Medicine
Volume 36, Issue 11 , Pages 579-585, November 2008

Epilepsy management

Linda M Parsons MD FRCP is a Consultant Neurologist at Royal Free, Luton and Dunstable and St Albans City hospitals, UK. She qualified from Sheffield University and trained in Neurology in Birmingham and London, UK. She has a long-standing interest in epilepsy and sits on the steering committee for the UK Epilepsy and Pregnancy Register. Competing interests: none declared

Heather Angus-Leppan MSc (Ep) MD FRACP FRCP is a Consultant Neurologist, Honorary Senior Lecturer and Epilepsy Lead at the Royal Free Hospital, London, UK. She is the Honorary Assistant Secretary of the Association of British Neurologists, Honorary Secretary of the Neurosciences Section of the Royal Society of Medicine and current Chair of the Map of Medicine Epilepsy Group, UK. Competing interests: none declared

Abstract 

Making the correct diagnosis of epilepsy is important as there are many mimics, some of which are life threatening. A good history, including an eyewitness account, is crucial as investigations may be unhelpful. Once a positive diagnosis is made, management requires attention to provoking factors or underlying disease together with antiepileptic drugs (AEDs). Thoughtful prescribing is required as some AEDs exacerbate some seizure types. Surgery and vagal nerve stimulation are considered in intractable cases. Status epilepticus is a medical emergency with significant mortality. Women of childbearing age with epilepsy have particular needs as some AEDs interact with hormonal contraceptives. Pregnancy can lead to an increase in seizure frequency through various mechanisms. There is a risk of teratogenicity with AEDs. Prepregnancy counselling is therefore important. Lifestyle issues, particularly driving, need careful discussion in the newly diagnosed patient.

Keywords: antiepileptic drugs, blackout, diagnosis, epilepsy, status epilepticus, syncope, teratogenicity, women

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PII: S1357-3039(08)00238-7

doi:10.1016/j.mpmed.2008.08.002

Medicine
Volume 36, Issue 11 , Pages 579-585, November 2008

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