eMedicine Specialties > Neurology > Seizures and Epilepsy

Seizures and Epilepsy, Overview and Classification: Follow-up

Author: Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, Audie L Murphy Veterans Affairs Medical Center
Coauthor(s): Mark Spitz, MD, Professor, Department of Neurology, University of Colorado Health Sciences Center
Contributor Information and Disclosures

Updated: Nov 10, 2009

Follow-up

Transfer

Refer patients with intractable spells to a neurologist or an epileptologist for further workup, including video-EEG monitoring, to characterize the etiology of their seizures.

Deterrence/Prevention

Encourage the use of helmets to prevent head trauma while the patient is biking, skiing, riding a motorcycle, or participating in other activities.

Prognosis

  • The patient's prognosis for disability and for a recurrence of epileptic seizures depends on the type of epileptic seizure and the epileptic syndrome in question.
  • See the other articles listed in the Introduction regarding specific epileptic syndromes.

Patient Education

  • Epilepsy Foundation of America has a large library of educational materials that are available to health care professionals and the general public.
  • The American Epilepsy Society is the professional organization of people who take care of patients with epilepsy. Their Web site provides a large amount of credible information.
  • For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Epilepsy.

Miscellaneous

Medicolegal Pitfalls

  • Inappropriate diagnosis
    • The diagnosis of seizures is based on the clinical history.
    • Because many types of seizures are associated with impairment of consciousness, patients are unaware of their occurrence. The history as related by a witness is of high importance.
    • The clinical diagnosis can be confirmed by abnormalities on the interictal EEG, but these abnormalities could be present in otherwise healthy individuals, and their absence does not exclude the diagnosis of epilepsy.
    • Video-EEG monitoring is the criterion standard for classifying the type of seizure or syndrome or to diagnose pseudoseizures. However, it is expensive and laborious study; therefore, monitoring all patients is impractical. Only those whose condition does not respond to treatment should undergo video-EEG. Referral to an epilepsy center should be reserved for patients whose seizures are refractory to treatment. Some frontal-lobe seizures are considered pseudoseizures for many years until appropriate diagnosis is made by means of video-EEG.
    • Not all spells are seizures.
  • Liability of having seizures
    • Patients who have lapses of consciousness during wakefulness and in whom seizures are suspected should be educated and warned about seizure precautions.
    • Documenting on the patient's chart that driving and occupational hazards for people with seizures were discussed is useful.
    • Physicians should be aware of the state regulations regarding driving, which vary considerably among states and nations.

Special Concerns

  • To avoid unnecessary injury, people who have epileptic seizures and other spells of sudden-onset seizures should be given restrictions for driving, ascending heights, working with fire or cooking, using power tools, taking unsupervised baths, and swimming.
  • The restrictions differ for each patient because of the individual features of the seizures; the degree of seizure control; and, in the United States, state laws. Other countries have more permissive or more restrictive laws regarding driving.
 


More on Seizures and Epilepsy, Overview and Classification

Overview: Seizures and Epilepsy, Overview and Classification
Differential Diagnoses & Workup: Seizures and Epilepsy, Overview and Classification
Treatment & Medication: Seizures and Epilepsy, Overview and Classification
Follow-up: Seizures and Epilepsy, Overview and Classification
References
[ CLOSE WINDOW ]

References

  1. Goodkin HP. The founding of the American Epilepsy Society: 1936-1971. Epilepsia. Jan 2007;48(1):15-22. [Medline].

  2. Luders H, Acharya J, Baumgartner C, et al. Semiological seizure classification. Epilepsia. Sep 1998;39(9):1006-13. [Medline].

  3. Loddenkemper T, Kellinghaus C, Wyllie E, Najm IM, Gupta A, Rosenow F. A proposal for a five-dimensional patient-oriented epilepsy classification. Epileptic Disord. Dec 2005;7(4):308-16. [Medline].

  4. Engel J Jr. Report of the ILAE classification core group. Epilepsia. Sep 2006;47(9):1558-68. [Medline].

  5. Wolf P. Basic principles of the ILAE syndrome classification. Epilepsy Res. Aug 2006;70 Suppl 1:S20-6. [Medline].

  6. Engel J Jr. A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia. Jun 2001;42(6):796-803. [Medline].

  7. Wolf P. Of cabbages and kings: some considerations on classifications, diagnostic schemes, semiology, and concepts. Epilepsia. Jan 2003;44(1):1-4; discussion 4-13. [Medline].

  8. Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. Apr 2005;46(4):470-2. [Medline].

  9. Beghi E. The concept of the epilepsy syndrome: how useful is it in clinical practice?. Epilepsia. May 2009;50 Suppl 5:4-10. [Medline].

  10. Rho JM, Sankar R, Cavazos JE. Epilepsy: Scientific Foundations of Clinical Practice. New York, NY: Marcel Dekker; 2004.

  11. Houser CR, Esclapez M. Vulnerability and plasticity of the GABA system in the pilocarpine model of spontaneous recurrent seizures. Epilepsy Res. Dec 1996;26(1):207-18. [Medline].

  12. Sloviter RS. Status epilepticus-induced neuronal injury and network reorganization. Epilepsia. 1999;40(suppl 1):S34-9; discussion S40-1. [Medline].

  13. Scharfman HE, Schwartzkroin PA. Protection of dentate hilar cells from prolonged stimulation by intracellular calcium chelation. Science. Oct 13 1989;246(4927):257-60. [Medline].

  14. Cavazos JE, Das I, Sutula TP. Neuronal loss induced in limbic pathways by kindling: evidence for induction of hippocampal sclerosis by repeated brief seizures. J Neurosci. May 1994;14(5 Pt 2):3106-21. [Medline].

  15. Sutula T, Cascino G, Cavazos J, et al. Mossy fiber synaptic reorganization in the epileptic human temporal lobe. Ann Neurol. Sep 1989;26(3):321-30. [Medline].

  16. McCormick DA. Cellular mechanisms underlying cholinergic and noradrenergic modulation of neuronal firing mode in the cat and guinea pig dorsal lateral geniculate nucleus. J Neurosci. Jan 1992;12(1):278-89. [Medline].

  17. Hosford DA, Clark S, Cao Z, et al. The role of GABAB receptor activation in absence seizures of lethargic (lh/lh) mice. Science. Jul 17 1992;257(5068):398-401. [Medline].

  18. FIRST Group. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. First Seizure Trial Group (FIRST Group). Neurology. Mar 1993;43(3 Pt 1):478-83. [Medline].

  19. [Best Evidence] Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW. The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. Lancet. Mar 24 2007;369(9566):1016-26. [Medline].

  20. Mattson RH, Cramer JA, Collins JF, et al. Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med. Jul 18 1985;313(3):145-51. [Medline].

  21. Mattson RH, Cramer JA, Collins JF. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. N Engl J Med. Sep 10 1992;327(11):765-71. [Medline].

  22. [Best Evidence] Rowan AJ, Ramsay RE, Collins JF, et al. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. Jun 14 2005;64(11):1868-73. [Medline].

  23. [Best Evidence] Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. Lancet. Mar 24 2007;369(9566):1000-15. [Medline].

  24. French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the AAN and the AES. Neurology. Apr 27 2004;62(8):1252-60. [Medline].

  25. French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs, II: treatment of refractory epilepsy. Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the AAAN and the AES. Neurology. Apr 27 2004;62(8):1261-73. [Medline].

  26. [Guideline] Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Allen Hauser W, et al. Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. May 2009;50(5):1229-36. [Medline].

  27. [Guideline] Harden CL, Meador KJ, Pennell PB, Hauser WA, Gronseth GS, French JA, et al. Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. May 2009;50(5):1237-46. [Medline].

  28. [Guideline] Harden CL, Pennell PB, Koppel BS, Hovinga CA, Gidal B, Meador KJ, et al. Management issues for women with epilepsy--focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. May 2009;50(5):1247-55. [Medline].

  29. Kossoff EH, Turner Z, Bluml RM, Pyzik PL, Vining EP. A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet. Epilepsy Behav. May 2007;10(3):432-6. [Medline].

  30. Benbadis SR, Luders HO. Epileptic syndromes: an underutilized concept. Epilepsia. Nov 1996;37(11):1029-34. [Medline].

  31. Brodie MJ, Dichter MA. Antiepileptic drugs. N Engl J Med. Jan 18 1996;334(3):168-75. [Medline].

  32. Dichter MA, Brodie MJ. New antiepileptic drugs. N Engl J Med. Jun 13 1996;334(24):1583-90. [Medline].

  33. Engel J Jr. Classifications of the International League Against Epilepsy: time for reappraisal. Epilepsia. Sep 1998;39(9):1014-7. [Medline].

  34. Engel J Jr. International classification: implications for neocortical epilepsies. Adv Neurol. 2000;84:119-24. [Medline].

  35. Engel J Jr. Surgery for seizures. N Engl J Med. Mar 7 1996;334(10):647-52. [Medline].

  36. Goldensohn ES, Porter RJ, Schwartzkroin PA. The American Epilepsy Society: an historic perspective on 50 years of advances in research. Epilepsia. Jan 1997;38(1):124-50. [Medline].

  37. Hauser WA, Hesdorffer D. Epilepsy: Frequency, Causes, and Consequences. New York, NY: Demos Medical; 1990.

  38. Hosford DA, Wang Y. Utility of the lethargic (lh/lh) mouse model of absence seizures in predicting the effects of lamotrigine, vigabatrin, tiagabine, gabapentin, and topiramate against human absence seizures. Epilepsia. Apr 1997;38(4):408-14. [Medline].

  39. McNamara JO. Cellular and molecular basis of epilepsy. J Neurosci. Jun 1994;14(6):3413-25. [Medline].

  40. Patsalos PN, Perucca E. Clinically important drug interactions in epilepsy: interactions between antiepileptic drugs and other drugs. Lancet Neurol. Aug 2003;2(8):473-81. [Medline].

  41. Sanchez-Vives MV, McCormick DA. Cellular and network mechanisms of rhythmic recurrent activity in neocortex. Nat Neurosci. Oct 2000;3(10):1027-34. [Medline].

  42. Scheuer ML, Pedley TA. The evaluation and treatment of seizures. N Engl J Med. Nov 22 1990;323(21):1468-74. [Medline].

  43. Sloviter RS, Pedley TA. Subtle hippocampal malformation: importance in febrile seizures and development of epilepsy. Neurology. Apr 1998;50(4):846-9. [Medline].

  44. Sutula T, He XX, Cavazos J, Scott G. Synaptic reorganization in the hippocampus induced by abnormal functional activity. Science. Mar 4 1988;239(4844):1147-50. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

epilepsy treatment, guidelines, seizure treatment, convulsions, epileptic seizures, classification of seizures, classification of epilepsy, partial-onset seizures, generalized-onset seizures, unclassified seizures, epileptic syndromes

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jose E Cavazos, MD, PhD, FAAN, Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, University of Texas Health Science Center at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center; Director of the Epilepsy Center, Audie L Murphy Veterans Affairs Medical Center
Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Spitz, MD, Professor, Department of Neurology, University of Colorado Health Sciences Center
Mark Spitz, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society
Disclosure: pfizer Honoraria Speaking and teaching; ortho-mcneil Honoraria Review panel membership

Medical Editor

Ramon Diaz-Arrastia, MD, PhD, Assistant Professor, Department of Neurology, Comprehensive Epilepsy Center, University of Texas Southwestern
Ramon Diaz-Arrastia, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, New York Academy of Sciences, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.