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2016 ; 12
(ä): 467-85
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Medical management of epileptic seizures: challenges and solutions
#MMPMID26966367
Sarma AK
; Khandker N
; Kurczewski L
; Brophy GM
Neuropsychiatr Dis Treat
2016[]; 12
(ä): 467-85
PMID26966367
show ga
Epilepsy is one of the most common neurologic illnesses. This condition afflicts
2.9 million adults and children in the US, leading to an economic impact
amounting to $15.5 billion. Despite the significant burden epilepsy places on the
population, it is not very well understood. As this understanding continues to
evolve, it is important for clinicians to stay up to date with the latest
advances to provide the best care for patients. In the last 20 years, the US Food
and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many
more currently in development. Other advances have been achieved in terms of
diagnostic modalities like electroencephalography technology, treatment devices
like vagal nerve and deep-brain stimulators, novel alternate routes of drug
administration, and improvement in surgical techniques. Specific patient
populations, such as the pregnant, elderly, those with HIV/AIDS, and those with
psychiatric illness, present their own unique challenges, with AED side effects,
drug interactions, and medical-psychiatric comorbidities adding to the conundrum.
The purpose of this article is to review the latest literature guiding the
management of acute epileptic seizures, focusing on the current challenges across
different practice settings, and it discusses studies in various patient
populations, including the pregnant, geriatric, those with HIV/AIDS, comatose,
psychiatric, and "pseudoseizure" patients, and offers possible evidence-based
solutions or the expert opinion of the authors. Also included is information on
newer AEDs, routes of administration, and significant AED-related
drug-interaction tables. This review has tried to address only some of these
issues that any practitioner who deals with the acute management of seizures may
encounter. The document also highlights the numerous avenues for new research
that would help practitioners optimize epilepsy management.