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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?. - PowerPoint PPT Presentation
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Epilepsy and Seizures in Adults: From Diagnosis to
Treatment and Beyond
Eduardo Garcia, MDAssistant Clinical Professor
Tufts University School of Medicine Newton-Wellesley Hospital
Newton, MA
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.
The Brain
Is there more than one type of seizure?
Epileptic• Generalized
• Absence• Tonic• Clonic• Tonic-clonic• Atonic• Myoclonic
• Focal• Simple Partial• Complex Partial
Nonepileptic• Psychogenic
• Physiologic
Focal Vs. Generalized Seizures
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.
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.
DiagnosisHistory
Physical Exam
Tests
EEG
Antiepileptic drugs (AEDs)
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®).
So what if AEDs do not work?
Epilepsy Monitoring Unit Evaluation
Intracranial investigation
Epilepsy Surgery
Anterior Temporal Lobectomy
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
Responsive Neurostimulation
FDA approved in 2013 adjunctive therapy in individuals > 18 with partial onset seizures with no > 2
epileptogenic foci
What if surgery does not work?