The management of patients with epilepsy is focused on three main goals: controlling seizures, avoiding treatment side effects, and maintaining or restoring quality of life. Physicians should assist in empowering patients with epilepsy to lead lifestyles consistent with their capabilities [1,2].
The optimal treatment plan is derived following an accurate diagnosis of the patient's seizure type(s), an objective measure of the intensity and frequency of the seizures, awareness of medication side effects, and an evaluation of disease-related psychosocial problems. A working knowledge of available antiepileptic drugs (AEDs), including their mechanisms of action, pharmacokinetics, drug-drug interactions, and adverse effects is essential.
It is usually appropriate to refer the patient to a neurologist, when establishing a diagnosis and formulating a course of treatment. Referral to an epilepsy specialist may be necessary if there is doubt about the diagnosis and/or if the patient continues to have seizures.
The overall approach to management of a patient with seizures is reviewed here. Evaluation of the patient who has had a first seizure and the pharmacology of specific AEDs are discussed separately. (See "Evaluation of the first seizure in adults" and "Initial treatment of epilepsy in adults" and "Overview of antiepileptic drugs".)
The first step in designing a treatment plan is to classify the patient's seizure type(s) using the framework of the International League Against Epilepsy (table 1) [3,4]. Seizure types and epilepsy syndromes are classified primarily upon clinical grounds, assisted by laboratory, neurophysiologic, and radiographic studies. Seizure type has important implications in the choice of antiepileptic drugs (AEDs). Accurate classification requires a full history from the patient and reports from observers who have witnessed actual seizures.