The Comprehensive Evaluation and Treatment of Epilepsy: A Practical Guide

Front Cover......Page 1
The Comprehensive Evaluation and Treatment of Epilepsy: A Practical Guide......Page 4
Copyright Page......Page 5
Contents......Page 6
Contributors......Page 16
Preface......Page 18
How Can the Physician Distinguish between Simple Partial and Complex Partial Seizures?......Page 20
What Are the Types of Generalized Seizures?......Page 22
What Is an Epileptic Syndrome?......Page 30
What Are the Categories of Idiopathic-Related Partial Epilepsies?......Page 32
What Are the Categories of Generalized Epilepsies and Syndromes?......Page 37
References......Page 51
Should Every Patient Who Has a Seizure Have an Imaging Workup?......Page 56
What Imaging Methods Are Indicated and What Should the Physician Order When Performing a Workup on a Patient with Seizures?......Page 57
What Type of Lesion Is Neuroimaging Most Likely to Show?......Page 65
How Should the Physician Interpret the Findings When Functional Imaging Methods Are Used?......Page 70
How Can Lesions Be Differentiated by a Combination of Magnetic Resonance Imaging Modalities?......Page 72
What Is the Optimal Radiographic Evaluation of a Patient with Epilepsy?......Page 74
When Are Follow-up Scans Indicated?......Page 75
Are There Any New Imaging Methods or Techniques for the Evaluation of Patients with Epilepsy?......Page 76
References......Page 78
How Does Diagnosis of the Patient\'s Seizure Type Influence the Choice of Therapy?......Page 80
What Can Be Done, as Treatment Is Initiated, to Maximize the Likelihood of a Successful Outcome?......Page 81
What Are the Results of AED Therapy?......Page 83
What Are the Typical Side Effects of AEDs?......Page 87
What Are the Advantages of Monotherapy over Polytherapy?......Page 88
What Are the Roles of AED Levels and Blood Tests?......Page 90
Is AED Treatment during Pregnancy Safe? What Are the Safest AEDs in General?......Page 91
What Are the Other Elements of Treatment besides Medical Therapy?......Page 92
References......Page 93
When Is Epilepsy Considered Intractable?......Page 94
How Do Physicians\' and Patients\' Perspectives on Intractable Epilepsy Tend to Differ?......Page 95
How Does AED Therapy Affect the Prognosis for Patients with Specific Epilepsy Syndromes?......Page 97
How Many Medications Should Be Tried before a Patient Is Evaluated for Surgery?......Page 99
What Factors Contribute to Incomplete Seizure Control or Disabling Side Effects?......Page 101
When Should the Diagnosis of Nonepileptic Seizures Be Considered?......Page 102
What Factors Contribute to Incorrect Classification of Seizures?......Page 103
How Do Lifestyle and Living Conditions Affect Seizure Control?......Page 104
How Does Uncontrolled Epilepsy Affect the Patient?......Page 105
References......Page 107
What Is the Patient\'s Perspective on Epilepsy?......Page 110
What Factors Affect a Person\'s Coping and Adjustment to Seizures?......Page 111
What Psychosocial Interventions Are Appropriate for Patients Whose Epilepsy Has Not Been Confirmed?......Page 115
What Seizure Variables May Affect the Patients\' Psychosocial Adjustment?......Page 116
What Impact Do Seizures Have on Patients\' Daily Lives?......Page 117
What Treatment Options Exist for Psychosocial Problems?......Page 119
What Psychosocial Issues Need to Be Addressed before and after Epilepsy Surgery?......Page 125
What Community Resources and Supports Are Available to Persons with Epilepsy and Their Families?......Page 126
References......Page 128
What Is Neuropsychology?......Page 130
How Does Temporal Lobe Epilepsy Affect Cognitive Status?......Page 131
How Does Temporal Lobe Epilepsy Affect Emotional and Psychological Status?......Page 132
What Are Specific Considerations in the Neuropsychological Evaluation of Patients with TLE?......Page 133
What Neuropsychological Tests Are Used in the Evaluation of Patients with Epilepsy?......Page 135
What Is the Intracarotid Amobarbital Test?......Page 139
How Is the Intracarotid Amobarbital Test Administered?......Page 140
What Is Cortical Mapping?......Page 141
What Neuropsychological Changes Are Associated with Surgery for Seizures?......Page 143
Conclusion......Page 144
References......Page 145
Does Epilepsy Predispose Patients to Particular Psychiatric Illnesses or Behavioral Problems?......Page 150
How Do Psychiatric or Behavioral Symptoms Vary in Patients with Simple as Opposed to Complex Partial Seizures?......Page 151
Are There Differences between Temporal and Frontal Lobe Epilepsies?......Page 153
Why Is Depression a Serious Complication of Epilepsy?......Page 154
What Types of Psychosis May Develop in Patients with Epilepsy?......Page 155
What Other Psychiatric Symptoms May Develop in Epilepsy?......Page 156
Have Specific Behaviors Been Described during the Interictal Period in Patients with TLE?......Page 157
Are Temper Problems or Aggression Associated with TLE?......Page 158
How Do Physicians Distinguish Psychogenic Nonepileptic Seizures from True Epileptic Seizures?......Page 159
What Constitutes an Appropriate Evaluation for the Epilepsy Patient with Psychiatric Symptoms?......Page 160
Which Psychotropic Medications May Be Helpful for Patients with Epilepsy?......Page 162
In Addition to Medication, What Psychiatric Interventions Can Be Helpful for Epilepsy Patients?......Page 164
What Effects Do Antiepileptic Medications Have on Psychiatric Symptoms in Epilepsy?......Page 165
Selected Readings......Page 166
What Is Generalized Convulsive Status Epilepticus and What Causes It?......Page 168
What Complications Can Occur with Convulsive Status Epilepticus?......Page 171
What Are the Other Types of Status Epilepticus?......Page 173
How Is Status Epilepticus Diagnosed?......Page 178
How Are Anticonvulsants Used to Treat Status Epilepticus?......Page 180
When Should Electroencephalography Be Used?......Page 186
When and How Should the Patient\'s Condition Be Reevaluated during Treatment?......Page 187
References......Page 188
Why Is an Understanding of Nonepileptic Seizures Important?......Page 192
What Clues to the Diagnosis of Nonepileptic Seizures May Be Provided by the Patient\'s History?......Page 193
Do Nonepileptic Seizures Have Characteristics That Suggest the Diagnosis?......Page 194
Are Any of These Clinical Characteristics Diagnostic for Nonepileptic Seizures?......Page 195
Do Nonepileptic Seizures Sometimes Coexist with Epilepsy?......Page 196
How Can One Make a Definitive Diagnosis of Nonepileptic Seizures?......Page 197
If Intensive EEG–Video Monitoring Is Not Available, What Alternatives Can Be Used?......Page 199
What Are the Most Common Psychiatric Diagnoses Associated with Nonepileptic Seizures?......Page 200
What Is the Best Approach to Treatment?......Page 201
References......Page 202
How Did the Event Recording System Evolve?......Page 204
How Does An Ambulatory EEG Monitoring System Differ from an Inpatient System?......Page 205
What Are the Clinical Applications of Ambulatory Monitoring?......Page 206
How Effective Is Ambulatory Outpatient EEG Monitoring?......Page 207
What Advances in Ambulatory Outpatient EEG Monitoring Can Be Expected in the Future?......Page 211
References......Page 214
How Do Surgeons Know that Lobectomy Will Help to Control or Eliminate Seizures?......Page 216
How Is a Cortical Excision Performed?......Page 217
How Much Brain Tissue Should Be Removed?......Page 218
What Are the Possible Complications of Surgery?......Page 219
What Is a Hemispherectomy?......Page 220
What Is a Callosotomy?......Page 221
What Are Implanted EEG Electrodes?......Page 222
How Are Depth Electrodes Implanted?......Page 223
Conclusion......Page 224
References......Page 225
How Do Hormones and Epilepsy Interact?......Page 226
Catamenial Epilepsy: What Is It and How Should It Be Evaluated and Treated?......Page 227
How Should Catamenial Epilepsy Be Evaluated?......Page 229
Menarche, Pregnancy, Menopause: Do They Affect Seizures?......Page 230
How Does Partial Epilepsy Affect Endocrine Reproductive Function in Women?......Page 232
How Should Women with Epilepsy and Reproductive Dysfunction be Evaluated?......Page 234
How Does Epilepsy Affect Women\'s Sexuality?......Page 236
How Do Seizures Affect Reproductive Endocrine Function in Men?......Page 237
What Effects Do Seizures Have on Hormone Production Acutely, and What Clinical Relevance Do These Effects Have?......Page 238
Of What Clinical Utility Is Postictal Prolactin Testing, and How Should It Be Done?......Page 239
Are Any Other Hormonal Systems Clinically Affected by Partial Seizures?......Page 240
What Is the Effect of AEDs on Sexuality in Men and Women and on Reproduction in Men?......Page 241
How Can AED-Related Hyposexuality Be Treated?......Page 242
What Additional Effects May AEDs Have on Reproductive Function in Women?......Page 243
Which Other Hormonal Systems Are Affected by AEDs?......Page 244
Can Hormones Be Used to Treat Epilepsy?......Page 245
References......Page 247
What Are the Most Common Causes of Seizures and Epilepsy in Older Age Groups?......Page 252
How Do Seizures Present In Older People?......Page 256
What Is the Differential Diagnosis of Transient Alterations in Function in This Population, and What Tests Best Distinguish One Disorder from Another?......Page 257
What Are the Most Important Elements of the History and Physical Examination, and What Ancillary Diagnostic Tests Should Be Performed to Evaluate a First Seizure?......Page 262
When Should Older Patients Receive Therapy after a First Seizure?......Page 263
What Considerations Apply to Choice of AEDs in the Elderly? What Potential Adverse Effects and Drug Interactions Are of Particular Concern in the Elderly?......Page 264
In What Ways Do Pharmacokinetic Factors Change with Aging? What Are the Implications for the Way AEDs Are Used in Older People?......Page 266
How Should Long-Standing, Apparently Stable Epilepsy in the Elderly Be Treated? When Can AEDs Be Withdrawn in This Population?......Page 267
Is Surgical Treatment for Medically Intractable Epilepsy a Possibility in Elderly Patients?......Page 268
What Are the Causes, Manifestations, and Risks of Status Epilepticus in the Elderly, and How Should It Be Treated?......Page 269
References......Page 270
What Is the Team Approach to the Management of Epilepsy?......Page 274
What Is the Physician\'s Role on the Team?......Page 275
What Is the Nurse\'s Role as a Member of the Team?......Page 276
What Is the Psychologist\'s or Neuropsychologist\'s Role as a Member of the Team?......Page 277
What Practical and Economic Advantages Do Comprehensive Epilepsy Management Teams Offer?......Page 278
Index......Page 280