A systematic search of the literature was performed on June 30,
2005. The search, limited to human subjects and journals in the
English language, included PubMed (including Practice Guidelines),
MD Consults, UpToDate®, and EBM Reviews (2000–2005):
Cochrane database, DARE, and ACP Journal Club.
Epilepsy is a common chronic neurological disorder with an age-adjusted
incidence of approximately 44 per 100000 person-years, a prevalence
of 6 to 8 per 1000, and a cumulative incidence, through age 74,
of 3.1%.1,2 There is a bimodal distribution of
the first seizure, with one peak occurring in newborn and young
children and the second in patients older than 65 years.3
It is important to recognize and optimally treat epileptic patients
since epilepsy can significantly impact their quality of life; it
can affect their chances of employment, social relationships, and feelings
of self-worth. Epilepsy may be responsible for significant morbidity
including psychological distress, anxiety and depression, and mortality.
Unfortunately up to 30% of the population develops drug-resistant
epilepsy, especially people with partial onset seizures. The failure
to respond to three or more antiepileptic drugs (AEDs) denotes drug-resistant
or intractable epilepsy.
To optimally manage a patient with epilepsy, the physician must
first determine the type of epilepsy. This is based on the clinical
history (both from the patient and observers), radiographic information,
and electroencephalogram (EEG) results. The International League
Against Epilepsy (ILAE) developed a seizure-classification scheme,
which is used today (Table 15-1)4. This scheme categorizes
seizures as partial, generalized, or unclassified. Partial seizures
are further subdivided into simple partial seizures (typified by
no impairment of consciousness), complex partial seizures (impairment
of consciousness present), and partial seizures developing into secondarily
generalized seizures. Generalized seizures are subdivided into nonconvulsive (absence
of convulsions) and convulsive seizures.
Table 15-1. International
Classification of Epileptic Seizures |Favorite Table|Download (.pdf)
Table 15-1. International
Classification of Epileptic Seizures
|I. Partial (Focal Seizures)|
|A. Simple partial seizures (consciousness not impaired)|
|1. With motor signs (including Jacksonian, versive, and postural)|
|2. With sensory symptoms (including visual, somatosensory,
auditory, olfactory, gustatory, and vertiginous)|
|3. With psychic symptoms (including dysphasic, dysmnesic, hallucinatory,
and affective changes)|
|4. With autonomic symptoms (including epigastric sensation, pallor, flushing, papillary change)|
|B. Complex partial seizures (consciousness is impaired)|
|1. Simple partial onset followed by impaired consciousness|
|2. With impairment of consciousness at onset|
|3. With automatisms|
|C. Partial seizures evolving to secondarily generalized seizures|
|II. Generalized Seizures of Nonfocal Origin (convulsive
|A. Absence seizures|
|1. With impaired consciousness only|
|2. With one or more of the following: atonic components,
tonic components, automatisms, autonomic components|
|B. Myoclonic jerks (single or multiple)|
|C. Tonic–clonic seizures (may include clonic–tonic–clonic seizures)|
|D. Tonic seizures|
|E. Atonic seizures|
|III. Unclassified Epileptic Seizures|
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