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Epilepsy: Treatment Options.

Abstract The occurrence of a single seizure does not always require initiation of antiepileptic drugs. Risk of recurrent seizures should guide their use. In adults, key risk factors for recurrence are two unprovoked seizures occurring more than 24 hours apart, epileptiform abnormalities on electroencephalography, abnormal brain imaging, nocturnal seizures, or an epileptic syndrome associated with seizures. In children, key risk factors are abnormal electroencephalography results, an epileptic syndrome associated with seizures, severe head trauma, and cerebral palsy. The risk of adverse effects from antiepileptic drugs is considerable and includes potential cognitive and behavioral effects. In the absence of risk factors, and because many patients do not experience recurrence of a seizure, physicians should consider delaying use of antiepileptic drugs until a second seizure occurs. Delaying therapy until a second seizure does not affect one- to two-year remission rates. Treatment should begin with monotherapy. The appropriate choice of medication varies depending on seizure type. Routine monitoring of drug levels is not correlated with reduction in adverse effects or improvement in effectiveness and is not recommended. When patients have been seizure free for two to five years, discontinuation of antiepileptic drugs may be considered. For patients with seizures that are not controlled with these agents, alternative treatments include surgical resection of the seizure focus, ketogenic diets, vagus nerve stimulators, and implantable brain neurostimulators. Patients who have had a recent seizure within the past three months or whose seizures are poorly controlled should refrain from driving and certain high-risk physical activities. Patients planning for pregnancy should know that antiepileptic drugs are possibly teratogenic.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title american family physician
Publication Year Start




PMID- 28762701
OWN - NLM
STAT- MEDLINE
DA  - 20170801
DCOM- 20170807
LR  - 20170807
IS  - 1532-0650 (Electronic)
IS  - 0002-838X (Linking)
VI  - 96
IP  - 2
DP  - 2017 Jul 15
TI  - Epilepsy: Treatment Options.
PG  - 87-96
AB  - The occurrence of a single seizure does not always require initiation of
      antiepileptic drugs. Risk of recurrent seizures should guide their use. In
      adults, key risk factors for recurrence are two unprovoked seizures occurring
      more than 24 hours apart, epileptiform abnormalities on electroencephalography,
      abnormal brain imaging, nocturnal seizures, or an epileptic syndrome associated
      with seizures. In children, key risk factors are abnormal electroencephalography 
      results, an epileptic syndrome associated with seizures, severe head trauma, and 
      cerebral palsy. The risk of adverse effects from antiepileptic drugs is
      considerable and includes potential cognitive and behavioral effects. In the
      absence of risk factors, and because many patients do not experience recurrence
      of a seizure, physicians should consider delaying use of antiepileptic drugs
      until a second seizure occurs. Delaying therapy until a second seizure does not
      affect one- to two-year remission rates. Treatment should begin with monotherapy.
      The appropriate choice of medication varies depending on seizure type. Routine
      monitoring of drug levels is not correlated with reduction in adverse effects or 
      improvement in effectiveness and is not recommended. When patients have been
      seizure free for two to five years, discontinuation of antiepileptic drugs may be
      considered. For patients with seizures that are not controlled with these agents,
      alternative treatments include surgical resection of the seizure focus, ketogenic
      diets, vagus nerve stimulators, and implantable brain neurostimulators. Patients 
      who have had a recent seizure within the past three months or whose seizures are 
      poorly controlled should refrain from driving and certain high-risk physical
      activities. Patients planning for pregnancy should know that antiepileptic drugs 
      are possibly teratogenic.
FAU - Liu, Gerald
AU  - Liu G
AD  - Atrius Health, Weymouth, MA, USA.
FAU - Slater, Nicole
AU  - Slater N
AD  - Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
FAU - Perkins, Allen
AU  - Perkins A
AD  - University of South Alabama, Mobile, AL, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Am Fam Physician
JT  - American family physician
JID - 1272646
RN  - 0 (Anticonvulsants)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Anticonvulsants/administration & dosage/therapeutic use
MH  - Child
MH  - Epilepsy/diagnosis/*drug therapy/surgery
MH  - Humans
EDAT- 2017/08/02 06:00
MHDA- 2017/08/08 06:00
CRDT- 2017/08/02 06:00
AID - d13106 [pii]
PST - ppublish
SO  - Am Fam Physician. 2017 Jul 15;96(2):87-96.