Fast Facts: Epilepsy in Adults

M.J. Brodie, S. Shepley, P. Tittensor

Description

Epilepsy is the most common serious neurological condition in the world; however, it is not a homogeneous disease. While some epilepsies spontaneously remit, some are lifelong and others have a variable prognosis. With a growing array of targeted therapies, specific syndromes need to be identified and characterized so appropriate treatment can be given. For others, there are surgical options, and over the last few years, significant advances have been made in neurostimulation. This resource focuses on the management of epilepsy in adults; its sister publication, Fast Facts: Epilepsy in Children and Adolescents', on the treatment of children and adolescents. The authors have provided a succinct and practical resource that will help clinicians investigate, diagnose and treat adults with a wide variety of seizure disorders; it will also help people with epilepsy better understand and manage their condition. Table of Contents: • Epidemiology and prognosis • Classification and causes of seizures, epilepsy types and syndromes • Diagnosis • Pharmacological management • Antiseizure medications • Non-pharmacological management • Status epilepticus and seizure clusters • Specific populations • Comorbidities, quality of life and education • Psychogenic non-epileptic seizures • Research directions

Sujets

• Medical
• Médecine
• Neurology

Informations

• Publié par: S. Karger AG
• Date de parution: 03 novembre 2022
• Nombre de lectures: 0
• EAN13: 9783318071948
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Fast Facts: Epilepsy in Adults
First published 2023
Text 2023 Phil Tittensor, Sheila Shepley, Martin J Brodie
2023 in this edition S. Karger Publishers Ltd
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ISBN 978-3-318-07081-1
Tittensor P (Phil)
Fast Facts: Epilepsy in Adults/
Phil Tittensor, Sheila Shepley, Martin J Brodie
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.
Contents
List of abbreviations
Introduction
Epidemiology and prognosis
Classification and causes of seizures, epilepsy types and syndromes
Diagnosis
Pharmacological management
Antiseizure medications
Non-pharmacological management
Status epilepticus and seizure clusters
Specific populations
Comorbidities, quality of life and education
Psychogenic non-epileptic seizures
Research directions
Useful resources
Appendix 1: Treatment algorithm for tonic-clonic SE in adults in hospital
Index
List of abbreviations
ACT: acceptance commitment therapy
AMPA: -amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
ASM: antiseizure medication
AV: atrioventricular
BMD: bone mineral density
BRV: brivaracetam
CBT: cognitive behavioral therapy
CBZ: carbamazepine
CEN: cenobamate
CI: confidence interval
CLB: clobazam
CNS: central nervous system
CT: computed tomography
CYP450: cytochrome P450
DBS: deep-brain stimulation
DEXA: dual-energy X-ray absorptiometry
DRESS: drug reaction with eosinophilia and systemic symptoms
DRN: dorsal raphe nuclei
DS: Dravet syndrome
ECG: electrocardiogram
EEG: electroencephalography/electroencephalogram
ESL: eslicarbazepine acetate
ESM: ethosuximide
FBM: felbamate
GABA: gamma-aminobutyric acid
GBP: gabapentin
GGE: genetic generalized epilepsies
GTCS: generalized tonic-clonic seizure(s)
HIV: human immunodeficiency virus
HRT: hormone replacement therapy
ID: intellectual disability
IGE: idiopathic generalized epilepsy
ILAE: International League Against Epilepsy
IUD: intrauterine device
LC: locus coeruleus
LCM: lacosamide
LEV: levetiracetam
LGS: Lennox-Gastaut syndrome
LTG: lamotrigine
MCM: major congenital malformation
MRI: magnetic resonance imaging
MRS: magnetic resonance spectroscopy
NCSE: non-convulsive status epilepticus
NMDA: N -methyl- D -aspartate
NTS: nucleus tractus solitarius
OCP: oral contraceptive pill
OXC: oxcarbazepine
PB: phenobarbital
PBN: parabrachial nucleus
PER: perampanel
PET: positron emission tomography
PGB: pregabalin
PHT: phenytoin
PNES: psychogenic non-epileptic seizures
PPI: patient and public involvement
PRM: primidone
PSP: priority setting partnership
RFN: rufinamide
RNS: responsive neural stimulation
SE: status epilepticus
SmPC: summary of product characteristics
SPECT: single photon emission computed tomography
STP: stiripentol
SUDEP: sudden unexpected death in epilepsy
SV2A: synaptic vesicle glycoprotein 2A
TGB: tigabine
TPM: topiramate
TSC: tuberous sclerosis complex
VGB: vigabatrin
VNS: vagus nerve stimulation
VPA: sodium valproate
ZNS: zonisamide
Introduction
Epilepsy is the most common serious neurological condition in the world. However, as it is not a homogeneous disease, it is preferable to use the term epilepsies , as this better describes a grouping of conditions that share a propensity for an individual to experience sudden unprovoked seizures because of abnormal electrical activity within the brain. While some epilepsies spontaneously remit, some are lifelong and others have a variable prognosis. Complicating the picture are seizures that superficially look like epilepsy but have a psychological cause (psychogenic non-epileptic seizures).
Seizures can affect people of all ages and ethnic backgrounds. They can be dangerous, with sudden unexpected death in epilepsy (SUDEP) occurring in 1 in 1000 people with epilepsy; perhaps as many as 1 in 100 with medically intractable seizures. Psychiatric and other comorbidities are common, and seizures are much more likely to occur in people with intellectual disability, where there can be a complex interplay between epilepsy, treatment and behavior.
With a growing array of targeted therapies, specific syndromes need to be identified and characterized so that these treatments can be offered to individuals who may derive benefit from them. Despite this, the proportion of people with seizures resistant to antiseizure medication (ASM) remains stubbornly static at around 30%. It is yet to be seen whether the latest ASM can have a significant effect on this figure. Surgical options exist for some people, and there have been significant advances in neurostimulation techniques over the last few years, including novel devices and new algorithms for vagus nerve stimulation.
In this resource, we focus on the management of epilepsy in adults. Its sister publication Fast Facts: Epilepsy in Children and Adolescents is also available, together with an online learning program. We hope to have produced a book that is accessible for both healthcare professionals and people with epilepsy. The aim is to provide a succinct and practical resource that will help clinicians investigate, diagnose and treat adults with a wide variety of seizure disorders and also to help people with epilepsy better understand and manage their condition.
1 Epidemiology and prognosis
Incidence and prevalence
Epilepsy is the most common serious neurological condition. It affects nearly 50 million people of all ages worldwide. 1 The pooled results of a systematic review and meta-analysis in 2020 showed the overall incidence of epilepsy worldwide to be 61.4 per 100 000 person-years. The incidence was higher in low- and middle-income countries than in high-income countries (139 versus 48.9 per 100 000 person-years, respectively), with greater exposure to perinatal risk factors and higher rates of CNS infections and traumatic brain injury thought to explain the differences. 2
A correlation exists between the prevalence of epilepsy and certain measures of socioeconomic deprivation, notably income, employment, and health deprivation and disability. For example, the population prevalence of epilepsy in England ranges from around 4.3 per 1000 in certain counties of the wealthier south-east to 11.6 per 1000 in the socioeconomically deprived north-west town of Blackpool. 3 In the USA, studies show racial and economic disparities exist in epilepsy diagnosis, treatment and overall care. 4 Differences in access to healthcare are likely to be one explanation for these disparities.
Incidence varies greatly with age, with high rates in early childhood, low levels in early adult life and a second peak in people aged over 65 years ( Figure 1.1 ). 5 In recent years, there has been a fall in the number of children affected as well as a sharp rise in epilepsy in the elderly. Indeed, old age has now become the most common time in life to develop the condition.
Prognosis
The epilepsies are a heterogeneous group of conditions. Prognosis depends on the underlying cause and syndromic diagnosis, but most people will have a good prognosis. In many people - particularly children - the condition will remit, although a substantial proportion will have epilepsy all their lives.
Overall, 60-70% of people with epilepsy become seizure free after treatment with antiseizure medication (ASM), 6 and some individuals can remain in remission after subsequent drug withdrawal, implying that the epileptogenic causes have truly remitted. The other 30-40% continue to have seizures with varying degrees of frequency and severity.

Figure 1.1 Incidence of single unprovoked seizures, epilepsy and all unprovoked seizures in Iceland between December 1995 and February 1999. Age-specific incidence of all unprovoked seizures was highest in the first year of life (130 per 100 000 person-years) and in those over 65 years old (110.5 per 100 000 person-years). Reproduced from Olafsson et al. 2005, with permission from Elsevier. 5
Some people become - and remain - seizure free on initiation of the first ASM, while in others the disorder may follow a more remitting-relapsing course, fluctuating between periods of seizure freedom and recurrence. A good example of this is temporal lobe epilepsy due to mesial temporal sclerosis, where patients often achieve seizure freedom following initiation of ASM, but relapse months to years later, with a poor response to additional medication. 7
Factors that indicate a poor prognosis for seizure control include:

poor response to the initial ASM
symptomatic causes
high seizure frequency before ASM
generalized tonic-clonic seizures (GTCS)
generalized epileptiform activity on the electroencephalogra