=Faught|first14=Edward|last15=French|first15=Jacqueline|title=Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy|journal=Neurology|volume=91|issue=2|year=2018|pages=74–81|issn=0028-3878|doi=10.1212/WNL.0000000000005755}}</ref>
*[[Lamotrigine]] should be used to decrease [[seizure]] frequency in patients aged ≥60 years.<ref name="KannerAshman2018" />
*[[Vagus nerve stimulation]] may be used to reduce [[seizure]] frequency over time for periods greater than 6 months and as long as 12 years. In adult patients receiving [[Vagus nerve stimulation|VNS]] for [[epilepsy]], improvement in mood may be an additional benefit.<ref name="MorrisGloss2013">{{cite journal|last1=Morris|first1=G. L.|last2=Gloss|first2=D.|last3=Buchhalter|first3=J.|last4=Mack|first4=K. J.|last5=Nickels|first5=K.|last6=Harden|first6=C.|title=Evidence-based guideline update: Vagus nerve stimulation for the treatment of epilepsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology|journal=Neurology|volume=81|issue=16|year=2013|pages=1453–1459|issn=0028-3878|doi=10.1212/WNL.0b013e3182a393d1}}</ref><ref name="KubaBrázdil2009">{{cite journal|last1=Kuba|first1=Robert|last2=Brázdil|first2=Milan|last3=Kalina|first3=Miroslav|last4=Procházka|first4=Tomáš|last5=Hovorka|first5=Jiří|last6=Nežádal|first6=Tomáš|last7=Hadač|first7=Jan|last8=Brožová|first8=Klára|last9=Sebroňová|first9=Věra|last10=Komárek|first10=Vladimír|last11=Marusič|first11=Petr|last12=Ošlejšková|first12=Hana|last13=Zárubová|first13=Jana|last14=Rektor|first14=Ivan|title=Vagus nerve stimulation: Longitudinal follow-up of patients treated for 5 years|journal=Seizure|volume=18|issue=4|year=2009|pages=269–274|issn=10591311|doi=10.1016/j.seizure.2008.10.012}}</ref>
*Adjust [[dose]] of [[Antiepileptics|antiepileptic]] [[drugs]] in [[Pregnancy|pregnant]], since [[pregnancy]] may increase the [[risks]] of [[seizure]].<ref name="HardenHopp2009">{{cite journal|last1=Harden|first1=C. L.|last2=Hopp|first2=J.|last3=Ting|first3=T. Y.|last4=Pennell|first4=P. B.|last5=French|first5=J. A.|last6=Hauser|first6=W. A.|last7=Wiebe|first7=S.|last8=Gronseth|first8=G. S.|last9=Thurman|first9=D.|last10=Meador|first10=K. J.|last11=Koppel|first11=B. S.|last12=Kaplan|first12=P. W.|last13=Robinson|first13=J. N.|last14=Gidal|first14=B.|last15=Hovinga|first15=C. A.|last16=Wilner|first16=A. N.|last17=Vazquez|first17=B.|last18=Holmes|first18=L.|last19=Krumholz|first19=A.|last20=Finnell|first20=R.|last21=Le Guen|first21=C.|title=Practice Parameter update: Management issues for women with epilepsy--Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society|journal=Neurology|volume=73|issue=2|year=2009|pages=126–132|issn=0028-3878|doi=10.1212/WNL.0b013e3181a6b2f8}}</ref>
*Adjust [[dosage]] of [[antiepileptics]] such as [[phenytoin]] and [[valproic acid]] in patients with [[HIV]] taking certain [[antivirals]].<ref name="BirbeckFrench2012">{{cite journal|last1=Birbeck|first1=G. L.|last2=French|first2=J. A.|last3=Perucca|first3=E.|last4=Simpson|first4=D. M.|last5=Fraimow|first5=H.|last6=George|first6=J. M.|last7=Okulicz|first7=J. F.|last8=Clifford|first8=D. B.|last9=Hachad|first9=H.|last10=Levy|first10=R. H.|title=Evidence-based guideline: Antiepileptic drug selection for people with HIV/AIDS: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy|journal=Neurology|volume=78|issue=2|year=2012|pages=139–145|issn=0028-3878|doi=10.1212/WNL.0b013e31823efcf8}}</ref>


==Don'ts==
==Don'ts==


*The content in this section is in bullet points.
*Do not use [[cannabinoids]] in [[epilepsy]]. Although, marihuana has been suggested to decrease [[seizure]] frequency in [[epilepsy]], there is insufficient studies to support or refute its efficacy.<ref>{{cite journal|doi=10.2165/11539000-000000000-00000.}}</ref><ref name="RaichlenFoster2012">{{cite journal|last1=Raichlen|first1=D. A.|last2=Foster|first2=A. D.|last3=Gerdeman|first3=G. L.|last4=Seillier|first4=A.|last5=Giuffrida|first5=A.|title=Wired to run: exercise-induced endocannabinoid signaling in humans and cursorial mammals with implications for the 'runner's high'|journal=Journal of Experimental Biology|volume=215|issue=8|year=2012|pages=1331–1336|issn=0022-0949|doi=10.1242/jeb.063677}}</ref>


<br />
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 01:17, 25 January 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Fahimeh Shojaei, M.D., Moises Romo, M.D.

Synonyms and keywords: Epilepsy management, Epilepsy workup, Epilepsy approach, approach to Epilepsy, Epilepsy treatment

Overview

Epilepsy is a common chronic neurological disorder that is characterized by recurrent unprovoked seizures. These seizures are transient signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. Epilepsy can be diagnosed based on history, symptoms and physical examination of a patient with seizure complain. Among the patients who present with clinical signs of seizures, the EEG is the most efficient test for diagnosis. Anti-seizure medications for epilepsy include drugs that affect voltage-dependent Na+ channels, drugs that affect Ca currents, drugs that affect GABA activity, drugs that affect glutamate receptor, and drugs with multiple mechanisms of action.

Causes

Life-threatening Causes

Life-threatening causes of epilepsy include:[1][2][3][4][5][6]

Common Causes

Common causes of epilepsy may include:[7][8][9][10][11][12]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Epilepsy according the the ESC guidelines:

 
 
 
 
 
 
 
 
 
Clinical presentation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Loss of conscoiusness
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Transient?
• Rapid onset?
• Short duration?
• Spontaneous recovery?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Falls
 
Altered consciousnes
 
 
 
Yes
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Coma
 
Aborted SCD
 
Others
 
 
 
 
 
 
 
 
 
 
T-LOC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-Traumatic
 
Traumatic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Syncope
 
 
Epileptic seizure
 
 
 
Psychogenic
 
 
Rare causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Reflex syncope
• Orthostatic hypotension
• Cardiac syncope
 
 
• Tonic
• Clonic
• Tonic-clonic
• Atonic
 
 
 
• Pseudo-epileptic
• Pseudo-syncopal
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

Don'ts


References

  1. ↑ Annegers JF, Coan SP (October 2000). "The risks of epilepsy after traumatic brain injury". Seizure. 9 (7): 453–7. doi:10.1053/seiz.2000.0458. PMID 11034867.
  2. ↑ Englot DJ, Chang EF, Vecht CJ (2016). "Epilepsy and brain tumors". Handb Clin Neurol. 134: 267–85. doi:10.1016/B978-0-12-802997-8.00016-5. PMC 4803433. PMID 26948360.
  3. ↑ Faught E, Peters D, Bartolucci A, Moore L, Miller PC (August 1989). "Seizures after primary intracerebral hemorrhage". Neurology. 39 (8): 1089–93. PMID 2761703.
  4. ↑ Misra UK, Tan CT, Kalita J (August 2008). "Viral encephalitis and epilepsy". Epilepsia. 49 Suppl 6: 13–8. doi:10.1111/j.1528-1167.2008.01751.x. PMID 18754956.
  5. ↑ Sloper JJ, Johnson P, Powell TP (September 1980). "Selective degeneration of interneurons in the motor cortex of infant monkeys following controlled hypoxia: a possible cause of epilepsy". Brain Res. 198 (1): 204–9. PMID 7407585.
  6. ↑ Chung JM (May 2014). "Seizures in the acute stroke setting". Neurol. Res. 36 (5): 403–6. doi:10.1179/1743132814Y.0000000352. PMID 24641717.
  7. ↑ Diaconu G, Burlea M, Grigore I, Frasin M (2003). "[Epilepsy in different types of cerebral palsy]". Rev Med Chir Soc Med Nat Iasi (in Romanian). 107 (1): 136–9. PMID 14755984.
  8. ↑ Riggs JE (February 2002). "Neurologic manifestations of electrolyte disturbances". Neurol Clin. 20 (1): 227–39, vii. PMID 11754308.
  9. ↑ Markand ON (2003). "Lennox-Gastaut syndrome (childhood epileptic encephalopathy)". J Clin Neurophysiol. 20 (6): 426–41. PMID 14734932.
  10. ↑ Shinnar S, Glauser TA (January 2002). "Febrile seizures". J. Child Neurol. 17 Suppl 1: S44–52. doi:10.1177/08830738020170010601. PMID 11918463.
  11. ↑ Cendes F, Andermann F, Carpenter S, Zatorre RJ, Cashman NR (January 1995). "Temporal lobe epilepsy caused by domoic acid intoxication: evidence for glutamate receptor-mediated excitotoxicity in humans". Ann. Neurol. 37 (1): 123–6. doi:10.1002/ana.410370125. PMID 7818246.
  12. ↑ D'Hooge R, Pei YQ, Marescau B, De Deyn PP (October 1992). "Convulsive action and toxicity of uremic guanidino compounds: behavioral assessment and relation to brain concentration in adult mice". J. Neurol. Sci. 112 (1–2): 96–105. PMID 1469446.
  13. ↑ 13.0 13.1 Krumholz, A.; Wiebe, S.; Gronseth, G. S.; Gloss, D. S.; Sanchez, A. M.; Kabir, A. A.; Liferidge, A. T.; Martello, J. P.; Kanner, A. M.; Shinnar, S.; Hopp, J. L.; French, J. A. (2015). "Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 84 (16): 1705–1713. doi:10.1212/WNL.0000000000001487. ISSN 0028-3878.
  14. ↑ Hirtz, D.; Berg, A.; Bettis, D.; Camfield, C.; Camfield, P.; Crumrine, P.; Gaillard, W. D.; Schneider, S.; Shinnar, S. (2003). "Practice parameter: Treatment of the child with a first unprovoked seizure: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society". Neurology. 60 (2): 166–175. doi:10.1212/01.WNL.0000033622.27961.B6. ISSN 0028-3878.
  15. ↑ 15.0 15.1 Kanner, Andres M.; Ashman, Eric; Gloss, David; Harden, Cynthia; Bourgeois, Blaise; Bautista, Jocelyn F.; Abou-Khalil, Bassel; Burakgazi-Dalkilic, Evren; Llanas Park, Esmeralda; Stern, John; Hirtz, Deborah; Nespeca, Mark; Gidal, Barry; Faught, Edward; French, Jacqueline (2018). "Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy". Neurology. 91 (2): 74–81. doi:10.1212/WNL.0000000000005755. ISSN 0028-3878.
  16. ↑ Morris, G. L.; Gloss, D.; Buchhalter, J.; Mack, K. J.; Nickels, K.; Harden, C. (2013). "Evidence-based guideline update: Vagus nerve stimulation for the treatment of epilepsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology. 81 (16): 1453–1459. doi:10.1212/WNL.0b013e3182a393d1. ISSN 0028-3878.
  17. ↑ Kuba, Robert; Brázdil, Milan; Kalina, Miroslav; Procházka, Tomáš; Hovorka, Jiří; Nežádal, Tomáš; Hadač, Jan; Brožová, Klára; Sebroňová, Věra; Komárek, Vladimír; Marusič, Petr; Ošlejšková, Hana; Zárubová, Jana; Rektor, Ivan (2009). "Vagus nerve stimulation: Longitudinal follow-up of patients treated for 5 years". Seizure. 18 (4): 269–274. doi:10.1016/j.seizure.2008.10.012. ISSN 1059-1311.
  18. ↑ Harden, C. L.; Hopp, J.; Ting, T. Y.; Pennell, P. B.; French, J. A.; Hauser, W. A.; Wiebe, S.; Gronseth, G. S.; Thurman, D.; Meador, K. J.; Koppel, B. S.; Kaplan, P. W.; Robinson, J. N.; Gidal, B.; Hovinga, C. A.; Wilner, A. N.; Vazquez, B.; Holmes, L.; Krumholz, A.; Finnell, R.; Le Guen, C. (2009). "Practice Parameter update: Management issues for women with epilepsy--Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society". Neurology. 73 (2): 126–132. doi:10.1212/WNL.0b013e3181a6b2f8. ISSN 0028-3878.
  19. ↑ Birbeck, G. L.; French, J. A.; Perucca, E.; Simpson, D. M.; Fraimow, H.; George, J. M.; Okulicz, J. F.; Clifford, D. B.; Hachad, H.; Levy, R. H. (2012). "Evidence-based guideline: Antiepileptic drug selection for people with HIV/AIDS: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy". Neurology. 78 (2): 139–145. doi:10.1212/WNL.0b013e31823efcf8. ISSN 0028-3878.
  20. ↑ . doi:10.2165/11539000-000000000-00000. Check |doi= value (help). Missing or empty |title= (help)
  21. ↑ Raichlen, D. A.; Foster, A. D.; Gerdeman, G. L.; Seillier, A.; Giuffrida, A. (2012). "Wired to run: exercise-induced endocannabinoid signaling in humans and cursorial mammals with implications for the 'runner's high'". Journal of Experimental Biology. 215 (8): 1331–1336. doi:10.1242/jeb.063677. ISSN 0022-0949.


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