epilepsy and seizures in adults: from diagnosis to treatment and beyond

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?