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Epilepsy and Seizures in Adults: From Diagnosis to Treatment and Beyond

Epilepsy and Seizures in Adults: From Diagnosis to Treatment and Beyond. Eduardo Garcia, MD Assistant Clinical Professor Tufts University School of Medicine Newton-Wellesley Hospital Newton, MA. What is a seizure?.

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Epilepsy and Seizures in Adults: From Diagnosis to Treatment and Beyond

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  1. Epilepsy and Seizures in Adults: From Diagnosis to Treatment and Beyond Eduardo Garcia, MD Assistant Clinical Professor Tufts University School of Medicine Newton-Wellesley Hospital Newton, MA

  2. What is a seizure? • International League Against Epilepsy Definition: An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.

  3. The Brain

  4. Is there more than one type of seizure? Epileptic Nonepileptic Psychogenic Physiologic • Generalized • Absence • Tonic • Clonic • Tonic-clonic • Atonic • Myoclonic • Focal • Simple Partial • Complex Partial

  5. Focal Vs. Generalized Seizures

  6. What is Epilepsy • ILAE Conceptual Definition: Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures, and by the neurobiological, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.

  7. What is Epilepsy? • Operational (practical) definition: Epilepsy is a disease of the brain defined by any of the following conditions: • 1. At least two unprovoked seizures occurring more than 24 hours apart. • 2. One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures (approximately 75% or more). • 3. At least two seizures in a setting of reflex epilepsy.

  8. Diagnosis History

  9. Physical Exam

  10. Tests

  11. EEG

  12. Antiepileptic drugs (AEDs)

  13. FDA approved antiepileptic drugs since 1993 Clobazam (Onfi®), eslicarbazepine (Aptiom®), ezogabine (Potiga®), felbamate (Felbatol®) gabapentin (Neurotin®), lamotrigine (Lamictal®), lacosamide (Vimpat®), levetiracetam (Keppra®), oxcarbazepine (Trilepal®), perampanel (Fycompa®), pregabalin (Lyrica®), rufinamide (Banzel®), tiagabine (Gabitril®), topiramate (Topamax®), vigabatrin (Sabril®) and zonisamide (Zonegran®).

  14. So what if AEDs do not work?

  15. Epilepsy Monitoring Unit Evaluation

  16. Intracranial investigation

  17. Epilepsy Surgery

  18. Anterior Temporal Lobectomy

  19. Vagus Nerve Stimulator • FDA approved 1997 for treatment of medically refractory partial onset seizures > 12 y/o • FDA approved 2005 for chronic recurrent depression > 18 y/o, who failed 4 medicaitons

  20. Responsive Neurostimulation FDA approved in 2013 adjunctive therapy in individuals > 18 with partial onset seizures with no > 2 epileptogenic foci

  21. What if surgery does not work?

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