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.

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 of 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. KEY CONCEPTS

O A distinction among convulsions, a single seizure, pseudoseizure, and epilepsy should be made in patients presenting with possible seizures.

© Selection of appropriate pharmacotherapy is dependent upon distinguishing, identifying, and understanding different seizure types.

Prior to starting pharmacologic therapy, it is essential to determine the risk of having a subsequent seizure.

Mechanisms of action, effectiveness for specific seizure ,ypes. common adverse effects, and potential for drug interactions are key elements in selecting a medication for individual patients.

® Antiepileptic drugs (AEDs) therapy should usually be initiated carefully using a titration schedule to minimize adverse events.

® Changes in AED regimens should be done in a stepwise fashion, keeping in mind drug interactions that may be present and that may necessitate dosage changes in concomitant drugs.

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.

Children and women with epilepsy have unique problems related to the use of AEDs.

O 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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