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Overview of evaluation and treatment guidelines for epilepsy

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Opinion statement

Choosing the most appropriate treatment for a patient with epilepsy depends on complicated and critical decisions. The number of treatment options has become large, and evidence of effectiveness for each treatment continues to expand. To address this problem, numerous guidelines have been produced by several societies and organizations. However, the guidelines do not always agree in their recommendations, mostly because of differing methods reflecting distinct purposes, but these differences are useful because they highlight both what is incontrovertible and what is unknown. Overall, the evidence needed to choose an antiepileptic drug (AED) wisely is incomplete, and no individual AED or group of AEDs is universally preferred as first-line therapy. Initial treatment should be based in part on the seizure-type diagnosis because the AEDs differ in their efficacy for various seizure types. The AEDs also differ in their safety, tolerability, and potential for pharmacologic interactions. These issues and the patient’s general medical history are additional factors to be used when selecting an AED. The failure of AEDs to completely control seizures should lead to consideration of epilepsy surgery, especially for patients with mesial temporal lobe epilepsy. However, there is no consensus regarding how many AEDs should be tried before the condition is deemed pharmacoresistant. Vagus nerve stimulation and the ketogenic diet are alternative treatments for patients with pharmacoresistant epilepsy who do not have epilepsy surgery or who have unsuccessful surgery.

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References and Recommended Reading

  1. French JA: Can evidence-based guidelines and clinical trials tell us how to treat patients? Epilepsia 2007, 48:1264–1267.

    Article  PubMed  Google Scholar 

  2. Payakachat N, Summers KH, Barbuto JP: A comparison of clinical practice guidelines in the initial pharmacological management of new-onset epilepsy in adults. J Manag Care Pharm 2006, 12:55–60.

    PubMed  Google Scholar 

  3. 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, 62:1252–1260.

    PubMed  CAS  Google Scholar 

  4. 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, 62:1261–1273.

    PubMed  CAS  Google Scholar 

  5. National Institute for Clinical Excellence: Newer drugs for epilepsy in adults. Technology appraisal 76, March 2004. http://www.nice.org.uk/nicemedia/pdf/TA076fullguidance.pdf. Accessed April 22, 2009.

  6. Scottish Intercollegiate Guidelines Network: Diagnosis and management of epilepsy in adults. A national clinical guideline. 2003 (addendum in 2005). Available at http://www.sign.ac.uk/pdf/sign70.pdf. Accessed April 22, 2009.

  7. Glauser T, Ben-Menachem E, Bourgeois B, et al.: ILAE treatment guidelines: Evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2006, 47:1094–1120.

    Article  PubMed  Google Scholar 

  8. Hirtz D, Berg A, Bettis D, et al.: 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 2003, 60:166–175.

    PubMed  CAS  Google Scholar 

  9. Practice parameter: a guideline for discontinuing antiepileptic drugs in seizure-free patients—summary statement. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1996, 47:600–602.

  10. Practice parameter: management issues for women with epilepsy (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1998, 51:944–948.

  11. Mackay MT, Weiss SK, Adams-Webber T, et al.: Practice parameter: medical treatment of infantile spasms: report of the American Academy of Neurology and the Child Neurology Society. Neurology 2004, 62:1668–1681.

    PubMed  CAS  Google Scholar 

  12. Engel J Jr, Wiebe 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, 60:538–547.

    PubMed  Google Scholar 

  13. Fisher RS, Handforth A: Reassessment: vagus nerve stimulation for epilepsy: a report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 1999, 53:666–669.

    PubMed  CAS  Google Scholar 

  14. Krumholz A, Wiebe S, Gronseth G, et al.: Practice parameter: Evaluating an apparent unprovoked first seizure in adults. Neurology 2007, 69:1996–2007.

    Article  PubMed  CAS  Google Scholar 

  15. Harden CL, Huff JS, Schwartz TH, et al.: Reassessment: Neuroimaging in the emergency patient presenting with seizure. Neurology 2007, 69:1772–1780.

    Article  PubMed  CAS  Google Scholar 

  16. Bailey EE, Pfeifer HH, Thiele EA: The use of diet in the treatment of epilepsy. Epilepsy Behav 2005, 6:4–8.

    Article  PubMed  Google Scholar 

  17. Kossoff EH: More fat and fewer seizures: dietary therapies for epilepsy. Lancet Neurol 2004, 3:415–420.

    Article  PubMed  Google Scholar 

  18. Pfeifer HH, Thiele EA: Low-glycemic-index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology 2005, 65:1810–1812.

    Article  PubMed  CAS  Google Scholar 

  19. Farhat G, Yamout B, Mikati MA, et al.: Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology 2002, 58:1348–1353.

    PubMed  CAS  Google Scholar 

  20. Pack AM, Morrell MJ: Epilepsy and bone health in adults. Epilepsy Behav 2004, 5(Suppl 2):S24–S29.

    Article  PubMed  Google Scholar 

  21. Pack A: Effects of treatment on endocrine function in patients with epilepsy. Curr Treat Options Neurol 2005, 7:273–280.

    Article  PubMed  Google Scholar 

  22. Drezner MK: Treatment of anticonvulsant drug-induced bone disease. Epilepsy Behav 2004, 5(Suppl 2):S41–S47.

    Article  PubMed  Google Scholar 

  23. Harden CL: Menopause and bone density issues for women with epilepsy. Neurology 2003, 61(Suppl 2):S16–S22.

    PubMed  Google Scholar 

  24. Assessment: generic substitution for antiepileptic medication. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 1990, 40:1641–1643.

  25. Liow K, Barkley GL, Pollard JR, et al.: Position statement on the coverage of anticonvulsant drugs for the treatment of epilepsy. Neurology 2007, 68:1249–1250.

    Article  PubMed  CAS  Google Scholar 

  26. French J, Smith M, Faught E, Brown L: Practice advisory: the use of felbamate in the treatment of patients with intractable epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 1999, 52:1540–1545.

    PubMed  CAS  Google Scholar 

  27. Patsalos PN, Berry DJ, Bourgeois BFD, et al.: Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring. Epilepsia 2008, 49:1239–1276.

    Article  PubMed  CAS  Google Scholar 

  28. Meierkord H, Boon P, Engelsen B, et al.: EFNS guideline on the management of status epilepticus. Eur J Neurol 2006, 13:445–450.

    Article  PubMed  CAS  Google Scholar 

  29. Kwan P, Brodie MJ: Early identification of refractory epilepsy. N Engl J Med 2000, 342:314–319.

    Article  PubMed  CAS  Google Scholar 

  30. Mirski MA, Rossell LA, Terry JB, Fisher RS: Anticonvulsant effect of anterior thalamic high frequency electrical stimulation in the rat. Epilepsy Res 1997, 28:89–100.

    Article  PubMed  CAS  Google Scholar 

  31. Kerrigan JF, Litt B, Fisher RS, et al.: Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy. Epilepsia 2004, 45:346–354.

    Article  PubMed  Google Scholar 

  32. Kossoff EH, Ritzl EK, Politsky JM, et al.: Effect of an external responsive neurostimulator on seizures and electrographic discharges during subdural electrode monitoring. Epilepsia 2004, 45:1560–1567.

    Article  PubMed  Google Scholar 

  33. Riviello JJ, Ashwal S, Hirtz D, et al.: Practice parameter: Diagnostic assessment of the child with status epilepticus. Neurology 2006, 67:1542–1550.

    Article  PubMed  Google Scholar 

  34. 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 Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009 Apr 27 (Epub ahead of print).

  35. Harden CL, Hopp J, Ting TY, et al.: 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 2009 Apr 27 (Epub ahead of print).

  36. Harden CL, Pennell PB, Koppel BS, et al.: Practice Parameter update: Management issues for women with epilepsy—focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009 Apr 27 (Epub ahead of print).

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  1. Department of Neurology, Geffen School of Medicine at UCLA, 710 Westwood Plaza, Suite 1250, Los Angeles, CA, 90095, USA

    John M. Stern

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  1. John M. Stern
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Correspondence to John M. Stern.

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Stern, J.M. Overview of evaluation and treatment guidelines for epilepsy. Curr Treat Options Neurol 11, 273–284 (2009). https://doi.org/10.1007/s11940-009-0031-7

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