The complex epilepsy patient: intricacies of assessment and treatment.
The aim of treatment of all patients with epilepsy is the same: a complete remission of seizures with minimal or no adverse events. However, the means to reach that common goal may differ among patients, not only because of differences in their epileptic syndrome or type of seizures within the same syndrome, but also because of a variety of comorbid pathologic entities that are commonly identified in patients with epilepsy. In this article, we discuss some of the complexities inherent in the planning of therapeutic regimens for epilepsy patients. Comorbid conditions, whether intrinsic or extrinsic to the epileptic disorder, must play a paramount role in the choice of the therapeutic regimen for seizure control. We review the impact of psychiatric comorbidities on the quality of life of patients with epilepsy, with special attention to the tight relationship between depression and epilepsy. Yet, despite this close relationship, comorbid depression is more often than not underrecognized and undertreated. Next, we review the impact of antiepileptic drugs (AEDs) on comorbid medical disorders and give clear examples of the potentially deleterious impact of several AEDs on the therapeutic effects of concomitant medications used for their treatment. Clearly, treating epilepsy is not only about controlling seizures.
Kanner
Andres M
AM
Laboratory of Electroencephalography and Video-EEG Telemetry, Department of Neurological Science, Rush-Presbyterian-St. Luke's Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, U.S.A. akanner@rush.edu
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D004347:Drug Interactions; D004569:Electroencephalography / Q000187:drug effects; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D011788:Quality of Life; D012307:Risk Factors
D000927:Anticonvulsants