Current Treatment Options in Neurology

, Volume 14, Issue 4, pp 356–368

Antiepileptic Drug Selection for Partial-Onset Seizures

EPILEPSY (E WATERHOUSE, SECTION EDITOR)

Opinion statement

Effective treatment of seizures resulting from epilepsy relies on several basic principles, regardless of which drug or treatment is selected. Treatment starts with a confident diagnosis that the symptoms are, indeed, seizure. The seizure type should be classified as focal in onset or primary generalized, and there should be a relentless search for the etiology. Many antiepileptic drugs (AEDs) are available to treat partial-onset seizures. Given that the efficacy of AEDs is comparable, selection of the appropriate drug is mostly determined by whether any comorbidities are present, such as migraine, obesity, depression, or chronic pain. In the absence of comorbidities, it depends on the side effect profile, cost, and convenience. Most AEDs, with a few exceptions, must be increased to a maximum tolerated dose before a second drug should be added. Most patients can become seizure free or adequately controlled if continued interventions are considered at each encounter until patients are seizure free.

Keywords

Antiepileptic drugs AEDs Seizures Selection Partial onset Pharmacologic Epilepsy Seizure disorder Focal seizures Treatment Diet Surgery Vagus nerve stimulation Deep brain stimulation Responsive neurostimulation 

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clin Proc. 1996;71:578–86.CrossRefGoogle Scholar
  2. 2.
    Dreifuss FE, Bancaud J, Henriksen O, Rubio-Donnadieu F, Seino M, Penry JK. Proposal for the revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489–501.CrossRefGoogle Scholar
  3. 3.
    Commission of Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 1989;30:389–99.CrossRefGoogle Scholar
  4. 4.
    Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies. Epilepsia. 2010;51:676–85.Google Scholar
  5. 5.
    Lee PR, Kossoff EH. Dietary treatments for epilepsy: management guidelines for the general practitioner. Epilepsy Behav. 2011;21(2):115–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics. 2000;105(4):E46.PubMedCrossRefGoogle Scholar
  7. 7.
    Frucht M, Quigg M, Schwaner C, Fountain N. Distribution of seizure precipitants among epilepsy syndromes. Epilepsia. 2000;41:1534–9.PubMedCrossRefGoogle Scholar
  8. 8.
    NIH Conference. “Curing Epilepsy: Hope for the Future.” Web address: http://www.ninds.nih.gov/news_and_events/conference_curing_epilepsy_summary.htm.
  9. 9.
    Fountain NB. Choosing Among Antiepileptic Drugs. Continuum: Lifelong Learning in Neurology. 2010;16(3):121–35.Google Scholar
  10. 10.
    French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new onset epilepsy: Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004;62:1252–60.PubMedCrossRefGoogle Scholar
  11. 11.
    French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy: Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004;62:1261–73.PubMedCrossRefGoogle Scholar
  12. 12.
    Harden CL, Meador KJ, Pennell PB, et al. Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:133–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Fisher RS, Handforth A. Reassessment: Vagus nerve stimulation for epilepsy: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 1999;53:666–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Engel J, Wiebe Jr S, French J, et al. Practice parameter: Temporal lobe and localized neocortical resections for epilepsy: Report of the Quality Standards Subcommittee of the American Academy of Neurology, in Association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology. 2003;60:538–47.PubMedCrossRefGoogle Scholar
  15. 15.
    Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Labiner DM, Bagic AI, Herman ST, Fountain NB, Walczak TS, Gumnit RJ, National Association of Epilepsy Centers. Essential services, personnel, and facilities in specialized epilepsy centers-Revised 2010 guidelines. Epilepsia. 2010;51:2322–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Fountain NB, Van Ness PC, Swain-Eng R, Tonn S, Bever Jr CT. For the American Academy of Neurology Epilepsy Measure Development Panel and the American Medical Association–Convened Physician Consortium for Performance Improvement Independent Measure Development Process. Quality improvement in neurology: AAN epilepsy quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology. 2011;76(1):94–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized controlled trial of surgery for temporal lobe epilepsy. N Engl J Med. 2001;345:311–8.PubMedCrossRefGoogle Scholar
  19. 19.••
    Engel J Jr, et al. Early randomized surgery for epilepsy trial (ERSET). JAMA 2012;307(9):922–930.PubMedCrossRefGoogle Scholar
  20. 20.
    Morrell MJ, RNS System in Epilepsy Study Group. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011;77(13):1295–304.PubMedCrossRefGoogle Scholar
  21. 21.
    Fisher R, SANTE Study Group. Electrical Stimulation of the Anterior Nucleus of Thalamus for Treatment of Refractory Epilepsy. Epilepsia. 2010;51(5):899–908.PubMedCrossRefGoogle Scholar
  22. 22.
    French JA, Wang S, Warnock B, Temkin N. Historical control monotherapy design in the treatment of epilepsy. Epilepsia. 2010;51:1936–43.PubMedCrossRefGoogle Scholar
  23. 23.
    French JA, Temkin NR, Shneker BF, Hammer AE, Caldwell PT, Messenheimer JA. Lamotrigine XR conversion to monotherapy: first study using a historical control group. Neurotherapeutics. 2012;9(1):176–84.PubMedCrossRefGoogle Scholar
  24. 24.
    Fountain NB. Manual of Antiepileptic Drug Therapy. West Islip: Professional Publications, Inc; 2010.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Ohio State UniversityColumbusUSA
  2. 2.Comprehensive Epilepsy Program, Department of NeurologyUniversity of VirginiaCharlottesvilleUSA

Personalised recommendations