The modern management of epilepsy

Abstract

Epilepsy is the most common of neurological disorders and it imposes a large burden on health care systems. The clinical features, aetiology, seuerity, prognosis and its association with other neurological disabilities uary greatly, and for this reason, many different disciplines may be responsible for supplying care including neurologists, pc.ediatricians, psychiatrists, and uery importantly too, the family doctor. Epilepsy is most easily defined as the name for occasional sudden, excessiue, rapid and local discharges of grey matter. (1) An epileptic seizure can be defined clinically as an intermittent, stereotyped, disturbance of consciousness, behauiour, emotion, motor function, or sensation that on clinical grounds is belieued to result from cortical neuronal discharge. Epilepsy can then be defined as a condition in which seizures recur, usually spontaneously. (2) These seizures may be partial or generalised. The International League Against Epilepsy (ILAE) has proposed two classification schemes, both of which are in current use. An understanding of these classifications is essential for proper management and communication among clinicians. The International Classification of Epileptic Seizures (ICES) in 1981 , makes use of clinical and EEG information. (3) Table 1. A second classification was formulated by the ILAE in 1989, as it was recognised that patients may experience similar seizure types within a syndrome with similar age of onset and aetiology. This is termed The International Classification of the Epilepsies and Epileptic Syndromes. (4) Classifying epilepsies into a syndrome where possible may be of uital importance in the management of patients with epilepsy.