100 - Epilepsies

Abstract

Epilepsy is one of the most common neurological diseases, affecting individuals across the life span. Recurrent seizures are the most prominent manifestation of epilepsy, with associated neurobiological, cognitive, psychological, and social consequences. Seizures have diverse clinical manifestations and require classification. The most recent classification divides seizures into broad categories based on onset, which can be focal, generalized, or unknown. A three-level classification of the epilepsies starts with classification of seizures, then classification of epilepsies, then classification of epileptic syndromes. At every level of classification the practitioner is encouraged to consider the epilepsy etiology as well as epilepsy comorbidities. The evaluation of epilepsy should include testing to confirm the diagnosis, help classify the epilepsy, and uncover its underlying etiology. When the epilepsy is resistant to pharmacological therapy, further testing can be pursued to localize the epileptogenic zone for possible surgical treatment. The treatment of epilepsy starts with pharmacotherapy, which currently aims to suppress seizures. Other treatment modalities are available when pharmacotherapy fails. These include dietary therapy, neurostimulation, and epilepsy surgery. Epilepsy surgery requires an extensive presurgical evaluation to localize the epileptogenic zone. Patients with a well-defined epileptogenic zone that does not overlap eloquent cortex are candidates for surgical resection with excellent odds of achieving seizure freedom.