Medical Imitators of Seizures................................... 12 OVERVIEW OF EPILEPSY Psychological Imitators of Epilepsy ......................... 13 Circumstances that Provoke Seizures ....................... 15 Robert Fisher, M.D., Ph.D., Tests for Epilepsy ..................................................... 16 Maslah Saul MD Professor, Postictal: The Aftermath of a Seizure ...................... 17 Stanford Neurology MEDICATIONS FOR EPILEPSY ....................... 18 Comprehensive Epilepsy Center, Room A343 General Points .......................................................... 19 300 Pasteur Drive, Stanford, CA 94305-5235 Brief Summary of Antiepileptic Drugs .................... 20 carbamazepine (brief) ....................................................... 20 clonazepam (brief) ............................................................ 20 copyright 1997, 2006, 2010 gabapentin (brief) ............................................................. 20 lacosamide (brief) ............................................................. 20 lamotrigine (brief) ............................................................ 20 DEFINITION OF EPILEPSY................................. 2 levetiracetam (brief) ......................................................... 21 lorazepam (brief) .............................................................. 21 WHO GETS EPILEPSY? ....................................... 3 oxcarbazepine (brief) ........................................................ 21 World Leaders: ............................................................... 3 phenobarbital (brief) ......................................................... 21 Writers and Artists: ........................................................ 4 phenytoin (brief) ............................................................... 21 Actors: ............................................................................ 4 pregabalin (brief) .............................................................. 21 Athletes: ......................................................................... 5 rufinamide (brief) ............................................................. 21 Other public figures: ....................................................... 5 topiramate (brief) .............................................................. 21 valproic acid (brief) .......................................................... 22 SEIZURE CLASSIFICATION ............................... 5 vigabatrin (brief) ............................................................... 22 Partial Seizures ............................................................... 6 zonisamide (brief) ............................................................. 22 Complex Partial Seizures .................................................... 6 others (brief) ..................................................................... 22 Generalized Seizures ...................................................... 6 ANTIEPILEPTIC DRUG SELECTION .................. 22 Absence Seizures ................................................................ 6 Benzodiazepines: ......................................................... 23 Tonic-Clonic Seizures......................................................... 6 Secondarily Generalized Seizures ....................................... 7 Carbamazepine (Tegretol, Novartis; Carbatrol) ........... 24 Atonic Seizures ................................................................... 7 Ethosuximide ............................................................... 25 Myoclonic Seizures ............................................................ 7 Felbamate (Felbatol) .................................................... 25 Tonic Seizures .................................................................... 7 Gabapentin (Neurontin) ............................................... 26 Mixed Seizure Types .......................................................... 7 Lacosamide (Vimpat) ................................................... 27 What Types are Common? ............................................. 7 Lamotrigine (Lamictal) ................................................ 28 Classification of Epilepsy Syndromes .................... 7 Levetiracetam (Keppra) ............................................... 29 Localization-Related Epilepsy .................................... 7 Methsuximide (Celontin) ............................................. 29 Infantile spasms / West‟s syndrome ........................... 7 Oxcarbazepine (Trileptal) ............................................ 30 Lennox-Gastaut Syndrome ......................................... 8 Phenobarbital (Luminal) .............................................. 31 Phenytoin (Dilantin) ..................................................... 32 Febrile seizures ........................................................... 8 Pregabalin (Lyrica) ...................................................... 33 Benign Rolandic Epilepsy .......................................... 8 Primidone (Mysoline) .................................................. 33 Juvenile Myoclonic Epilepsy ...................................... 8 Rufinamide (Banzel) .................................................... 34 CAUSES (ETIOLOGIES) OF SEIZURES: ........... 8 Tiagabine (Gabitril) ...................................................... 35 Causes for Focal Seizures ........................................... 9 Topiramate (Topamax)................................................. 35 Head Trauma .................................................................. 9 Valproic Acid (Depakote, Depakene, Depacon) .......... 36 Stroke ............................................................................. 9 Vigabatrin (Sabril) ....................................................... 37 Infection ......................................................................... 9 Zonisamide (Zonegran) ................................................ 38 Vascular Malformations ................................................. 9 Other Medications ........................................................ 39 Tumors (Neoplasms) ...................................................... 9 Explaining Prescriptions .......................................... 39 Dysplasia ...................................................................... 10 Switching medicines ................................................ 40 Mesial Temporal Sclerosis ........................................... 10 Research Testing of New Drugs ............................... 40 Causes for Generalized Seizures .............................. 10 Stopping Seizure Medicines ..................................... 41 Metabolic ...................................................................... 10 Uncontrolled (Refractory) Epilepsy ...................... 42 Medication Reactions ................................................... 10 Idiopathic (cause unknown) ......................................... 10 EPILEPSY SURGERY ......................................... 44 Genetic Causes of Seizures .......................................... 10 Candidates for Epilepsy Surgery .............................. 44 Photosensitive Seizures ................................................ 11 Pre-surgical evaluation ............................................. 44 1 Temporal Lobectomy Surgical Procedure .................... 46 Other Surgical Procedures ........................................ 47 Surgery Conclusion .................................................. 47 The Ketogenic Diet ............................................... 47 DEFINITION OF EPILEPSY Biofeedback for Seizures ...................................... 48 n epileptic seizure is a transient occurrence of signs What Can a Person do to Control Seizures? ......... 48 A and/or symptoms due to abnormal excessive or syn- Vagus Nerve Stimulation ...................................... 48 chronous neuronal activity in the brain. Epilepsy is a disorder The Patient-Doctor Relationship........................... 49 of the brain characterized by an enduring predisposition to SOCIAL ISSUES IN EPILEPSY: ........................ 49 generate epileptic seizures, and by the neurobiological, cogni- tive, psychological, and social consequences of this condition. Employment.............................................................. 50 The definition of epilepsy requires the occurrence of at least School ....................................................................... 51 one epileptic seizure. Pregnancy ................................................................. 51 Risks of Epilepsy .................................................. 53 herefore, a seizure is the event and epilepsy is the dis- Driving ...................................................................... 53 T order. By definition, one seizure does not make epi- Water Safety ............................................................. 53 lepsy, nor does a small series of seizures that have an im- Burn safety ................................................................ 53 mediate precipitating factor, for example, alcohol with- Heights ...................................................................... 54 drawal seizures. The seizures must be spontaneous and Equipment and Power Tools ..................................... 54 recurrent to represent epilepsy. Child Care Safety ...................................................... 54 eizures result from an electrochemical disorder in the Sudden