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Diagnosis and Treatment of Partial Seizures

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Abstract

Partial seizures are manifestations of abnormal epileptic firing of brain cells in a localised area or areas of the brain. The diagnosis of partial seizures entails initially an electroencephalogram (EEG), a detailed history from the patient and eyewitnesses, as well as computer tomographic (CT) or preferably magnetic resonance imaging (MRI) scans. Video EEG to record ictal events may be necessary to establish the correct diagnosis.

Partial seizures are classified according to the International Classification of Epileptic Seizures and International Classification of Epilepsies and Epilepsy Syndromes. It is important to try to decide how the seizure event fits into this system in order to successfully evaluate and optimise treatment as well as to give detailed information to the patient about their seizures and prognosis.

Once the decision to treat seizures has been made, the physician must choose which is the most appropriate medication to begin with. Often carbamazepine or valproic acid (sodium valproate) are rated as first-line drugs, but factors such as adverse effect profiles, age, possibility of pregnancy, concomitant diseases and medication also need to be considered. Most of the newer anticonvulsants appear to have good efficacy and fewer adverse effects than their older counterparts, but the higher costs may inhibit their wider use, especially in poorer countries.

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References

  1. Lennox WG. The petit mal epilepsies: their treatment with tridone. JAMA 1945; 129: 1069–74

    Article  CAS  Google Scholar 

  2. Commission on Classification and Terminology of the International League Against Epilepsy: proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981; 22: 489-501

    Google Scholar 

  3. Commission on Classification and Terminology of the International League Against Epilepsy: proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30: 389-99

    Google Scholar 

  4. Sander T. The genetics of idiopathic generalized epilepsy: implications for the understanding of its aetiology. Mol Med Today 1996; 2: 173–80

    Article  PubMed  CAS  Google Scholar 

  5. Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940–1980. Epilepsia 1991; 32:429–45

    Article  PubMed  CAS  Google Scholar 

  6. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993; 34: 453–68

    Article  PubMed  CAS  Google Scholar 

  7. Rowan AT, Gates JR. Non-epileptic seizures. Stoneham: Butterworth-Heinemann, 1993

    Google Scholar 

  8. Niedermeyer ED. Electroencephalography and the diagnosis of epilepsy. In: Fisher RS, editor. Imitators of epilepsy. New York: Demos Publ., 1994: 227–80

    Google Scholar 

  9. Musicco M, Beghi E, Solari A, et al. Treatment of first tonic-clonic seizure does not improve the prognosis of epilepsy. Neurology 1997; 49: 991–8

    Article  PubMed  CAS  Google Scholar 

  10. Shinnar S, Berg AT, Moshe SL, et al. Risk of seizure recurrence following a first unprovoked seizure in childhood. Paediatrics 1990; 85: 1076–85

    CAS  Google Scholar 

  11. Medical Product Agency, Sweden. Behandling av epilepsi: rekommendationer. (Treatment of epilepsy: recommendations). Info från Läkemedelsverket 1997; 4: 13–41

    Google Scholar 

  12. 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: 145–51

    Article  PubMed  CAS  Google Scholar 

  13. Marson AG, Kadir ZA, Chadwick DW. New antiepileptic drugs: a systematic review of their efficacy and tolerability. BMJ 1966; 313(7066): 1169–74

    Article  Google Scholar 

  14. Delgado-Escueta AV, Enrile-Bacsal F. Juvenile-myoclonic epilepsy of Janz. Neurology 1984; 34: 285–94

    Article  PubMed  CAS  Google Scholar 

  15. Chadwick D, Taylor J, Johnson T, et al. Drug Withdrawal Group. Outcomes after seizure recurrence in people with well controlled epilepsy and the factors that influence it. Epilepsia 1996; 37; 1043–50

    Article  PubMed  CAS  Google Scholar 

  16. Johannessen SI. Plasma drug concentration monitoring of anti-convulsants. CNS Drugs 1997; 7(5): 349–65

    Article  CAS  Google Scholar 

  17. Liporace JD, Sperling MR, Dichter MA. Absence seizures and carbamazepine in adults. Epilepsia 1994; 35: 1026–102

    Article  PubMed  CAS  Google Scholar 

  18. McLean MK, Macdonald RL. Carbamazepine and 10,11-epoxycarbamazepine produce use-and voltage-dependent limitation of rapid firing of action potentials of mouse central neurons in cell culture. J Pharmacol Exp Ther 1986; 238: 727–38

    PubMed  CAS  Google Scholar 

  19. Holmes GL. Carbamazepine: toxicity. In: Levy RH, Mattson RH, Meldrum BS, editors. Antiepileptic drugs. 4th ed. New York: Raven Press, 1995: 567–79

    Google Scholar 

  20. Johannessen SI. Pharmacokinetics of antiepileptic drugs and their clinical significance. Behav Neurol 1990; 3 Suppl. 1: 1–11

    Google Scholar 

  21. Battino D, Estienne M, Avanzini G. Clinical pharmacokinetics of antiepileptic drugs in paediatric patients. Pt II. Phenytoin, carbamazepine, sulthiame, lamotrigine, vigabatrin, oxcarbazepine and felbamate. Clin Pharmacokinet 1995; 29: 241–369

    Google Scholar 

  22. Brodie MJ, Dichter MA. Antiepileptic drugs. N Engl J Med 1996; 334: 168–75

    Article  PubMed  CAS  Google Scholar 

  23. Seltzer ME. The action of phenytoin on a composite electrical-chemical synapse in the lamprey spinal chord. Ann Neurol 1978; 3: 202–6

    Article  Google Scholar 

  24. Bruni J, Wilder BJ. The toxicology of antiepileptic drugs. In: Viken PJ, Bruyn G, editors. Handbook of clinical neurology. Vol 37. Intoxications of the nervous system. Pt 20. New York: North-Holland Publishing Co., 1979: 199–222

    Google Scholar 

  25. Mattson RH, Cramer JA, Collins JF, et al. A comparison of valproate with carbamazepine for complex partial seizures and secondarily generalized tonic-clonic seizures in adults. N Engl J Med 1992; 327: 765–71

    Article  PubMed  CAS  Google Scholar 

  26. McLean MK, Macdonald RL. Sodium valproate, but not ethosuximide, produces use-and voltage-dependent limitation of high-frequency repetitive firing of action potentials of mouse central neurons in cell culture. J Pharmacol Exp Ther 1986; 237: 1001–11

    PubMed  CAS  Google Scholar 

  27. Wilder BJ, Ramsay RE, Murphy JV, et al. Comparison of valproic acid and phenytoin in newly diagnosed tonic-clonic seizures. Neurology 1983; 33(11): 1474–6

    Article  PubMed  CAS  Google Scholar 

  28. Jeavons PM. Non-dose-related side effects of valproate. Epilepsia 1984; 25 Suppl. 1: 18S–23S

    Google Scholar 

  29. Dreifuss FE, Langer DH, Moline KA, et al. Valproic acid hepatic fatalities II: US experience since 1984. Neurology 1988; 33: 201–7

    Google Scholar 

  30. Battino D, Estienne M, Avanzini G. Clinical pharmacokinetics of antiepileptic drugs in paediatric patients. Pt 1. Phenobarbital, primidone, valproic acid, ethosuximide, and mesuximide. Clin Pharmacokinet 1995; 29: 257–86

    Article  PubMed  CAS  Google Scholar 

  31. Twyman RE, Rogers CJ, Macdonald RL. Differential regulation of gamma aminobutyric acid receptor channels by diazepam and phenobarbital. Ann Neurol 1989; 25: 213–20

    Article  PubMed  CAS  Google Scholar 

  32. Gallagher BB, Baumel IP, Mattson RH, et al. Primidone, diphenylhydantoin and phenobarbital: aspects of acute and chronic toxicity. Neurology 1973; 23: 145–9

    Article  PubMed  CAS  Google Scholar 

  33. Robertson MM. Current states of the 1,4 and 1,5 benzodiazepines in the treatment of epilepsy: the place of clobazam. Epilepsia 1986; 27 Suppl. 1: 27S–41S

    Article  Google Scholar 

  34. Trimble MR. Clobazam. In: Resor SRJ, Kutt H, editors. The medical treatment of epilepsy. New York: Marcel Dekker, Inc., 1992: 319–28

    Google Scholar 

  35. Koeppen DA. A review of clobazam studies in epilepsy. In: Hindmarch I, Stonier PD, Trimble MR, editors. Clobazam - Royal Society of Medicine International Congress Symposium Series No. 74. Lond R Soc Med 1985; 149-53

  36. Wolf P. Clobazam in drug-resistant patients with complex focal seizures — report of an open study. In: Hindmarch I, Stonier PD, Trimble MR, editors. International Congress and Symposium Series No. 74. Lond R Soc Med 1985; 167-71

  37. Dam M, Ekberg R, Loyning Y, et al. A double-blind study comparing oxcarbazepine and carbamazepine in patients with newly diagnosed, previously untreated epilepsy. Epilepsy Res 1989; 3: 70–6

    Article  PubMed  CAS  Google Scholar 

  38. Schmutz M, Brugger F, Gentsch C, et al. Oxcarbazepine: pre-clinical anticonvulsant profile and putative mechanisms of action. Epilesia 1994; 35 Suppl. 5: 47S–50S

    Article  Google Scholar 

  39. Friis ML, Kristensen O, Boas J, et al. Therapeutic experience with 947 epileptic out-patients in oxcarbazepine treatment. Acta Neurol Scand 1993; 87: 224–7

    Article  PubMed  CAS  Google Scholar 

  40. Lloyd P, Flesch G, Dieterie W. Clinical pharmacology and pharmacokinetics of oxcarbazepine. Epilepsia 1994; 35 Suppl 3: 10S–13S

    Article  Google Scholar 

  41. Baruzzi A, Albani F, Riva R. Oxcarbazepine: pharmacokinetic interactions and their clinical relevance. Epilepsia 1994; 35 Suppl. 3: 9S–14S

    Google Scholar 

  42. Seino M, Naruto S, Ito T, et al. Other antiepileptic drugs; Zonisamide. In: Levy RH, Mattson RH, Meldrum BS, editors. Antiepileptic drugs. New York: Raven Press, 1995: 1011–23

    Google Scholar 

  43. Leppik IE. Antiepileptic drugs in development: prospects for the near future. Epilesia 1994; 35 Suppl. 4: 29S–40S

    Article  Google Scholar 

  44. Ito T, Yamaguchi T, Miyazaki H, et al. Pharmacokinetic studies of AD-810, a new antiepileptic compound: phase I trials. Arzneimittelforschung 1982; 32: 1581–6

    PubMed  CAS  Google Scholar 

  45. Sackellares JC, Donofrio PD, Wagner JG, et al. Pilot study of ZNS (1,2-benzisoxazole-3 methanesulfonamide) in patients with refractory partial seizures. Epilesia 1985; 26: 206–11

    Article  CAS  Google Scholar 

  46. Mumford JP, Lewis PJ. Vigabatrin. In: Pisani F, Perucca E, Avanzini G, et al., editors. New antiepileptic drugs. Epilepsy Res 1991; Suppl. 3: 161-8

  47. Tartara A, Manni R, Galimberti CA, et al. Vigabatrin in the treatment of epilepsy: a double-blind placebo-controlled study. Epilesia 1986; 27: 717–23

    Article  CAS  Google Scholar 

  48. Ramsay RE, Slater JD. Antiepileptic drugs in clinical development. In: French JA, Dichter MA, Leppik IE, editors. New antiepileptic drug development, preclinical and clinical aspects. Epilepsy Res 1993; Suppl. 10: 45-67

  49. Schechter PJ. Clinical pharmacology of vigabatrin. Br J Clin Pharmacol 1989; 27: 19S–22S

    Article  PubMed  CAS  Google Scholar 

  50. Rimmer EM, Richens A. Interaction between vigabatrin and phenytoin. Br J Clin Pharmacol 1989; 27: 27S–33S

    Article  PubMed  Google Scholar 

  51. McKee PJW, Brodie MJ. Lamotrigine. In: Shorvon S, Dreifuss F, Fish D, et al., editors. The treatment of epilepsy. Oxford: Blackwell Science; 1996: 438–45

    Google Scholar 

  52. Yuen AWC. Lamotrigine. In: Pisani F, Perucca E, Avanzini G, et al., editors. New antiepileptic drugs. Epilepsy Res 1991; Suppl. 3: 115-23

  53. Brodie MJ. Lamotrigine. Lancet 1992; 339: 1397–400

    Article  PubMed  CAS  Google Scholar 

  54. Goa KL, Ross SR, Chris P. Lamotrigine. A review of its pharmacological properties and clinical efficacy in epilepsy. Drugs 1993; 46: 152–76

    Article  PubMed  CAS  Google Scholar 

  55. Leppik IE, Driefuss FE, Pledger GW, et al. Felbamate for partial seizures: results of a controlled clinical trial. Neurology 1991; 41: 1785–9

    Article  PubMed  CAS  Google Scholar 

  56. Rho JM, Donevan SD, Rogawski MA. Felbamate inhibits NMDA responses and potentiates GABA responses in cultured rat hippocampal neurons [abstract]. Epilepsia 1993; 34 Suppl. 6: 119S

    Google Scholar 

  57. Leppik IE, Wolff DL. The place of felbamate in the treatment of epilepsy. CNS Drugs 1995; 4: 294–301

    Article  CAS  Google Scholar 

  58. Dichter MA, Brodie MJ. New antiepileptic drugs. N Engl J Med 1996; 334: 1583–9

    Article  PubMed  CAS  Google Scholar 

  59. Anhut H, Ashman P, Feuerstein TJ, et al. Gabapentin (Neurontin) as add-on therapy in patients with partial seizures; a double-blind, placebo-controlled study. Epilepsia 1994; 35: 795–801

    Article  PubMed  CAS  Google Scholar 

  60. Goa KL, Sorkin EM. Gabapentin: a review of its pharmacological properties and clinical potential in epilepsy. Drugs 1993; 46: 409–27

    Article  PubMed  CAS  Google Scholar 

  61. Faught E, Wilder BJ, Ramsay RE, et al. Topiramate placebo-controlled dose-ranging trial in refractory partial epilepsy using 200-, 400-, and 600 mg daily dosages. Neurology 1996; 46: 1684–90

    Article  PubMed  CAS  Google Scholar 

  62. Johannessen SI. Pharmacokinetics and interaction profile of topiramate: review and comparison with other newer antiepileptic drugs. Epilesia 1997: 38 Suppl. 1: 50S–55S

    Google Scholar 

  63. Ben-Menachem E. International experience with tiagabine add-on therapy. Epilepsia 1995; 36 Suppl. 6: 14S–21S

    Article  Google Scholar 

  64. Mengel H. Tiagabine. Epilepsia 1994; 35 Suppl. 5: 81S–84S

    Article  Google Scholar 

  65. Leppik IE. Tiagabine: the safety landscape. Epilesia 1995; 36 Suppl. 6: 10S–13S

    Article  Google Scholar 

  66. Brodie MJ. Tiagabine in the management of epilepsy. Epilepsia 1997; 38 Suppl. 2: 23S–27S

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Neuroscience, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden

    Elinor Ben-Menachem

  2. The National Center for Epilepsy, Sandvika, Norway

    Olaf Henriksen & Svein I. Johannessen

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  1. Elinor Ben-Menachem
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  2. Olaf Henriksen
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  3. Svein I. Johannessen
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Correspondence to Elinor Ben-Menachem.

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Ben-Menachem, E., Henriksen, O. & Johannessen, S.I. Diagnosis and Treatment of Partial Seizures. Mol Diag Ther 11, 23–39 (1999). https://doi.org/10.2165/00023210-199911010-00003

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