Partial Epilepsies Treatment & Management

Updated: Feb 22, 2016
  • Author: Alberto Figueroa Garcia, MD; Chief Editor: Helmi L Lutsep, MD  more...
  • Print
Treatment

Approach Considerations

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

Next:

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, brivaracetam, oxcarbazepine, eslicarbazepine, 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.

Previous
Next:

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.

Previous
Next:

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.

Previous
Next:

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).

Previous
Next:

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.

Previous