1. Epilepsy and Seizures in Adults: From Diagnosis to Treatment and Beyond
Eduardo Garcia, MD
Assistant Clinical Professor
Tufts University School of Medicine
Newton-Wellesley Hospital
Newton, MA

2. What is a seizure?
International League Against Epilepsy Definition: An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.

3. The Brain

4. Is there more than one type of seizure?
Epileptic
Nonepileptic
Generalized
Absence
Tonic
Clonic
Tonic-clonic
Atonic
Myoclonic
Focal
Simple Partial
Complex Partial
Psychogenic
Physiologic

5. Focal Vs. Generalized Seizures

6. What is Epilepsy
ILAE Conceptual Definition: Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures, and by the neurobiological, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.

7. What is Epilepsy?
Operational (practical) definition: Epilepsy is a disease of the brain defined by any of the following conditions:
1. At least two unprovoked seizures occurring more than 24 hours apart.
2. One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures (approximately 75% or more).
3. At least two seizures in a setting of reflex epilepsy.

8. Diagnosis
History

9. Physical Exam

10. Tests

11. EEG

12. Antiepileptic drugs (AEDs)

13. FDA approved antiepileptic drugs since 1993
Clobazam (Onfi®), eslicarbazepine (Aptiom®), ezogabine (Potiga®), felbamate (Felbatol®) gabapentin (Neurotin®), lamotrigine (Lamictal®), lacosamide (Vimpat®), levetiracetam (Keppra®), oxcarbazepine (Trilepal®), perampanel (Fycompa®), pregabalin (Lyrica®), rufinamide (Banzel®), tiagabine (Gabitril®), topiramate (Topamax®), vigabatrin (Sabril®) and zonisamide (Zonegran®).
Alt+0174 Alt+r ® C-x 8 R

14. So what if AEDs do not work?

15. Epilepsy Monitoring Unit Evaluation

16. Intracranial investigation

17. Epilepsy Surgery

18. Anterior Temporal Lobectomy

19. Vagus Nerve Stimulator
FDA approved 1997 for treatment of medically refractory partial onset seizures > 12 y/o
FDA approved 2005 for chronic recurrent depression > 18 y/o, who failed 4 medicaitons

20. Responsive Neurostimulation
FDA approved in 2013 adjunctive therapy in individuals > 18 with partial onset seizures with no > 2 epileptogenic foci

21. What if surgery does not work?