Semin Neurol 2003; 23(3): 285-294
DOI: 10.1055/s-2003-814736
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Questions for the Consultant: Seizures and Epilepsy

Joseph I. Sirven1 , Richard S. Zimmerman2
  • 1Department of Neurology, Mayo Clinic, Scottsdale, Arizona
  • 2Department of Neurosurgery, Mayo Clinic, Scottsdale, Arizona
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Publikationsverlauf

Publikationsdatum:
14. Januar 2004 (online)

ABSTRACT

Issues regarding management of acute and chronic seizures constitute one of the more frequent consultations that all neurologists encounter. With a significant medical and surgical therapeutic armamentarium now available, many clinicians are perplexed about how to approach the most basic of seizure consultation questions. In this article, four of the most commonly asked seizure consultation questions are reviewed: when antiepileptic drug (AED) treatment should be initiated; how to choose an AED; when to refer a patient for surgery; and when to withdraw AEDs in a seizure-free patient. By utilizing frequently encountered clinical scenarios, the decision-making process to best illustrate application of existing clinical evidence to the individual patient is explored.

REFERENCES

  • 1 Hauser W A, Hesdorffer D C. Epilepsy: Frequency, Causes, and Consequences.  New York: Demos; 1990
  • 2 Camfield P R, Camfield C S, Dooley J M. et al . Epilepsy after a first unprovoked seizure in childhood.  Neurology . 1985;  35 1657-1660
  • 3 Hopkins A, Garman A, Clarke C. The first seizure in adult life: value of clinical features, electroencephalography, and computerized tomographic scanning in prediction of seizure recurrence.  Lancet . 1988;  1 21-26
  • 4 Berg A T, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review.  Neurology . 1991;  41 965-972
  • 5 Shinnar S, Berg A T, Moshe S L. et al . Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study.  Pediatrics . 1990;  85 1076-1085
  • 6 Annegers J F, Shirts S B, Hauser W A. et al . Risk of recurrence after an initial unprovoked seizure.  Epilepsia . 1986;  27 43-50
  • 7 Shinnar S, Berg A T, Moshe S L. et al . The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up.  Pediatrics . 1996;  98 216-225
  • 8 Beghi E, Berg A, Hauser W. Treatment of single seizures. In: Engel J, Pedley T, eds. Epilepsy: A Comprehensive Textbook Philadelphia: Lippincott Williams & Wilkins 1998: 1285-1294
  • 9 Gilad R, Lampl Y, Gabbay U. et al . Early treatment of a single generalized tonic-clonic seizure to prevent recurrence.  Arch Neurol . 1996;  53 1149-1152
  • 10 First Seizure Trial Group. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure.  Neurology . 1993;  43 478-483
  • 11 Camfield P R, Camfield C S, Dooley J S. et al . A randomized study of carbamazepine versus no medication after a first unprovoked seizure in childhood.  Neurology . 1989;  39 851-852
  • 12 Mattson R H, Cramer J A, Collins J F. et al . Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondary generalized tonic-clonic seizures.  N Engl J Med . 1985;  313 145-151
  • 13 Department of Veterans Affairs Epilepsy Cooperative Study Number 264 Group. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults.  N Engl J Med . 1992;  327 765-771
  • 14 Theodore W H, Porter R J. Epilepsy: 100 Elementary Principles 3rd ed.   Philadelphia: WB Saunders 1995
  • 15 Sirven J. Acute and chronic seizures in the older adult.  Mayo Clin Proc . 2001;  76 175-183
  • 16 Cramer J A, Fisher R, Ben-Menachem E. et al . New antiepileptic drugs: a comparison of key clinical trials.  Epilepsia . 1999;  40 590-600
  • 17 Engel Jr J. Surgery for seizures.  N Engl J Med . 1996;  334 647-652
  • 18 Lamoureux D, Spencer S S. Epilepsy surgery in adults.  Curr Opin Neurol . 1995;  8 107-111
  • 19 Silfvenius H. Latest advances in epilepsy surgery.  Acta Neurol Scand Suppl . 1995;  162 11-16
  • 20 Sperling M R, O'Connor M J, Saykin A J. et al . Temporal lobectomy for refractory epilepsy.  JAMA . 1996;  276 470-475
  • 21 Sperling M R, Shewmon D A. General principles for presurgical evaluation. In: Engel J, Pedley T, eds. Epilepsy, a Comprehensive Textbook New York: Lippincott Williams & Wilkins 1998: 1697-1705
  • 22 Kwan P, Brodie M J. Early identification of refractory epilepsy.  N Engl J Med . 2000;  432 314-319
  • 23 Dlugos D J, Samuel M D, Strom B L, Farrar J T. Response to first drug trial predicts outcome in childhood temporal lobe epilepsy.  Neurology . 2001;  57 2259-2264
  • 24 Wiebe S, Blume W T, Girvin J P. et al . Effectiveness of Surgery for Temporal Lobe Epilepsy Study Group. A randomized controlled trial of surgery for temporal-lobe epilepsy.  N Engl J Med . 2001;  345 311-318
  • 25 Sperling M R, Saykin A J, Roberts D, French J A, O'Connor M J. Occupational outcome after temporal lobectomy for refractory epilepsy.  Neurology . 1995;  45 970-977
  • 26 Berg A T, Vickrey B G, Sperling M R. et al . Driving in adults with refractory localization-related epilepsy. Multi-center study of epilepsy surgery.  Neurology . 2000;  54 625-630
  • 27 Reeves A L, So E, Evans R W. et al . Factors associated with work outcome after anterior temporal lobectomy for intractable epilepsy.  Epilepsia . 1997;  38 689-695
  • 28 Carran M A, Kohler C G, O'Connor M J, Cloud B, Sperling M R. Marital status after epilepsy surgery.  Epilepsia . 1999;  40 1755-1760
  • 29 Sperling M R, Feldman H, Kinman J, Liporace J D, O'Connor M J. Seizure control and mortality in epilepsy.  Ann Neurol . 1999;  46 45-50
  • 30 Pilcher W H, Roberts D W, Flannigan H F. et al .Complications of epilepsy surgery. In: Engel J Jr, ed. Surgical Treatment of the Epilepsies 2nd ed. New York: Raven Press 1993: 565-581
  • 31 Guldvog B, Loyning Y, Hangle-Hanssen E. et al . Surgical versus medical treatment for epilepsy I. Outcome related to survival, seizures, and neurological deficit.  Epilepsia . 1991;  32 375-388
  • 32 Medical Research Council Antiepileptic Drug Withdrawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission.  Lancet . 1991;  337 1175-1180
  • 33 Callaghan N, Garrett A, Goggin T. Withdrawal of anticonvulsant drugs in patients free of seizures for two years. A prospective study.  N Engl J Med . 1988;  318 942-946
  • 34 Overweg J, Binnie C D, Oosting J, Rowan A J. Clinical and EEG prediction of seizure recurrence following antiepileptic drug withdrawal.  Epilepsy Res . 1987;  1 272-283
  • 35 Tinuper P, Avoni P, Riva R, Provini F, Lugaresi E, Baruzzi A. The prognostic value of the EEG in antiepileptic drug withdrawal in partial epilepsy.  Neurology . 1996;  47 76-78
  • 36 Uesiga H, Kojima T, Miyasaka M, Matsuura M, Ohtaka T, Moriiwa M. Discontinuation of antiepileptic drug treatment in controlled seizure patients.  J Epilepsy . 1994;  7 178-188
  • 37 Sirven J, Sperling M, Wingerchuk D. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission.  Cochrane Database Syst Rev . 2001;  4
  • 38 Chadwick D, Taylor J, Johnson T. Outcomes after seizure recurrence in people with well-controlled epilepsy and the factors that influence it. The MRC Antiepileptic Drug Withdrawal Group.  Epilepsia . 1996;  37 1043-1050
  • 39 Quality Standards Subcommittee of the American Academy of Neurology. Practice parameters; a guideline for discontinuing antiepileptic drugs in seizure-free patients.  Neurology . 1996;  47 600-602
  • 40 Berg A T, Shinnar S. Relapse following discontinuation of antiepileptic drugs: a meta analysis.  Neurology . 1994;  44 601-608
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