The first step toward initiating therapy is to establish the type or types of seizures the patient is experiencing. The classifications of seizure type and epilepsy syndrome are made primarily on clinical grounds and may be supported by laboratory, neurophysiologic, and radiographic studies. This determination has important implications for the selection of AEDs.
The International Classification of Epileptic Seizures published by the International League Against Epilepsy2 is a helpful framework to follow. If possible, determining the patient's epilepsy syndrome provides even more information about which therapies are most likely to succeed.
An accurate diagnosis requires a thorough history from the patient and observers, with close attention to descriptions of actual seizures. The patient may find it easier to express symptoms by referring to published seizure descriptions.3
If the patient is experiencing more than one type of seizure and can describe the different symptoms of each type, that may allow the clinician to better categorize the patient's seizure types and epilepsy syndrome, as well as plan the therapeutic approach more effectively.
It is often necessary to ask pointed questions to uncover seizure triggers, behaviors or environmental factors that may increase the possibility of a seizure. Common triggers include sleep deprivation, alcohol intake, stress, and other potentially modifiable factors. Measures to limit exposure to these triggers may successfully augment AED therapy.
Reviewed and revised December 2003 by Steven C. Schachter, MD, Harvard Medical School
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