In the past, many physicians considered the goal of epilepsy therapy to be complete control of seizures regardless of side effects. This goal has evolved so that now the emphasis is on enabling patients with epilepsy to lead lifestyles consistent with their capabilities.1 The introduction of new medications and other treatment modalities, the increased availability of epilepsy surgery, and the heightened awareness of quality-of-life issues have brought new hope to patients previously hampered by seizures, medication side effects, or psychosocial difficulties.
The strategy for designing and implementing a treatment plan begins with accurate diagnosis of the patient's seizure type(s) and measurement of seizure frequency and severity. Referral to a neurologist may be appropriate to establish the diagnosis and formulate a treatment plan, but subsequent follow-up is often managed by the primary care physician.
In evaluating the effectiveness of treatment, the clinician takes into consideration medication side effects and any psychosocial problems the patient many be having. The treatment process is more likely to be successful when the clinician has a working knowledge of available antiepileptic drugs (AEDs), their pharmacokinetics, side effects, and drug-drug interactions.
Reviewed and revised December 2003 by Steven C. Schachter, MD, Harvard Medical School
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