Diagnosis and Treatment of Epilepsy: Overview and General Principles

Abstract

The management of a patient with epilepsy requires the physician to address himself to two basic tasks: (1) an accurate diagnosis must be made with special attention to the possibility of progressive intracranial disease; and (2) an effective regimen for control of the seizures must be devised. DIAGNOSTIC CONSIDERATIONS ASSOCIATED WITH AGE Seizures beginning in infancy are accompanied, in about half of cases, by other evidence of cerebral damage, especially mental subnormality. The precise pathology often cannot be determined during life, although a cerebral developmental defect or birth injury is usually responsible. In a small proportion of cases a metabolic error, subdural hematoma, neuronal degenerative disease, or some other progressive process will be revealed by a history of deterioration in skills previously acquired. The diagnosis can then be established by other characteristic signs of the condition under consideration and appropriate laboratory studies. Grand mal, focal seizures and minor motor seizures are the types usually encountered in infancy. The same factors which commonly cause seizures in infancy continue to initiate seizures in childhood and early adolescence, but to a steadily decreasing extent. Thus, seizures due to a birth injury, like most post-traumatic seizures, usually begin within 24 months after the traumatic incident1; however, they may be delayed until late childhood or adolescence. Seizures appearing as a sequela of meningitis or other infections are sometimes similarly delayed. After the second year of life, seizures of unknown cause rapidly increase in incidence, including cases of so-called genetic epilepsy. In the latter, centrencephalic seizure bursts (3/sec wave and spike discharges) appear diffusely in the EEG, not only in patients, but in 45% of their asymptomatic siblings (aged 4 to 16 years), as well.