Partial Epilepsies Treatment & Management

Author: Alberto Figueroa Garcia, MD; Chief Editor: Helmi L Lutsep, MD more...

Updated: Jun 7, 2011

What would you like to print?

Approach Considerations
Antiepileptic Drug Therapy
Surgical Care
Dietary Modification
Activity Restriction
Consultations
Show All

Approach Considerations

Partial epilepsies are generally treated with antiepileptic drugs (AEDs). Nonpharmacologic treatments in certain refractory cases include surgery and dietary modification.

Antiepileptic Drug Therapy

Many AEDs are available. In general, these drugs have similar rates of efficacy. Important factors in choosing among various drugs include potential adverse effects, dosing schedules, drug interactions, available formulations, and cost.

Conventionally, phenytoin, carbamazepine, valproic acid, primidone, and phenobarbital have been used for generalized seizure or epilepsies. The US Food and Drug Administration (FDA) has approved the following AEDs during the past 2 decades: gabapentin, lamotrigine, tiagabine, topiramate, zonisamide, levetiracetam, oxcarbazepine, and vigabatrin.

Most of these newer AEDs are approved as adjuncts for partial epilepsy. Note that most epilepsy specialists believe that all AEDs that have been approved by the FDA for adjunctive therapy may be effective as monotherapy, and their prescribing practices reflect this.

After they are on the market, many AEDs (eg, carbamazepine, valproic acid, levetiracetam, lamotrigine) are made available in a long-acting or extended-release preparation that may allow once-a-day dosing. It is not clear whether these preparations have sufficient advantages to offset their cost.^{[4, 5, 6]}

Go to Antiepileptic Drugs for complete information on this topic.

Surgical Care

Patients with medically refractory seizures may be candidates for nonpharmacologic treatments, which include epilepsy surgery and vagus nerve stimulation.^[7]Resective surgery is an underutilized therapeutic option. In the United States, an estimated 20,000-70,000 people each year are candidates for a potentially curative surgical procedure. However, only 5,000 surgeries are performed per year in the 150 epilepsy centers in the United States.

Go Vagus Nerve Stimulation and Epilepsy Surgery for complete information on these topics.

Dietary Modification

Consider the ketogenic diet as alternative therapy for children with difficult-to-control seizures. It is effective but very strict; compliance is extremely cumbersome.

Activity Restriction

In the United States, each state has its own laws and regulations about driving with epilepsy. Strict enforcement is nonexistent and depends on reporting by patients. In a few states, reporting the condition is mandatory for physicians. A loophole exists for interstate drivers, in that state governments have no regulations and regulations are poorly enforced federally. Required seizure-free periods for US drivers range from 3 months (many states) to 2 years (Vermont).

Consultations

If seizures are refractory to the first 2-3 trials of medication, refer patients to a comprehensive epilepsy center to evaluate other treatment options. Nonpharmacologic treatments include surgery, vagus nerve stimulation, and (rarely in adults) the ketogenic diet.

Proceed to Medication

Contributor Information and Disclosures

Author

Alberto Figueroa Garcia, MD Resident Physician, Department of Neurology, University of South Florida College of Medicine

Alberto Figueroa Garcia, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Coauthor(s)

Vikas K Agrawal, MD Attending Neurologist, Medical Director of Stroke Unit, Bronx Lebanon Hospital Center; Clinical Instructor, Albert Einstein College of Medicine

Vikas K Agrawal, MD is a member of the following medical societies: American Academy of Neurology and American Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

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: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Specialty Editor Board

Claude G Wasterlain, MD Chair, Department of Neurology, VA Greater Los Angeles Health Care System; Distinguished Professor and Vice-Chair, Department of Neurology, University of California, Los Angeles, David Geffen School of Medicine

Claude G Wasterlain, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Federation for Medical Research, American Neurological Association, Royal Society of Medicine, and Society for Neuroscience

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jose E Cavazos, MD, PhD, FAAN Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director of the San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, 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 American Neurological Association

Disclosure: GXC Global, Inc. Intellectual property rights Medical Director - company is to develop a seizure detecting device. No conflict with any of the eMedicine articles that I wrote or edited.

Chief Editor

Helmi L Lutsep, MD Professor, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, Oregon Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association

Disclosure: Co-Axia Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

References

Cohn A. Stool withholding presenting as a cause of non-epileptic seizures. Dev Med Child Neurol. Oct 2005;47(10):703-5. [Medline].
Rudzinski LA, Shih JJ. The Classification of Seizures and Epilepsy Syndromes. CONTINUUM: Lifelong Learning in Neurology. Jun 2010;16(3):15-35. [Full Text].
Sveinbjornsdottir S, Duncan JS. Parietal and occipital lobe epilepsy: a review. Epilepsia. May-Jun 1993;34(3):493-521. [Medline].
Naritoku DK, Warnock CR, Messenheimer JA, Borgohain R, Evers S, Guekht AB, et al. Lamotrigine extended-release as adjunctive therapy for partial seizures. Neurology. Oct 16 2007;69(16):1610-8. [Medline].
Richy FF, Banerjee S, Brabant Y, Helmers S. Levetiracetam extended release and levetiracetam immediate release as adjunctive treatment for partial-onset seizures: an indirect comparison of treatment-emergent adverse events using meta-analytic techniques. Epilepsy Behav. Oct 2009;16(2):240-5. [Medline].
Powell G, Saunders M, Marson AG. Immediate-release versus controlled-release carbamazepine in the treatment of epilepsy. Cochrane Database Syst Rev. Jan 20 2010;CD007124. [Medline].
Benbadis SR. Evaluation for surgical treatment of partial epilepsy: an overview. Wis Med J. 1995;94(9):500-4. [Medline].

This graph illustrates the 2 peaks of incidence of epilepsy: early and late in life.

View Table List

Read more about Partial Epilepsies on Medscape