Adult Epilepsy (eBook)

Gregory Cascino is a Professor of Neurology and principalinvestigator at the Mayo Clinic, in the National Institutes ofHealth funded study Epilepsy Phenome Genome Project (EPGP)beginning in 2007. He is interested in the care and management ofpatients with seizures and epilepsy and the evaluation of patientsfor surgical treatment of epilepsy. Joseph Sirven is a Professor of Neurology atthe Mayo Clinic and chair of neurology at Mayo Clinic Arizona.His main interests are in Epilepsy and Seizure Treatments in Adultsand Children (particularly older adults), Epilepsy Surgery,Electroencephalography, Investigational Antiepilepsy Drugs, StatusEpilepticus, Vagal Nerve Stimulator, Ketogenic Diet.

Adult Epilepsy 3
Contents 9
List of contributors 15
Preface 19
1 Introduction: epilepsy 21
1.1 Epilepsy care: beginnings of observation and recognition 21
1.2 Epilepsy care: initial understanding and treatment 22
1.3 Epilepsy care: the Mayo Clinic 23
Section 1 Pathophysiology and epidemiology of seizures and epilepsy 27
2 Seizure and epilepsy syndromes classification 29
2.1 Introduction 29
2.2 The classification of epileptic seizures 29
2.3 Conclusion 36
3 Epidemiology of seizure disorders 39
3.1 Incidence and prevalence of epilepsy 39
3.2 Incidence and prevalence of acute symptomatic seizures 41
3.3 Looking beyond epidemiology: the state of epilepsy care in the United States 42
3.4 Risk factors for epilepsy 43
3.5 Conclusion 44
Section 2 Diagnostic evaluation 47
4 The role of routine scalp electroencephalography 49
4.1 Introduction 49
4.2 Clinical application of EEG 50
4.3 Scalp EEG recording methods 52
4.4 Activation procedures 53
4.5 Interictal discharges correlated with epilepsy 54
4.6 Epileptic syndromes and the role of EEG 62
4.7 Conclusions 65
5 Neuroimaging in epilepsy 69
5.1 Introduction 69
5.2 Magnetic resonance imaging 70
5.3 Functional neuroimaging 77
6 Video-EEG monitoring data 87
6.1 Introduction 87
6.2 Pre-monitoring evaluation and preparation 87
6.3 Management during monitoring 88
6.4 Discharge management 98
Acknowledgments 98
7 Etiologies of seizures 103
7.1 Introduction 103
7.2 Acute symptomatic seizures 103
7.3 Febrile seizures 106
7.4 Unprovoked seizures 107
8 The evaluation of nonepileptic paroxysmal events 119
8.1 Introduction 119
8.2 Syncope 121
8.3 Transient ischemic events (TIAs) 123
8.4 Transient global amnesia (TGA) 124
8.5 Movement disorders 125
8.6 Sleep disorders 125
8.7 Psychogenic nonepileptic seizures (PNESs) 127
8.8 Summary 128
Section 3 Principles of medical management 133
9 Mechanisms of action of antiepileptic drugs 135
9.1 Introduction 135
9.2 Treatment of epilepsy 136
9.3 Excitatory mechanisms targeted by AEDs 138
9.4 Inhibitory mechanisms targeted by AEDs 140
9.5 Mechanism of action-specific drugs 142
9.6 Conclusions 146
10 Antiepileptic drugs: pharmacology, epilepsy indications, and selection 151
10.1 Introduction 151
10.2 AED selection 152
10.3 Generic AED therapy 165
10.4 The AEDs: summary of clinical use, pharmacokinetics, and efficacy 167
Section 4 Generalized epilepsies 191
11 Idiopathic generalized epilepsies 193
11.1 Overview of the generalized epilepsies 193
11.2 Introduction 194
11.3 Differentiating generalized seizures from partial seizures 195
11.4 Clinical and EEG characteristics of generalized seizures 196
11.5 Generalized epilepsy syndromes 198
11.6 Treating generalized seizures 200
11.7 Treatment algorithm 200
11.8 Prognosis/outcomes 202
12 Symptomatic generalized epilepsies 203
12.1 Introduction 203
12.2 Infantile onset syndromes 204
12.3 Childhood onset syndromes 210
12.4 Symptomatic generalized epilepsy syndromes of known cause 216
Section 5 Partial epilepsies 231
13 Overview of diagnosis and medical treatment of partial epilepsies 233
13.1 Diagnosis and evaluation 233
13.2 Electroencephalography (EEG) 234
13.3 Imaging 235
13.4 Treatment and management 236
13.5 Which patient should be treated with antiseizure drugs? 236
13.6 Evidence-based guidelines 238
13.7 How well do seizure medications work? 238
13.8 Conclusion and summary 239
14 Medial temporal lobe epilepsy 241
14.1 Introduction 241
14.2 Functional neuroanatomy of the temporal lobe 242
14.3 Pathology 243
14.4 Differential diagnosis 245
14.5 Diagnosis 247
14.6 Concluding statements 259
15 Substrate-directed epilepsy 267
15.1 Intractable partial epilepsy 267
15.2 Epilepsy surgery 268
15.3 Localization of the epileptogenic zone 270
15.4 Lesional MRI (or substrate-directed epilepsy syndromes) 273
15.5 Functional neuroimaging and intracranial EEG 273
15.6 Symptomatic partial epilepsy 278
15.7 Non-lesional MRI (non-substrate-directed partial epilepsy) 281
15.8 Non-lesional temporal lobe epilepsy (surgically remediable syndrome?) 282
15.9 Surgical advances 283
16 Non-substrate-directed partial epilepsy 291
16.1 Introduction 291
16.2 Genetic or IPE syndromes 292
16.3 Medically refractory non-substrate-directed partial epilepsy 292
16.4 Conclusions 299
17 Surgical treatment 305
17.1 Introduction 305
17.2 The process of presurgical evaluation 306
17.3 Intracranial monitoring 307
17.4 Surgical procedures 309
17.5 Conclusion 314
Index 317

"To summarize, this book can be used as a practical guideto the diagnosis and management of many of the common aspects ofepilepsy. It is suitable for the general neurologist,non-neurologist or trainees who wants a quick review of a specifictopic or a general survey of the whole field." (Canadian Journal of Neurological Sciences, 1 November2012)