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Adult Epilepsy

Gregory Cascino (Editor), Joseph Sirven (Editor)
ISBN: 978-0-470-74122-1
326 pages
April 2011
Adult Epilepsy (0470741228) cover image

Description

Designed to provide a comprehensive but accessible introduction to epilepsy and seizure disorders, Adult Epilepsy provides state-of-the-art information in a concise format useful to a wide audience, from neurology residents to epilepsy fellows and practitioners. This illustrated guide to the assessment, diagnosis, and treatment of epilepsy is a valuable resource enabling clinicians to stay on top of the latest recommendations for best practice.
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Table of Contents

List of contributors xiii

Preface xvii

1 Introduction: epilepsy 1
Gregory D. Cascino

1.1 Epilepsy care: beginnings of observation and recognition 1

1.2 Epilepsy care: initial understanding and treatment 2

1.3 Epilepsy care: the Mayo Clinic 3

Section 1 Pathophysiology and epidemiology of seizures and epilepsy 7

2 Seizure and epilepsy syndromes classification 9
Jerry J. Shih

2.1 Introduction 9

2.2 The classification of epileptic seizures 9

2.3 Conclusion 16

3 Epidemiology of seizure disorders 19
Joseph I. Sirven

3.1 Incidence and prevalence of epilepsy 19

3.2 Incidence and prevalence of acute symptomatic seizures 21

3.3 Looking beyond epidemiology: the state of epilepsy care in the United States 22

3.4 Risk factors for epilepsy 23

3.5 Conclusion 24

Section 2 Diagnostic evaluation 27

4 The role of routine scalp electroencephalography 29
Terrence D. Lagerlund and Gregory A. Worrell

4.1 Introduction 29

4.2 Clinical application of EEG 30

4.3 Scalp EEG recording methods 32

4.4 Activation procedures 33

4.5 Interictal discharges correlated with epilepsy 34

4.6 Epileptic syndromes and the role of EEG 42

4.7 Conclusions 45

5 Neuroimaging in epilepsy 49
Gregory D. Cascino

5.1 Introduction 49

5.2 Magnetic resonance imaging 50

5.3 Functional neuroimaging 57

6 Video-EEG monitoring data 67
Elson L. So

6.1 Introduction 67

6.2 Pre-monitoring evaluation and preparation 67

6.3 Management during monitoring 68

6.4 Discharge management 78

Acknowledgments 78

7 Etiologies of seizures 83
Katherine H. Noe and Korwyn Williams

7.1 Introduction 83

7.2 Acute symptomatic seizures 83

7.3 Febrile seizures 86

7.4 Unprovoked seizures 87

8 The evaluation of nonepileptic paroxysmal events 99
Joseph F. Drazkowski and Matthew Hoerth

8.1 Introduction 99

8.2 Syncope 101

8.3 Transient ischemic events (TIAs) 103

8.4 Transient global amnesia (TGA) 104

8.5 Movement disorders 105

8.6 Sleep disorders 105

8.7 Psychogenic nonepileptic seizures (PNESs) 107

8.8 Summary 108

Section 3 Principles of medical management 113

9 Mechanisms of action of antiepileptic drugs 115
Jeffrey W. Britton, Tarek M. Zakaria, and Eduardo Benarroch

9.1 Introduction 115

9.2 Treatment of epilepsy 116

9.3 Excitatory mechanisms targeted by AEDs 118

9.4 Inhibitory mechanisms targeted by AEDs 120

9.5 Mechanism of action-specific drugs 122

9.6 Conclusions 126

10 Antiepileptic drugs: pharmacology, epilepsy indications, and selection 131
Jeffrey W. Britton and Julie Cunningham

10.1 Introduction 131

10.2 AED selection 132

10.3 Generic AED therapy 145

10.4 The AEDs: summary of clinical use, pharmacokinetics, and efficacy 147

Section 4 Generalized epilepsies 171

11 Idiopathic generalized epilepsies 173
Raj D. Sheth

11.1 Overview of the generalized epilepsies 173

11.2 Introduction 174

11.3 Differentiating generalized seizures from partial seizures 175

11.4 Clinical and EEG characteristics of generalized seizures 176

11.5 Generalized epilepsy syndromes 178

11.6 Treating generalized seizures 180

11.7 Treatment algorithm 180

11.8 Prognosis/outcomes 182

12 Symptomatic generalized epilepsies 183
Katherine C. Nickels and Elaine Wirrell

12.1 Introduction 183

12.2 Infantile onset syndromes 184

12.3 Childhood onset syndromes 190

12.4 Symptomatic generalized epilepsy syndromes of known cause 196

Section 5 Partial epilepsies 211

13 Overview of diagnosis and medical treatment of partial epilepsies 213
Joseph I. Sirven

13.1 Diagnosis and evaluation 213

13.2 Electroencephalography (EEG) 214

13.3 Imaging 215

13.4 Treatment and management 216

13.5 Which patient should be treated with antiseizure drugs? 216

13.6 Evidence-based guidelines 218

13.7 How well do seizure medications work? 218

13.8 Conclusion and summary 219

14 Medial temporal lobe epilepsy 221
William O. Tatum IV

14.1 Introduction 221

14.2 Functional neuroanatomy of the temporal lobe 222

14.3 Pathology 223

14.4 Differential diagnosis 225

14.5 Diagnosis 227

14.6 Concluding statements 239

15 Substrate-directed epilepsy 247
Gregory A. Worrell

15.1 Intractable partial epilepsy 247

15.2 Epilepsy surgery 248

15.3 Localization of the epileptogenic zone 250

15.4 Lesional MRI (or substrate-directed epilepsy syndromes) 253

15.5 Functional neuroimaging and intracranial EEG 253

15.6 Symptomatic partial epilepsy 258

15.7 Non-lesional MRI (non-substrate-directed partial epilepsy) 261

15.8 Non-lesional temporal lobe epilepsy (surgically remediable syndrome?) 262

15.9 Surgical advances 263

16 Non-substrate-directed partial epilepsy 271
Korwyn Williams and Katherine H. Noe

16.1 Introduction 271

16.2 Genetic or IPE syndromes 272

16.3 Medically refractory non-substrate-directed partial epilepsy 272

16.4 Conclusions 279

17 Surgical treatment 285
Cheolsu Shin

17.1 Introduction 285

17.2 The process of presurgical evaluation 286

17.3 Intracranial monitoring 287

17.4 Surgical procedures 289

17.5 Conclusion 294

Index 297

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Author Information

Gregory Cascino is a Professor of Neurology and principal investigator at the Mayo Clinic, in the National Institutes of Health funded study Epilepsy Phenome Genome Project (EPGP) beginning in 2007. He is interested in the care and management of patients with seizures and epilepsy and the evaluation of patients for surgical treatment of epilepsy.

Joseph Sirven is  a  Professor of Neurology at the Mayo Clinic and chair of neurology at Mayo Clinic Arizona. His main interests are in Epilepsy and Seizure Treatments in Adults and Children (particularly older adults), Epilepsy Surgery, Electroencephalography, Investigational Antiepilepsy Drugs, Status Epilepticus, Vagal Nerve Stimulator, Ketogenic Diet.

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Reviews

“To summarize, this book can be used as a practical guide to the diagnosis and management of many of the common aspects of epilepsy.  It is suitable for the general neurologist, non-neurologist or trainees who wants a quick review of a specific topic or a general survey of the whole field.”  (Canadian Journal of Neurological Sciences, 1 November 2012)                   

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