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.
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.
Seizures and epilepsy in older adults: Etiology, clinical presentation, and diagnosis
Seizures and epilepsy are common in older adults. Nearly one-half of new-onset seizures occur in individuals over the age of 65 years; however, recognizing seizures in this population is challenging because of the paroxysmal nature of the condition and the clinically subtle presentation of seizures in the majority of cases. Treatment decisions are also more complex; older patients are more susceptible to medication side effects and carry a greater burden of medical comorbidities.
Seizures are episodes of transient neurologic change due to hypersynchronous, hyperexcited neuronal activity. Seizures are divided into two categories: provoked and unprovoked. Provoked seizures, also known as acute symptomatic seizures, occur with an identifiable proximate cause and are not expected to recur in the absence of that particular cause or trigger (eg, hypoglycemia, alcohol withdrawal).
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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