Optimizing therapy of seizures in specific clinical situations

Abstract

The last International Epilepsy Congress (IEC) held in Paris in September of 2005 focused primarily on the major issues raised by comorbidities and special populations in epilepsy. It was the intention of Dr. Arzimanoglou and myself, who were honored to chair this meeting, to invite a broad medical community to participate in this thorough discussion. This proved to be a successful initiative, with the largest attendance of over 5000 participants ever gathered at an international epilepsy congress. This supplement is largely inspired by those aspects of the 2005 IEC program that specifically dealt with epilepsy treatment in specific patient populations. Three main types of clinical situations should be distinguished, although they might eventually result in similar recommendations: 1) Diseases directly responsible for the seizure disorder, such as stroke,1 brain tumors,2,3 and chronic CNS infection, including HIV and neurocysticercosis4; 2) medical conditions that share more complex or inconstant relations with the patient's epilepsy but might still require specific treatment considerations, such as endocrine disorders,5 renal and hepatic dysfunction,6 organ transplants,7 psychiatric disorders, including substance abuse and ADHD,8–10 and developmental disabilities11; and 3) women with epilepsy of childbearing age, with respect to oral contraceptives and pregnancy.12,13 A few figures illustrate the size of the population concerned by the above issues. Stroke might represent up to 11% of all etiologies in adult epilepsy,1 and brain tumors might account for another 6%. In many developing countries, and particularly in South America, neurocysticercosis appears to be …