Identifying and treating clinical subgroups of patients with epilepsy: A case review

These patients' cases highlight key clinical factors that can be used to guide treatment selection. Table 3 lists key AED properties: spectrum of action, relative efficacy and tolerability, dosing interval, and potential for drug interactions [55]. The elderly patient with partial-onset seizures caused by cerebrovascular disease, for example, was particularly vulnerable to CNS side effects of AEDs, was taking multiple medications, and yet had relatively easy to control epilepsy. Consequently, she required treatment with a well-tolerated, but not necessarily highly potent AED that has limited drug interactions. Based on differences between AEDs (Table 3) and profiles of individual drugs (Table 4), appropriate treatments may be lamotrigine or gabapentin. Conversely, the patient with developmental disabilities and multiple seizure types needed a potent broad-spectrum AED, and valproic acid and levetiracetam were appropriate choices based on AED and patient profiles. It is hoped that this article encourages clinicians to consider individual patient factors in evaluating and treating seizures. As these examples illustrate, recognizing characteristic clinical patterns in subgroups of patients is a key to assessing individual treatment needs for patients with epilepsy.