Challenges in seizure management: Wrong diagnosis, wrong drug, wrong dose?

Research output: Contribution to journalReview articlepeer-review


PURPOSE: To review the management of patients with epilepsy, particularly those who experience seizures refractory to traditional pharmacologic therapy. EPIDEMIOLOGY: Epilepsy affects approximately 2.5 million Americans. As many as two thirds of individuals can be successfully managed with medication; the remainder may experience recurrent episodes due to inappropriate therapy or misdiagnosis. REVIEW SUMMARY: Epilepsy ranks among the most common neurologic diseases, and individuals with uncontrolled epilepsy bear the financial burden of costly medical treatments and lost work, as well as a tremendous psychosocial burden of a disorder that is often feared. This condition prevents individuals from performing essential functions in society and can be associated with serious injuries and death. Although the majority of patients can be successfully managed with medication, the remainder may experience recurring episodes because of inappropriately selected therapies. This review highlights common areas of misdiagnosis (such as psychogenic nonepileptic seizures), discusses various pharmacologic options (including the benefits of and management of monotherapy), and discusses epilepsy surgery. TYPE OF AVAILABLE EVIDENCE: Randomized-controlled trials, prospective studies, textbooks. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: The first step in helping individuals with refractory seizures is to exclude other clinical entities that mimic epilepsy. Complex multidrug regimens often can be avoided if monotherapy with the correct medication is prescribed at an adequate dose. Polypharmacy can be responsible for noncompliance because of impractical medication schedules and adverse effects. Nonpharmacologic modalities such as behavioral modification, counseling, and ketogenic diet are useful for many epileptic patients. If the patient continues to have seizures despite efforts to optimize therapy, surgery should be considered.

Original languageEnglish (US)
Pages (from-to)124-132
Number of pages9
JournalAdvanced Studies in Medicine
Issue number3
StatePublished - Mar 1 2005

ASJC Scopus subject areas

  • General Medicine


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