Simple Partial Seizures Treatment & Management
- Author: Jane G Boggs, MD; Chief Editor: Selim R Benbadis, MD more...
Benign focal epilepsy of childhood is usually a self-limited condition; if no seizures with secondarily generalization occur, patient care need not include antiepilepsy drugs (AEDs). In other patients, AED treatment is appropriate for simple partial seizures (SPS). Selected patients with SPS refractory to AEDs may be candidates for surgical treatment.
Go to Epilepsy and Seizures for an overview of this topic.
Antiepileptic Drug Therapy
Numerous AEDs currently are approved worldwide with indications for SPS, and others are in development. No one drug of choice is recommended for SPS, since in clinical trials all the drugs have demonstrated similar levels of efficacy. Selection of the most appropriate medication is based on potential side effects, dosing schedules, available formulations, and individual factors.[16, 17, 18, 19, 20]
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Patients with medically refractory seizures may be candidates for epilepsy surgery, especially if they have a well-localized seizure onset documented by video-EEG and a corresponding lesion on neuroimaging. Such cases should be carefully evaluated preoperatively with the resection properly planned by the epilepsy surgical team to minimize the risk of postoperative deficit.
Focal cortical resection, amygdalo-hippocampectomy, lesionectomy, thermal laser ablation, or gamma knife surgery may be the most appropriate procedure. The specific procedure should be tailored individually to the features of each case. Implantable responsive neurostimulation (RNS) can be an alternative to focal resection in some patients.
Rasmussen encephalitis responds poorly to medical treatment and usually is treated by hemispherectomy to prevent involvement of the contralateral hemisphere.
Patients whose seizures are medically refractory but are not good candidates for epilepsy surgery may be candidates for implantation of a device to provide vagus nerve stimulation.
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Treatment During Pregnancy
Although often perceived to be less severe than complex partial and generalized seizures, SPS in pregnancy can be associated with fetal distress. Every effort must be made to control seizures during pregnancy by using appropriate doses of the most successful agent for the individual. If possible, avoid AED drug changes.
Go to Women's Health and Epilepsy for complete information on this topic.
Cardiac, gastrointestinal, psychiatric, or endocrine consultation, depending on individual cases, may be necessary in diagnostically difficult cases.
Psychiatric consultation may be necessary for management of concurrent depression, anxiety, and/or non-epileptic events.
Although a ketogenic diet has been used successfully in refractory seizures, it is not used commonly for patients exhibiting SPS exclusively (except children) who are not responding to medication.
The medium-chain triglyceride diet is more convenient and palatable, and it does not result in hypercholesterolemia, although it appears to be less successful in the treatment of refractory seizures. The Atkins diet has also been reported to have some adjunctive benefit to some patients with refractory seizures.
As SPS do not impair consciousness, activity may not need to be restricted severely as with other types of seizures. Compliant patients with a consistent, exclusively SPS pattern that does not interfere with the ability to manipulate the controls of a motor vehicle are legally allowed to drive in states in which the motor vehicle authority approves exceptions to complete seizure control. Compliance with state guidelines may require self-reporting by patients or specific documentation of patient symptoms, compliance, and medications by the treating physician.
The safety of swimming and other potentially hazardous recreational or employment activities should be evaluated on an individual basis. The ability of an affected patient to care for infants in an unsupervised setting should be evaluated on an individual basis.
At least monthly outpatient follow-up is recommended when seizures are not well controlled. As seizure control improves, the interval between evaluations can be increased.
Seizure-free patients may be monitored by a neurologist once or twice annually. Outpatient laboratory studies should be performed to monitor metabolic effects of the medications used to treat SPS, and to monitor underlying medical conditions.
AED levels should be performed when toxicity is suspected, or to confirm adequate compliance or absorption of medications. In the absence of side effects of medication, metabolic changes, or breakthrough seizures, routine monitoring of AED levels usually is not justified.
Patients diagnosed with SPS may require follow-up inpatient care if new patterns of seizures develop. EEG or video-EEG studies are often necessary to clarify the nature of the new seizure type. Neuroimaging and laboratory studies may help in identifying reasons for seizure exacerbations. In addition, medications usually can be adjusted more quickly in inpatients, and hospitalization in a video-EEG-monitoring unit optimizes the safety of rapid adjustment in the doses of medication.
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