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, but are not limited to, surgical treatment, which is highly effective for specific types of pharmacoresistant epilepsy, vagus nerve stimulation, and the ketogenic diet. The health burden of epilepsy results not only from the epileptic seizures, but also from the social, psychological, and neurologic consequences of these seizures, which can include disabling morbidity and mortality. In this updated article, the author stresses the importance of referral to a full-service, multidisciplinary epilepsy center when trials of 2 antiseizure drugs fail.

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.
  • The global burden of disease attributed to epilepsy is comparable to depression, Alzheimer disease, and substance abuse.
  • The primary treatment for epilepsy is antiseizure drugs, which can control disabling seizures in approximately two thirds of people with epilepsy.
  • People with epileptic seizures that are not controlled by medication are at greater risk for disabling irreversible disability, mobility, and mortality and should be referred to a full-service epilepsy center.

In This Article

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