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Epilepsy - Highlights

Description

An in-depth report on the types, causes, diagnosis, and treatment of epilepsy.

Highlights:

Suicide Risk and Antiepileptic Drugs

In 2008, the U.S. Food and Drug Administration (FDA) announced that it will require warnings about suicidal risks to be added to the prescribing labels of all antiepileptic drugs. The FDA based its decision on clinical trials that showed that patients who took antiepileptic drugs had twice the risk of suicidal behavior or thoughts compared to patients who received placebo. The FDA recommends that patients who receive these drugs should be closely observed for signs of suicidality.

Antiepileptic drugs include:

Carbamazepine (Carbatrol, Equetro, Tegretol)
Valproate (Depakene)
Divalproex sodium (Depakote)
Ethosuximide (Zarontin)
Clonazepam (Klonopin)
Lamotrigine (Lamictal)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Topiramate (Topamax)
Oxcarbazepine (Trileptal)
Zonisamide (Zonegran)
Levetiracetam (Keppra)
Tiagabine(Gabitril)

Febrile Seizures and Epilepsy

Febrile seizures are caused by high fever and are common in young children. This type of seizure usually has no long-term effects. Although children who have simple febrile seizures have a slightly higher risk of developing epilepsy than children who do not have febrile seizures, the overall risk is still low. According to 2008 guidelines from the American Academy of Pediatrics, there is no evidence that preventive treatment of simple febrile seizures reduces the risk of epilepsy. Furthermore, due to the low risks of febrile seizures compared to the risks of anticonvulsant drugs, the AAP does not recommend anticonvulsant drug therapy to prevent febrile seizure recurrence.

Resources

www.epilepsyfoundation.org -- Epilepsy Foundation
www.aesnet.org -- American Epilepsy Society
www.aan.com -- American Academy of Neurology
www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke

References

Christensen J, Vestergaard M, Mortensen PB, Sidenius P, Agerbo E. Epilepsy and risk of suicide: a population-based case-control study. Lancet Neurol. 2007 Aug;6(8):693-8.

Foldvary-Schaefer N, Wyllie E. Epilepsy. In: Goetz C, ed. Textbook of Clinical Neurology. 3rd edition. Philadelphia, PA: Saunders Elsevier. 2007:chap 52.

Freeman JM, Kossoff EH, Hartman AL. The ketogenic diet: one decade later. Pediatrics. 2007 Mar;119(3):535-43.

French JA, Pedley TA. Clinical practice. Initial management of epilepsy. N Engl J Med. 2008 Jul 10;359(2):166-76.

Hemming K, Maguire MJ, Hutton JL, Marson AG. Vigabatrin for refractory partial epilepsy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD007302.

Jette N, Hemming K, Hutton JL, Marson AG. Topiramate add-on for drug-resistant partial epilepsy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001417.

Johnson MV. Seizures in childhood. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 586.

Krebs PP. Psychogenic nonepileptic seizures. Am J Electroneurodiagnostic Technol. 2007 Mar;47(1):20-8.

Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007 Nov 20;69(21):1996-2007.

Kwan P, Brodie MJ. Emerging drugs for epilepsy. Expert Opin Emerg Drugs. 2007 Sep;12(3):407-22.

Leone MA, Solari A, Beghi E; FIRST Group. Treatment of the first tonic-clonic seizure does not affect long-term remission of epilepsy. Neurology. 2006 Dec 26;67(12):2227-9.

Salanova V, Worth R. Neurostimulators in epilepsy. Curr Neurol Neurosci Rep. 2007 Jul;7(4):315-9.

Spencer SS. Seizures and epilepsy. In: Goldman L, ed. Cecil Medicine. 23rd edition. Saunders. 2007.

Tomson T, Hiilesmaa V. Epilepsy in pregnancy. BMJ. 2007 Oct 13;335(7623):769-73.

Reviewed last on: 2/11/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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