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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

  1. Describe the epidemiology and social impact of epilepsy.

  2. Define terminology related to epilepsy, including seizure, convulsion, and epilepsy.

  3. Describe the basic pathophysiology of seizures.

  4. Describe the basic pathophysiology of epilepsy.

  5. Differentiate and classify seizure types when provided a description of the clinical presentation of the seizure and electroencephalogram.

  6. Identify key therapeutic decision points in the treatment of epilepsy.

  7. Establish therapeutic goals for pharmacotherapy in a patient with epilepsy.

  8. Discuss nonpharmacologic treatments for epilepsy.

  9. Recommend an appropriate pharmacotherapeutic regimen for the treatment of epilepsy.

  10. Select appropriate monitoring parameters for a pharmacotherapeutic regimen for epilepsy.

  11. Devise a plan for switching a patient from one antiepileptic regimen to a different regimen.

  12. Recognize complications of pharmacotherapy for epilepsy.

  13. Analyze potential drug interactions with antiepileptic drugs (AEDs).

  14. Determine when and how to discontinue AED therapy.

  15. Educate a patient or caregiver on epilepsy and pharmacotherapy for this disorder.

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KEY CONCEPTS

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  • Image not available. A distinction between convulsions, a single seizure, pseudoseizure, and epilepsy should be made in patients presenting with possible seizures.

  • Image not available. Selection of appropriate pharmacotherapy depends on distinguishing, identifying, and understanding different seizure types.

  • Image not available. Prior to starting pharmacologic therapy, it is essential to determine the risk of having a subsequent seizure.

  • Image not available. Mechanisms of action, effectiveness for specific seizure types, common adverse effects, and potential for drug interactions are key elements in selecting a medication for individual patients.

  • Image not available. Antiepileptic drug (AED) therapy should usually be initiated carefully using a titration schedule to minimize adverse events.

  • Image not available. Changes in AED regimens should be done in a stepwise fashion, keeping in mind drug interactions that may be present and may necessitate dosage changes in concomitant drugs.

  • Image not available. Discontinuation of AEDs should be done gradually, only after the patient has been seizure-free for 2 to 5 years, and with careful consideration of factors predictive of seizure recurrence.

  • Image not available. Children and women with epilepsy have unique problems related to the use of AEDs.

  • Image not available. Older adults have the highest incidence of newly diagnosed epilepsy and face unique challenges in treatment.

  • Image not available. Patients receiving AEDs for seizures should have regular monitoring for seizure frequency, seizure patterns, acute adverse effects, chronic adverse effects, and possible drug interactions.

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EPIDEMIOLOGY, SOCIAL IMPACT, AND ETIOLOGY

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Epidemiology

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Epilepsy is a disorder that afflicts approximately 2 million individuals in the United States, with an age-adjusted prevalence of approximately 4 to 7 cases/1,000 persons.1

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The incidence of epilepsy in the United States is estimated at 35 to 75 cases/100,000 persons per year.2,3 In developing countries, the incidence is higher at 100 to 190 cases/100,000 persons per year, possibly related to poor health care and prenatal care, increased risk of neurologic trauma, and increased rates of infections. About 8% of the U.S. population will experience a seizure during their lifetime. New-onset seizures occur most frequently in infants younger than 1 year of age and in adults after age 55.4 However, ...

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