Epilepsy and Seizures Questions & Answers

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
  • Print
Questions & Answers

Overview

What is epilepsy?

What determines the signs and symptoms of seizures in epilepsy?

Which questions are asked to help clarify the type of seizure a patient experienced?

How are epileptic seizures diagnosed?

What is the role of lab tests in the evaluation of suspected epileptic seizures?

Which imaging studies are performed after epileptic seizures?

How is the clinical diagnosis for epilepsy confirmed?

What is the role of video EEG monitoring in the diagnosis of seizures and epilepsy?

What is the goal of treatment for epilepsy?

What is the standard of care for a single, unprovoked epileptic seizure?

When do seizures require treatment?

Which medications are used in the treatment of epileptic seizures?

What are nonpharmacologic treatment options for epileptic seizures?

What is the role of surgery in the treatment of epilepsy?

What are the possible causes of epileptic seizures?

How is epilepsy defined?

What is required for the diagnosis of epilepsy?

What are the clinical signs or symptoms of epileptic seizures?

Where can more information regarding seizure types be found?

Where can more information be found regarding epileptic syndromes and epilepsy treatment?

When were the first epileptic seizures recognized in history?

What role did Hippocrates have in the history of epilepsy?

When did modern investigation of the etiology of epilepsy begin?

What are epileptic seizures?

How is the brain involved in epileptic seizures?

How does the pathophysiology of focal-onset epileptic seizures differ from generalized-onset epileptic seizures?

What is the electroencephalographic (EEG) hallmark of focal-onset epileptic seizures?

How is paroxysmal depolarization shift (PDS) characterized in epileptic seizures?

How does an interictal spike transition to an epileptic seizure?

Which pathophysiologic mechanisms cause focal-onset epileptic seizures?

How do medications work to prevent epileptic seizures?

What is the role of gamma-aminobutyric acid (GABA) release in the pathophysiology of epileptic seizures?

Which mechanisms lead to decreased neurotransmitter inhibition in epileptic seizures?

What is the main inhibitory neurotransmitter in epileptic seizures?

What is the role of chloride channels in the pathophysiology of epileptic seizures?

Which medications modulate chloride channels in epilepsy?

How does alteration of the normal state of the chloride channels affect the pathophysiology of epilepsy?

What is the role of excitatory postsynaptic potentials (EPSPs) in the pathophysiology of epilepsy?

What is the role of inhibitory postsynaptic potential (IPSP) in the pathophysiology of epileptic seizures?

Which nervous system channels are subject to modulation in epilepsy?

What are the characteristics of each channel involved in the pathophysiology of epileptic seizures?

How many different electrophysiologic responses of gamma-aminobutyric acid A (GABA-A) receptors exist in epileptic seizures?

What is the role of gamma-aminobutyric acid A (GABA-A) inhibition in the pathophysiology of epileptic seizures?

What is the role of gamma-aminobutyric acid B (GABA-B) inhibition in the pathophysiology of epileptic seizures?

How are gamma-aminobutyric acid (GABA) neurons activated in epileptic seizures?

What is the role of feedforward inhibition in the pathophysiology of epileptic seizures?

How does the activation of gamma-aminobutyric acid (GABA)ergic neurons affect epileptic seizures?

What is the role of feedback inhibition in the pathophysiology of epileptic seizures?

What is the role of synaptic reorganization in the pathophysiology of epileptic seizures?

What is the role of hippocampal sprouting in the pathophysiology of epileptic seizures?

What is the role of intracellular calcium buffering in the pathophysiology of epileptic seizures?

Which mechanisms lead to increased excitation in the pathophysiology of epilepsy?

What is the role of glutamate in the pathophysiology of epileptic seizures?

How is fast neurotransmission achieved in the pathophysiology of epilepsy?

What is the role of calcium in the pathophysiology of epileptic seizures?

How do nonsynaptic interactions affect the pathophysiology of epilepsy?

What is the role of the limbic system in the pathophysiology of focal-onset epilepsy?

How frequently is hippocampal sclerosis found in epilepsy?

What is the role of mossy-fiber sprouting in the pathophysiology of epilepsy?

What is the role of denervation in the pathophysiology of epilepsy?

What is the role of recurrent excitatory collaterals in the pathophysiology of epilepsy?

What is the best understood pathophysiologic mechanism of generalized seizures?

What is the role of altered thalamocortical rhythms in the pathophysiology of generalized seizures?

What is the role of thalamic relay neurons in the pathophysiology of generalized seizures?

What is the role of nucleus reticularis of the thalamus (NRT) in the pathophysiology of generalized seizures?

What are the functional states of T-calcium in the pathophysiology of generalized seizures?

What is the role of hyperpolarization in the pathophysiology of generalized seizures?

What is the pathophysiologic mechanism of medications that prevent absence seizures?

What is the role of increased GANA levels in the pathophysiology of epileptic seizures?

What is the prevalence of seizures in Rett syndrome?

What is the prevalence of seizures in Prader-Willi syndrome?

What is Sturge-Weber syndrome?

What causes epilepsy?

What is the role of genetics in the etiology of epilepsy?

What categories of genetic disorders cause epileptic seizures?

Which genetic syndromes cause seizures?

What is the prevalence of seizures in Angelman syndrome?

What is the prevalence of seizures in Pitt-Hopkins syndrome?

What are major features of tuberous sclerosis?

What are minor features of tuberous sclerosis?

What is required for a definite diagnosis of tuberous sclerosis?

What is the prevalence of epileptic seizures in tuberous sclerosis?

What is the prevalence of seizures in chromosomal 22q deletion syndrome?

What is the prevalence of seizures in Wolf-Hirschhorn syndrome?

What is the prevalence of seizures in chromosome 1p36 deletion syndrome?

Which metabolic disorders may cause epileptic seizures?

Which rare diseases cause epileptic seizures?

Which mitochondrial diseases may cause epileptic seizures?

How is myoclonic epilepsy with ragged red fibers (MERRF) characterized?

What causes autosomal dominant nocturnal frontal lobe epilepsy?

What causes autosomal dominant juvenile myoclonic epilepsy?

What causes benign familial neonatal seizures?

Which genetic mutations cause seizure syndromes?

What is the incidence of recurrent nonfebrile seizures in the US?

What is the prevalence of epileptic seizures in developed nations?

Which factors affect the prognosis of epilepsy?

What are the common morbidities of epileptic seizures?

What are the mortality risks of epilepsy?

Which factors increase the risk for sudden, unexpected death in epilepsy (SUDEP)?

What is the mechanism of death in sudden, unexpected death in epilepsy (SUDEP)?

Where can the NIH report on sudden, unexpected death in epilepsy (SUDEP) be found?

What should be included in patient education about injury prevention during seizures?

Where are patient education resources found?

Presentation

How are epileptic seizures diagnosed?

Which questions may help to clarify the type of seizure in the evaluation of epilepsy?

What is the role of the physical exam in the diagnosis of epilepsy?

What is the 1981 International League Against Epilepsy (ILAE) classification of epileptic seizures?

What is semiologic classification of epileptic seizures?

What revisions have been made to the International League Against Epilepsy (ILAE) classification of epileptic seizures?

What are the types of focal-onset seizures?

How are simple and complex focal seizures differentiated?

What is the basis for the diagnosis of different seizure types?

How is impaired conscientiousness assessed in epileptic seizures?

How do complex focal seizures progress?

What are the signs and symptoms of complex focal seizures of frontal-lobe origin?

What are the features of complex focal seizures on EEG?

How do secondary generalized seizures progress?

How are generalized tonic-clonic seizures classified?

What are the types of generalized-onset seizures?

How are generalized-onset seizure types classified and diagnosed?

What are absence seizures?

How are absence seizures diagnosed in adults?

What are the signs and symptoms of absence seizures in children?

What is the role of the classic ictal EEG in the diagnosis of absence seizures?

What are myoclonic seizures?

What are clonic seizures?

What are tonic seizures?

What is the ictal correlate of tonic seizures?

What are tonic-clonic (grand mal) seizures?

What is the ictal correlate of generalized tonic-clonic seizures?

What are atonic seizures?

What is epileptic syndrome?

What is the International League Against Epilepsy (ILAE) classification of epileptic syndromes?

What are some localization-related epilepsies and syndromes?

What are some generalized epilepsies and syndromes?

What is the ILAE 5-axis diagnostic scheme for epilepsy?

Which epilepsy terms did ILAE propose abandoning in 2001?

What are the criticisms of the ILAE 5-axis diagnostic scheme for epilepsy?

DDX

What is the basis for diagnosis of epileptic seizures?

How is the clinical diagnosis of epileptic seizures confirmed?

Which conditions should be considered in the differential diagnoses of epileptic seizures?

What are the differential diagnoses for Epilepsy and Seizures?

Workup

Which imaging studies are recommended for the diagnosis of epileptic seizures?

What is the role of prolactin assays in the evaluation of epileptic seizures?

What are the American Academy of Neurology (AAN) recommendations for the use of prolactin to diagnose epileptic seizures?

When are serum antiepileptic drug (AED) levels measured in the management of epilepsy?

Why do serum antiepileptic drug (AED) baseline trough levels decrease over time?

How is the serum antiepileptic drug (AED) trough level used in the management of epilepsy?

What is the usefulness of serum concentrations of antiepileptic drugs (AEDs) in the management of epileptic seizures?

Which neuroimaging studies are used in the diagnosis of epileptic seizures?

Which findings on EEG aid in the diagnosis of epileptic seizures?

What is the role of video-EEG in the diagnosis of epileptic seizures?

Treatment

What is the goal of treatment for epilepsy?

What are the benefits of monotherapy in the treatment of epilepsy?

What are the indications for social and/or vocational rehabilitation in the treatment of epilepsy?

When is referral to a neurologist or epileptologist indicated for treatment of epileptic seizures?

What are the risk factors for recurrence of epileptic seizures?

Which abnormalities on the electroencephalogram (EEG) increase the risk of recurrent epileptic seizures?

What is the risk of recurrence in patients with one generalized tonic-clonic seizure?

How is the risk of recurrence of epileptic seizures managed in patients with one abnormality?

What is the mainstay of treatment for epilepsy?

Which anticonvulsants are used in the treatment of epileptic seizures?

Where can information be found on which anticonvulsants are used to treat specific epileptic seizure types?

Which anticonvulsants are used to treat absence seizures?

Which anticonvulsants are used to treat tonic or atonic seizures?

Which anticonvulsant drugs are used to treat myoclonic seizures?

Which anticonvulsant drugs are used to treat juvenile myoclonic epilepsy (JME)?

Which anticonvulsant drugs are used to treat primary generalized tonic-clonic seizures?

Which anticonvulsant drugs are used to treat generalized and unclassified epilepsies?

What are the antiepileptic drug (AED) options for the treatment of focal-onset seizures?

How does the efficacy of specific anticonvulsants for the treatment of epilepsy vary among patient groups?

What is the efficacy of lamotrigine in the treatment of epilepsy?

How do newer medications compare to carbamazepine in the treatment of epileptic seizures?

What are the medication options if carbamazepine fails to control epileptic seizures?

What are the FDA warnings regarding use of ezogabine in the treatment of epileptic seizures?

What are the treatment options for medically refractory epilepsy?

What is the probability of achieving seizure freedom in pediatric patients?

What is the role of immunotherapy in the treatment of epileptic seizures?

What is the efficacy of immunotherapy for the treatment of medically refractory epilepsy?

What is the focus of future advances in the medical treatment of epileptic seizures?

In which patient populations does the use of anticonvulsants vary for the treatment of epileptic seizures?

What are considerations when administering medications to neonates and children for the treatment of epilepsy?

What are considerations when administering medications to elderly patients for the treatment of epilepsy?

What are the medication options for the treatment of epilepsy in women taking oral contraceptives?

What are the AAN/AES treatment guidelines for epilepsy during pregnancy?

Why are frequent drug serum levels obtained in pregnant women with epilepsy?

What are the considerations for performing amniocentesis in women with epilepsy?

How is epilepsy managed in patients with hepatic and renal insufficiency?

When is discontinuation of medication considered for patients with epilepsy?

What is the recurrence rate of juvenile myoclonic epilepsy (JME) during adulthood?

How is the risk of epileptic seizure recurrence assessed?

Which factors increase the risk of epileptic seizure recurrence after discontinuation of medication?

What is the likelihood of epileptic seizure recurrence after discontinuation of medication?

How long does it take to gradually discontinue epilepsy medications?

What are some nonpharmacologic treatment options for epilepsy?

What is the role of a ketogenic diet in the treatment of epilepsy?

What is the efficacy of the Atkins diet in the treatment of epilepsy?

What is the role of vagus nerve stimulation (VNS) in the treatment of epilepsy?

What is the efficacy of vagus nerve stimulation (VNS) for the treatment of epilepsy?

What are positive predictors of a favorable outcome with vagal nerve stimulation (VNS) therapy for epilepsy?

What is the role of implantable neurostimulators in the treatment of epilepsy?

What are the surgical options for the treatment of epilepsy?

What are curative surgical options for patients with epilepsy?

What is the role of lobectomy in the treatment of epilepsy?

What is the role of lesionectomy in the treatment of epilepsy?

What is the role of surgery in the treatment of drug-resistant epilepsy?

What is the efficacy of surgery for drug-resistant epilepsy?

What activity restrictions are advisable for patients with epilepsy?

When are precautions against head trauma necessary in patients with epilepsy?

How do driving restrictions vary among patients with epilepsy?

Which precautions should patients with epilepsy take when swimming or bathing?

Which precautions should patients with epilepsy take when using power tools?

Are any devices approved for seizure tracking and epilepsy management?

Medications

Which medications are used for the treatment of epileptic seizures?

Which medications in the drug class Anticonvulsants, Hydantoins are used in the treatment of Epilepsy and Seizures?

Which medications in the drug class Anticonvulsants, Neuronal Potassium Channel Opener are used in the treatment of Epilepsy and Seizures?

Which medications in the drug class Anticonvulsants, Succinimide are used in the treatment of Epilepsy and Seizures?

Which medications in the drug class Anticonvulsants, Benzodiazepine are used in the treatment of Epilepsy and Seizures?

Which medications in the drug class Anticonvulsants, Barbiturates are used in the treatment of Epilepsy and Seizures?

Which medications in the drug class Anticonvulsants, Other are used in the treatment of Epilepsy and Seizures?