Epilepsy

Introduction
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By Jerome Engel Jr MD PhD

Epilepsy is also known as or subsumes Seizure disorder. -ed.

Epilepsy is a common serious disorder of the brain characterized by recurrent epileptic seizures. Differential diagnosis depends on distinguishing between nonepileptic events that resemble epileptic seizures, epileptic seizures that are provoked and do not indicate a diagnosis of epilepsy, and epilepsy, which implies the presence of an epileptogenic disturbance in the brain even when seizures are not occurring. Treatment is based on diagnosis of specific epileptic seizure types and, when present, specific epilepsy syndromes. Pharmacotherapy is the treatment of choice, and 60% to 70% of patients have seizures that can be controlled with medication. Alternative therapies include surgical treatment, which is highly effective for specific types of pharmacoresistant epilepsy, vagus nerve stimulation, and the ketogenic diet. This updated review by Dr. Jerome Engel of the David Geffen School of Medicine at the University of California, Los Angeles, includes recent practice guidelines from the American Academy of Neurology.

Key Points

  • Epilepsy is the most common serious primary disorder of the brain: 10% of people will have at least one seizure in a lifetime. One third of these will develop epilepsy, and between 0.5% and 1% of the world’s population has active epilepsy.
  • Epilepsy is not a benign condition: it accounts for 1% of the global burden of disease due to disability and premature death, equivalent to lung cancer in men and breast cancer in women.
  • There are many types of epileptic seizures and epilepsy disorders: prognosis and treatment depend on the etiology if known, seizure type, and epilepsy syndrome when this can be diagnosed.
  • The treatment objectives for epilepsy are no seizures and no side effects as soon as possible, but 30% to 40% of people with epilepsy have pharmacoresistant seizures, which are defined as seizures that do not respond to adequate trials of 2 appropriate antiepileptic drugs.
  • Referral to an epilepsy center as soon as possible after failure of 2 antiepileptic drug trials provides the best opportunity to avoid the development of irreversible adverse psychological and social consequences and a lifetime of disability.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
References cited
Contributors