The management of epilepsy in children and adults

Abstract

The International League Against Epilepsy has recently published a new classification of epileptic seizures and epilepsies to reflect the major scientific advances in our understanding of the epilepsies since the last formal classification 28 years ago. The classification emphasises the importance of aetiology, which allows the optimisation of management. Antiepileptic drugs (AEDs) are the main approach to epilepsy treatment and achieve seizure freedom in about two-thirds of patients. More than 15 second generation AEDs have been introduced since the 1990s, expanding opportunities to tailor treatment for each patient. However, they have not substantially altered the overall seizure-free outcomes. Epilepsy surgery is the most effective treatment for drug-resistant focal epilepsy and should be considered as soon as appropriate trials of two AEDs have failed. The success of epilepsy surgery is influenced by different factors, including epilepsy syndrome, presence and type of epileptogenic lesion, and duration of post-operative follow-up. For patients who are not eligible for epilepsy surgery or for whom surgery has failed, trials of alternative AEDs or other non-pharmacological therapies, such as the ketogenic diet and neurostimulation, may improve seizure control. Ongoing research into novel antiepileptic agents, improved techniques to optimise epilepsy surgery, and other non-pharmacological therapies fuel hope to reduce the proportion of individuals with uncontrolled seizures. With the plethora of gene discoveries in the epilepsies, "precision therapies" specifically targeting the molecular underpinnings are beginning to emerge and hold great promise for future therapeutic approaches.

Pharmaceutical Benefits Scheme restrictions on anti‐epileptic drug prescribing promote unsafe and outdated practice

“…Since 1978, numerous new AEDs with similar efficacy to the old AEDs but improved side effect profiles and safety 6,7 have been marketed. Most of these are listed on the PBS but with varying degrees of prescribing restrictions.…”

Epileptic Seizures: the challenge continues

“…In adults, benzodiazepines [specifically (IM) Midazolam, Lorazepam (IV) or Diazepam (IV)] are recommended as the initial therapy of choice, given its demonstrated efficacy, safety and tolerability (level of evidence A, class I) (Fiest et al, 2017, Glauser et al, 2016, Perucca, Scheffer & Kiley, 2018.…”

“…It is estimated that the risk of recurrence of a person who had two crises not provoked again to have epileptic seizures is around 60-90% (Table 5) (Johnson, 2019). On the other hand, epilepsy is considered to be resolved in those individuals who had epilepsy related to a specific age group and who exceeded that age or those who had the last crisis for more than 10 years and have been at least five years without Use antiepileptic medications (Martinez-Juarez et al, 2016, Perucca, Scheffer & Kiley, 2018.…”

Cardiomyopathy Secondary to Selenium Deficiency: A Review of Clinical Cases

“…The classic ketogenic diet is based on a 4:1 of fat to carbohydrate ratio [41]. The ketogenic diet has been proven to be beneficial to patients with drug-resistant epilepsy [42]. One study showed that 38% children in the study who had been placed on ketogenic diet for three months experienced a reduction in seizures by over 50% compared to 6% in the control group [43].…”