title: Practical neurology--5: Recurrent unresponsive episodes and seizures.
abstract: Careful history-taking is essential when evaluating patients with suspected epileptic seizures. It should focus on ascertaining whether the episodes are seizures or a seizure mimic such as syncope. Recurrent unresponsive episodes associated with seizures may indicate a diagnosis of focal epilepsy or complex partial epilepsy. Adults with a clinical diagnosis of a focal seizure disorder require investigation with electroencephalography and magnetic resonance imaging. The goal of treatment should be to achieve a life free of seizures, with minimum adverse effects from anticonvulsant medication. The choice of medication should be individualised to a patient's seizure characteristics, circumstances and preferences. Dose adjustments should be made according to clinical response (seizure frequency and adverse effects), rather than on serum drug concentrations alone. Lifestyle advice, such as advice about driving restrictions, is important for the safety of the patient and others. All anticonvulsants are potentially teratogenic. Poorly controlled epilepsy in pregnancy imparts significant risks to the mother and baby, which need to be weighed against the risks of teratogenicity. The risk of major congenital malformations is highest with valproate, particularly in high doses.
authors: St Vincent's Hospital, Melbourne, VIC, Australia. markcook@unimelb.edu.au
authors: Melissa A
authors: MA
authors: Degruyter
authors: Mark J
authors: MJ
authors: Cook
mesh_terms: D001774:Blood Chemical Analysis; D002220:Carbamazepine / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008487:Medical History Taking; D059906:Neuroimaging / Q000379:methods; D009460:Neurologic Examination / Q000379:methods; D010808:Physical Examination; D012008:Recurrence; D018570:Risk Assessment; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy*; D012720:Severity of Illness Index; D013575:Syncope / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002220:Carbamazepine