Current Neurology and Neuroscience Reports

, Volume 3, Issue 4, pp 349–356

The current treatment of epilepsy: A challenge of choices

  • Joseph I. Sirven


There are now several distinct choices for seizure and epilepsy treatment. These include 16 antiepileptic medications, surgery, vagus nerve stimulation, and ketogenic diet. However, not every option is appropriate for all individuals with epilepsy. This article reviews the commonly employed treatments for chronic seizures, with the goal of trying to assess when certain treatments should be considered. An approach to seizure management is presented to help navigate the challenge of epilepsy treatment choices.


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References and Recommended Reading

  1. 1.
    Hauser WA, Annegers JF, Kurland LT: Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993, 34:453–468.PubMedCrossRefGoogle Scholar
  2. 2.
    Hauser WA, Hesdorffer DC: Epilepsy: Frequency, Causes and Consequences. New York: Demos; 1990.Google Scholar
  3. 3.
    Kirby S, Sadler RM: Injury and death as a result of seizures. Epilepsia 1995; 36:25–28.PubMedCrossRefGoogle Scholar
  4. 4.
    Nashef L, Fish DR, Garner S, et al.: Sudden death in epilepsy: a study of incidence in a young cohort with epilepsy and learning difficulty. Epilepsia 1995, 36:1187–1194.PubMedCrossRefGoogle Scholar
  5. 5.
    Gowers WR: Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms & Treatment. New York: William Wood & Co; 1885.Google Scholar
  6. 6.
    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.PubMedGoogle Scholar
  7. 7.
    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(3Pt 1):478–483.Google Scholar
  8. 8.
    Mattson RH, Cramer JA, Collins JF, 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.PubMedCrossRefGoogle Scholar
  9. 9.
    Department of Veterans Affairs Epilepsy Cooperative Study No.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.CrossRefGoogle Scholar
  10. 10.
    Theodore WH, Porter RJ: Epilepsy: 100 Elementary Principles, edn 3. Philadelphia: WB Saunders; 1995.Google Scholar
  11. 11.
    Sirven J: Acute and chronic seizures in the older adult. Mayo Clin Proc 2001, 76:175–183.PubMedCrossRefGoogle Scholar
  12. 12.
    Clinical update: felbatol (felbamate). Wallace Laboratories, 1995.Google Scholar
  13. 13.
    Ben-Menachem E: Expanding antiepileptic drug options: clinical efficacy of new therapeutic agents. Epilepsia 1996, 37(suppl 2):S4-S7.PubMedGoogle Scholar
  14. 14.
    Cramer JA, Fisher R, Ben-Menachem E, et al.: New antiepileptic drugs: a comparison of key clinical trials. Epilepsia 1999, 40:590–600.PubMedCrossRefGoogle Scholar
  15. 15.
    Mattson RH, Cramer JA, Collins JF, et al.: Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med 1985, 313:145–151.PubMedCrossRefGoogle Scholar
  16. 16.
    Engel J Jr: Surgery for seizures. N Engl J Med 1996, 334:647–652.PubMedCrossRefGoogle Scholar
  17. 17.
    Lamoureux D, Spencer SS: Epilepsy surgery in adults. Curr Opin Neurol 1995, 8:107–111.PubMedCrossRefGoogle Scholar
  18. 18.
    Silfvenius H: Latest advances in epilepsy surgery. Acta Neurol Scand 1995, 162(suppl):11–16.Google Scholar
  19. 19.
    Sperling MR, O’Connor MJ, Saykin AJ, et al.: Temporal lobectomy for refractory epilepsy. JAMA 1996, 276:470–475.PubMedCrossRefGoogle Scholar
  20. 20.
    Kwan P, Brodie MJ: Early identification of refractory epilepsy. N Engl J Med 2000, 432:314–319.An important study that begins to clinically define what constitutes medical intractability and predicts which individuals may benefit from early aggressive intervention.CrossRefGoogle Scholar
  21. 21.
    Dlugos DJ, Samuel MD, Strom BL, Farrar JT: Response to first drug trial predicts outcome in childhood temporal lobe epilepsy. Neurology 2001, 57:2259–2264.An important study that begins to identify medical intractability in pediatric epilepsy patients.PubMedGoogle Scholar
  22. 22.
    Sperling MR, Shewmon DA: General principles for presurgical evaluation. In Epilepsy, A Comprehensive Textbook. Edited by Engel J, Pedley T. New York: Lippincott, Williams & Wilkins; 1998:1697–1705.Google Scholar
  23. 23.
    Wiebe S, Blume WT, Girvin JP, et al.: Effectiveness of surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy [see comments]. N Engl J Med 2001, 345:311–318.A landmark study in which refractory epilepsy patients were randomized to surgery or medication, demonstrating the superiority of surgery.PubMedCrossRefGoogle Scholar
  24. 24.
    Baumgartner JE, Clifton GC, Wheless JW, et al.: Corpus callosotomy. Technique Neurosurg 1995, 1:45–51.Google Scholar
  25. 25.
    Sperling MR, Saykin AJ, Roberts D, et al.: Occupational outcome after temporal lobectomy for refractory epilepsy. Neurology 1995, 45:970–977.PubMedGoogle Scholar
  26. 26.
    Berg AT, Vickrey BG, Sperling MR, et al.: Driving in adults with refractory localization-related epilepsy. Multi-center study of epilepsy surgery. Neurology 2000, 54:625–630.This study is a prospective, long-term outcome from epilepsy surgery demonstrating the important quality of life outcomes that can result from successful epilepsy surgery.PubMedGoogle Scholar
  27. 27.
    Reeves AL, So E, Evans RW, et al.: Factors associated with work outcome after anterior temporal lobectomy for intractable epilepsy. Epilepsia 1997, 38:689–695.PubMedCrossRefGoogle Scholar
  28. 28.
    Carran MA, Kohler CG, O’Connor MJ, et al.: Marital status after epilepsy surgery. Epilepsia 1999, 40:1755–1760.PubMedCrossRefGoogle Scholar
  29. 29.
    Sperling MR, Feldman H, Kinman J, et al.: Seizure control and mortality in epilepsy. Ann Neurol 1999, 46:45–50.PubMedCrossRefGoogle Scholar
  30. 30.
    Pilcher WH, Roberts DW, Flannigan HF, et al.: Complications of epilepsy surgery. In Surgical Treatment of the Epilepsies, edn 2.Edited by Engel J Jr. New York: Raven Press; 1993:565–581.Google Scholar
  31. 31.
    Guldvog B, Loyning Y, Hauglie-Hanssen E, Flood S, et al.: Surgical versus medical treatment for epilepsy I. Outcome related to survival, seizures, and neurological deficit. Epilepsia 1991, 32:375–388.PubMedGoogle Scholar
  32. 32.
    Vagus Nerve Stimulation Study Group: A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. Neurology 1995, 45:224–230.Google Scholar
  33. 33.
    Handforth A, DeGiorgio CM, Schachter SC, et al.: Vagus nerve stimulation therapy for partial onset seizures: a randomized active control trial. Neurology 1995, 45:224–230.Google Scholar
  34. 34.
    DeGiorgio CM, Schachter SC, Handforth A, et al.: Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 2000, 41:1195–1200.CrossRefGoogle Scholar
  35. 35.
    Morris GL, Mueller WM: Vagus Nerve Stimulation Study Group EO1-EO5. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. Neurology 1999, 53:1731–1735.PubMedGoogle Scholar
  36. 36.
    Sirven J, Sperling M, Naritoku D, et al.: VNS therapy for epilepsy in older adults. Neurology 2000, 54:1179–1182.PubMedGoogle Scholar
  37. 37.
    Freeman JM, Vining EP, Pillas DJ, et al.: Ketogenic Diet-1998: a prospective evaluation of Intervention in 150 Children. Pediatrics 1998, 102:1358–1363.PubMedCrossRefGoogle Scholar
  38. 38.
    Vining EP, Freeman JM, Balaban GK, et al.: A multicenter study of the efficacy of the ketogenic diet. Arch Neurol 1998, 55:1433–1437.PubMedCrossRefGoogle Scholar
  39. 39.
    Sirven J, Whedon B, Caplan D, et al.: The ketogenic diet for intractable epilepsy in adults: preliminary results. Epilepsia 1999, 40:1721–1726.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Joseph I. Sirven
    • 1
  1. 1.Department of NeurologyMayo Clinic HospitalPhoenixUSA

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