The Comprehensive Evaluation and Treatment of Epilepsy

by Schachter; Schomer

• ISBN13: 9780126213553
• ISBN10: 0126213550
• Edition: 1st
• Format: Hardcover
• Copyright: 1997-04-22
• Publisher: Elsevier Science

Summary

Epilepsy is, after headache, the second most common neurological disorder. This book clarifies the many courses of action to take in treating patients with epilepsy. It presents current knowledge about seizures and epilepsy in a comprehensive, socially conscious, and clear manner. The editors have provided this information in a comprehensive, easy-to-use, and practical form. This short, simple pedagogical guide to the diagnosis and management of epilepsy is an important reference work for all medical schools, hospitals, clinics, and primary care centers.

Table of Contents

Contributors	xv	(2)
Preface	xvii
CHAPTER 1 Classification of Seizures and the Epilepsies	1	(36)
Gregory L. Holmes
How Are Seizures Classified?	1	(1)
How Can the Physician Distinguish between Simple Partial and Complex Partial Seizures?	1	(2)
What Are the Types of Generalized Seizures?	3	(8)
What Is an Epileptic Syndrome?	11	(2)
What Are the Categories of Idiopathic-Related Partial Epilepsies?	13	(5)
What Are the Categories of Generalized Epilepsies and Syndromes?	18	(14)
References	32	(5)
CHAPTER 2 Radiographic Assessment of Patients with Epilepsy	37	(24)
Gottfried Schlaug
Mahesh Patel
Should Every Patient Who Has a Seizure Have an Imaging Workup?	37	(1)
What Imaging Methods Are Indicated and What Should the Physician Order When Performing a Workup on a Patient with Seizures?	38	(8)
What Type of Lesion Is Neuroimaging Most Likely to Show?	46	(5)
When Should the Physician Order a SPECT or PET Scan?	51	(1)
How Should the Physician Interpret the Findings When Functional Imaging Methods Are Used?	51	(2)
How Can Lesions Be Differentiated by a Combination of Magnetic Resonance Imaging Modalities?	53	(2)
What Is the Optimal Radiographic Evaluation of a Patient with Epilepsy?	55	(1)
When Are Follow-up Scans Indicated?	56	(1)
Are There Any New Imaging Methods or Techniques for the Evaluation of Patients with Epilepsy?	57	(2)
References	59	(2)
CHAPTER 3 Treatment of Seizures	61	(14)
Steven C. Schachter
What Are the Goals of Therapy?	61	(1)
How Does Diagnosis of the Patient's Seizure Type Influence the Choice of Therapy?	61	(1)
When Should Treatment Be Started?	62	(1)
What Can Be Done, as Treatment Is Initiated, to Maximize the Likelihood of a Successful Outcome?	62	(2)
What Are the Results of AED Therapy?	64	(4)
Is Noncompliance with AED Therapy a Significant Problem?	68	(1)
What Are the Typical Side Effects of AEDs?	68	(1)
What Are the Advantages of Monotherapy over Polytherapy?	69	(2)
What Are the Roles of AED Levels and Blood Tests?	71	(1)
When Can AEDs Be Discontinued?	72	(1)
Is AED Treatment during Pregnancy Safe? What Are the Safest AEDs in General?	72	(1)
What Are the Other Elements of Treatment besides Medical Therapy?	73	(1)
Conclusion	74	(1)
References	74	(1)
CHAPTER 4 Definition and Overview of Intractable Epilepsy	75	(16)
Orrin Devinsky
When Is Epilepsy Considered Intractable?	75	(1)
How Do Physicians' and Patients' Perspectives on Intractable Epilepsy Tend to Differ?	76	(2)
How Does AED Therapy Affect the Prognosis for Patients with Specific Epilepsy Syndromes?	78	(2)
How Many Medications Should Be Tried before a Patient Is Evaluated for Surgery?	80	(2)
How Long Should Drug Therapy Be Tried before Surgery Is Considered?	82	(1)
What Factors Contribute to Incomplete Seizure Control or Disabling Side Effects?	82	(1)
When Should the Diagnosis of Nonepileptic Seizures Be Considered?	83	(1)
What Factors Contribute to Incorrect Classification of Seizures?	84	(1)
Why Do Patients Sometimes Not Comply with Treatment?	85	(1)
How Do Lifestyle and Living Conditions Affect Seizure Control?	85	(1)
What Special Resources Do Comprehensive Epilepsy Centers Offer?	86	(1)
How Does Uncontrolled Epilepsy Affect the Patient?	86	(2)
References	88	(3)
CHAPTER 5 Psychosocial Aspects of Epilepsy	91	(20)
Patricia O. Shafer
Eileen Salmanson
What Is the Patient's Perspective on Epilepsy?	91	(1)
What Is the Spectrum of Epilepsy?	92	(1)
What Factors Affect a Person's Coping and Adjustment to Seizures?	92	(4)
What Psychosocial Interventions Are Appropriate for Patients Whose Epilepsy Has Not Been Confirmed?	96	(1)
What Seizure Variables May Affect the Patient's Psychosocial Adjustment?	97	(1)
What Impact Do Seizures Have on Patients' Daily Lives?	98	(2)
What Treatment Options Exist for Psychosocial Problems?	100	(6)
What Psychosocial Issues Need to Be Addressed before and after Epilepsy Surgery?	106	(1)
What Community Resources and Supports Are Available to Persons with Epilepsy and Their Families?	107	(2)
Conclusion	109	(1)
References	109	(2)
CHAPTER 6 Neuropsychologicl Assessment and Application to Temporal Lobe Epilepsy	111	(20)
Peter J. Hayashi
Margaret O'Connor
What Is Neuropsychology?	111	(1)
What Is the Role of Neuropsychology in the Care of Patients with Epilepsy?	112	(1)
How Does Temporal Lobe Epilepsy Affect Cognitive Status?	112	(1)
How Does Temporal Lobe Epilepsy Affect Emotional and Psychological Status?	113	(1)
What Does Comprehensive Neuropsychological Evaluation Entail?	114	(1)
What Are Specific Considerations in the Neuropsychological Evaluation of Patients with TLE?	114	(2)
What Neuropsychological Tests Are Used in the Evaluation of Patients with Epilepsy?	116	(4)
What Role Does Neuropsychology Play in the Care of Patients Who Are Undergoing Surgical Resection?	120	(1)
What Is the Intracarotid Amobarbital Test?	120	(1)
How Is the Intracarotid Amobarbital Test Administered?	121	(1)
What Is Cortical Mapping	122	(2)
What Neuropsychological Changes Are Associated with Surgery for Seizures?	124	(1)
How Does Surgery for the Treatment of Epilepsy Affect the Patient's Emotional-Psychological State?	125	(1)
Conclusion	125	(1)
References	126	(4)
CHAPTER 7 Psychiatric Considerations in Patients with Epilepsy	131	(18)
Jacob C. Holzer
David M. Bear
Does Epilepsy Predispose Patients to Particular Psychiatric Illnesses or Behavioral Problems?	131	(1)
Are There Differences between Ictal and Interictal Behavioral Symptoms?	132	(1)
How Do Psychiatric or Behavioral Symptoms Vary in Patients with Simple as Opposed to Complex Partial Seizures?	132	(1)
Are There Differences between Temporal and Frontal Lobe Epilepsies?	133	(2)
Why Is Depression a Serious Complication of Epilepsy?	135	(1)
What Types of Psychosis May Develop in Patients with Epilepsy?	136	(1)
What Other Psychiatric Symptoms May Develop in Epilepsy?	137	(1)
Have Specific Behaviors Been Described during the Interictal Period in Patients with TLE?	138	(1)
Are Temper Problems or Aggression Associated with TLE?	139	(1)
Can Epilepsy Contribute to Creative Behavior?	140	(1)
How Do Physicians Distinguish Psychogenic Nonepileptic Seizures from True Epileptic Seizures?	140	(1)
What Constitutes an Appropriate Evaluation for the Epilepsy Patient with Psychiatric Symptoms?	141	(2)
Which Psychotropic Medications May Be Helpful for Patients with Epilepsy?	143	(2)
In Additin to Medication, What Psychiatric Interventions Can Be Helpful for Epilepsy Patients?	145	(1)
What Effect Does Epilepsy Surgery Have on Psychiatric Symptoms?	146	(1)
What Effects Do Antiepileptic Medications Have on Psychiatric Symptoms in Epilepsy?	146	(1)
References	147	(1)
Selected Readings	147	(2)
CHAPTER 8 Status Epilepticus	149	(24)
Frank W. Drislane
What Is Generalized Convulsive Status Epilepticus and What Causes It?	149	(3)
What Complications Can Occur with Convulsive Status Epilepticus?	152	(2)
What Are the Other Types of Status Epilepticus?	154	(5)
How Is Status Epilepticus Diagnosed?	159	(2)
How Are Anticonvulsants Used to Treat Status Epilepticus?	161	(6)
When Should Electroencephalography Be Used?	167	(1)
When and How Should the Patient's Condition Be Reevaluated during Treatment?	168	(1)
References	169	(4)
CHAPTER 9 Diagnosis and Management of Nonepileptic Seizures	173	(12)
A. James Rowan
What Are Nonepileptic Seizures?	173	(1)
Why Is an Understanding of Nonepileptic Seizures Important?	173	(1)
What Causes Nonepileptic Seizures?	174	(1)
What Clues to the Diagnosis of Nonepileptic Seizures May Be Provided by the Patient's History?	174	(1)
Do Nonepileptic Seizures Have Characteristics That Suggest the Diagnosis?	175	(1)
Are Any of These Clinical Characteristics Diagnostic for Nonepileptic Seizures?	176	(1)
Do Nonepileptic Seizures Sometimes coexist with Epilepsy?	177	(1)
How Can One Make a Definitive Diagnosis of Nonepileptic Seizures?	178	(2)
What Is the Diagnostic Role of Prolactin Determinations?	180	(1)
If Intensive EEG-Video Monitoring Is Not Available, What Alternatives Can Be Used?	180	(1)
Do Patients with Nonepileptic Seizures Have a Typical Psychologic Profile?	181	(1)
What Are the Most Common Psychiatric Diagnoses Associated with Nonepileptic Seizures?	181	(1)
What Is the Best Approach to Treatment?	182	(1)
What Is the Outlook for Patients with Nonepileptic Seizures?	183	(1)
References	183	(2)
CHAPTER 10 Ambulatory Electroencephalographic Monitoring: Technology and Uses	185	(12)
John R. Ives
What Is the History of Ambulatory Electroencephalographic Monitoring?	185	(1)
How Did the Event Recording System Evolve?	185	(1)
How Does An Ambulatory EEG Monitoring System Differ from an Inpatient System?	186	(1)
What Are the Clinical Applications of Ambulatory Monitoring?	187	(1)
How Effective Is Ambulatory Outpatient EEG Monitoring?	188	(4)
What Advances in Ambulatory Outpatient EEG Monitoring Can Be Expected in the Future?	192	(3)
References	195	(2)
CHAPTER 11 The Surgical Treatment of Epilepsy	197	(10)
Howard Blume
Who Is a Candidate for Epilepsy Surgery?	197	(1)
How Do Surgeons Know that Lobectomy Will Help to Control or Eliminate Seizures?	197	(1)
How Is a Cortical Excision Performed?	198	(1)
How Much Brain Tissue Should Bee Removed?	199	(1)
What Is the Likelihood of Success in Arresting or Reducing Seizure Activity with Cortical Excisions or Lobectomies?	200	(1)
What Are the Possible Complications of Surgery?	200	(1)
Will a Person Who Undergoes Lobectomy for Seizures Be "Different" after Surgery?	201	(1)
What Is a Hemispherectomy?	201	(1)
What Is a Callosotomy?	202	(1)
How Is Callosal Sectioning Carried Out?	203	(1)
What Are Implanted EEG Electrodes?	203	(1)
How Are Depth Electrodes Implanted?	204	(1)
What Are the Risks of Implanting Electrodes?	205	(1)
Conclusion	205	(1)
References	206	(1)
CHAPTER 12 Endocrine Aspects of Partial Seizures	207	(26)
Pavel Klein
Andrew G. Herzog
How Do Hormones and Epilepsy Interact?	207	(1)
Catamenial Epilepsy: What Is It and How Should It Be Evaluated and Treated?	208	(2)
How Should Catamenial Epilepsy Be Evaluated?	210	(1)
Menarche, Pregnancy, Menopause: Do They Affect Seizures?	211	(2)
In What Other Ways May Hormones Affect Seizures?	213	(1)
How Does Partial Epilepsy Affect Endocrine Reproductive Function in Women?	213	(2)
How Should Women with Epilepsy and Reproductive Dysfunction be Evaluated?	215	(2)
How Does Epilepsy Affect Women's Sexuality?	217	(1)
How Do Seizures Affect Reproductive Endocrine Function in Men?	218	(1)
What Effects Do Seizures Have on Hormone Production Acutely, and What Clinical Relevance Do These Effects Have?	219	(1)
Of What Clinical Utility Is Postictal Prolactin Testing, and How Should It Be Done?	220	(1)
Is the Checking of Other Hormone Levels Postictally Worthwhile?	221	(1)
Are Any Other Hormonal Systems Clinically Affected by Partial Seizures?	221	(1)
What Is the Effect of AEDs on Sexuality in Men and Women and on Reproduction in Men?	222	(1)
What Are the Laboratory Findings in Hyposexual Patients Who Are Given AEDs?	223	(1)
How Can AED-Related Hyposexuality Be Treated?	223	(1)
What Additional Effects May AEDs Have on Reproductive Function in Women?	224	(1)
Which Other Hormonal Systems Are Affected by AEDs?	225	(1)
Can Hormone Be Used to Treat Epilepsy?	226	(2)
References	228	(5)
CHAPTER 13 Epilepsy and the Elderly	233	(22)
Edward B. Bromfield
How Common Is Epilepsy in the Elderly Population?	233	(1)
What Are the Most Common Causes of Seizures and Epilepsy in Older Age Groups?	233	(4)
What Types of Strokes Are Most Likely to Cause Seizures?	237	(1)
How Do Seizures Present In Older People?	237	(1)
What Is the Differential Diagnosis of Transient Alterations in Function in This Population, and What Tests Best Distinguish One Disorder from Another?	238	(5)
What Are the Most Important Elements of the Histroy and Physical Examination, and What Ancillary Diagnostic Tests Should Be Performed to Evaluate a First Seizure?	243	(1)
When Should Older Patients Receive Therapy after a First Seizure?	244	(1)
What Considerations Apply to Choice of AEDs in the Elderly? What Potential Adverse Effects and Drug Interactions Are of Particular Concern in the Elderly?	245	(2)
In What Do Pharmacokinetic Factors Change with Aging? What Are the Implications for the Way AEDs Are Used in Older People?	247	(1)
What Is the Prognosis of Epilepsy in Elderly Patients?	248	(1)
How Should Long-Standing, Apparently, Stable Epilepsy in the Elderly Be Treated? When Can AEDs Be Withdrawn in This Population?	248	(1)
Is Surgical Treatment for Medically Intractable Epilepsy a Possibility in Elderly Patients?	249	(1)
What Are the Causes, Manifestations, and Risks of Status Epilepticus in the Elderly, and How Should It Be Treated?	250	(1)
What Are the Implications of Epilepsy and AED Therapy for Independent Function in Older Persons?	251	(1)
References	251	(4)
CHAPTER 14 The Team Approach to the Treatment of Epilepsy	255	(5)
Donald L. Schomer
What Is the Team Approach to the Management of Epilepsy?	255	(1)
What Is the Physician's Role on the Team?	256	(1)
What Is the Nurse's Role as a Member of the Team?	257	(1)
What Role Does the Psychiatrist Play as a Member of the Team?	258	(1)
What Is the Psychologist's or Neuropsychologist's Role as a Member of the Team?	258	(1)
What Is the Social Worker's Role on the Team?	259	(1)
What Role Does the Neurosurgeon Play on the Team?	259	(1)
What Practical and Economic Advantages Do Comprehensive Epilepsy Management Teams Offer?	259	(2)
Index	261