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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  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 and epilepsy.

  4. Differentiate and classify seizure types given a description of the clinical presentation of the seizure and electroencephalogram.

  5. Identify key therapeutic decision points and therapeutic goals in the treatment of epilepsy.

  6. Discuss nonpharmacologic treatments for epilepsy.

  7. Recommend an appropriate pharmacotherapeutic regimen with monitoring parameters for the treatment of epilepsy.

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

  9. Manage potential drug interactions with antiepileptic drugs (AEDs).

  10. Determine when and how to discontinue AED therapy.

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

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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 per 1000 persons.1 The incidence of epilepsy in the United States is estimated at 35 to 75 cases per 100,000 persons per year.2,3 In developing countries, the incidence is higher at 100 to 190 cases per 100,000 persons per year. About 8% of the US population will experience a seizure during their lifetime. New-onset seizures occur most frequently in infants younger than 1 year and in adults after age 55.2

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SOCIAL IMPACT

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Epilepsy has a profound impact on a patient’s life. Due to restrictions on driving, individuals who have recently had a seizure face major impediments to engaging in simple activities.4 Fifty percent of patients with epilepsy report cognitive and learning difficulties.5,6 Underemployment and unemployment are major concerns for individuals with epilepsy, due to limited transportation options, cognitive and learning difficulties, and seizures, resulting in problems paying for health care. Additionally, the social stigma of embarrassment or injury due to seizures in public results in isolation of the patient.7

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Patients with epilepsy often depend on caregivers to assist with medications, transportation, and ensuring the patient’s safety, so they should be informed about treatments and managing seizures.

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ETIOLOGY

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In approximately 80% of patients with epilepsy, the underlying etiology is unknown.8 The most common causes of epilepsy are head trauma and stroke. Developmental and identifiable genetic defects cause about 5% of cases. Genetic causes are presumed in up to 25% of patients but are often unproven. Brain tumors, central nervous system (CNS) infections, and neurodegenerative diseases are other common causes. Human immunodeficiency virus infection and neurocysticercosis infection are also important causes.

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Isolated seizures can be caused by stroke, CNS trauma, CNS infections, metabolic disturbances (eg, hyponatremia, hypoglycemia), and hypoxia. Failure to correct these causes may lead to the development of epilepsy. Drugs commonly associated with causing seizures are tramadol, bupropion, ...

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