UpToDate® Content
Overview of the management of epilepsy in adults
The management of patients with epilepsy is focused on three main goals: controlling seizures, avoiding treatment adverse effects, and maintaining or restoring quality of life. Clinicians should assist in empowering patients with epilepsy to lead lifestyles consistent with their capabilities [1,2].
The optimal treatment plan is derived from an accurate diagnosis of the patient's seizure type(s), an objective measure of the intensity and frequency of the seizures, awareness of medication adverse effects, and an evaluation of disease-related psychosocial problems. A working knowledge of available antiseizure medications (ASMs), 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 ASMs are discussed separately:
Evaluation and management of the first seizure in adults
Seizures are a common occurrence, affecting an estimated 8 to 10 percent of the population over a lifetime [1,2]. Seizures account for 1 to 2 percent of all emergency department visits, and approximately one-quarter of these will be a first seizure [3].
The differential diagnosis and clinical features of seizures and the diagnostic evaluation of the first seizure in adults are reviewed here. Other paroxysmal events that can mimic seizure in adults, including syncope, convulsive syncope, migraine, transient ischemic attack, and psychogenic nonepileptic seizures, are reviewed separately:
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