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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.

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Table 15-1. International Classification of Epileptic Seizures

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