Antiepileptic drug management in patients with seizure disorders

Epilepsy is a chronic disorder characterized by recurrent, unprovoked seizure episodes. A seizure is a behavioral alteration produced by abnormal activity of the neurons in the cerebral cortex of the brain. The treatment of the patient with epilepsy depends on the underlying etiology, the type of seizure activity, and the presence of precipitating factors. The initial management must include appropriate patient education and counselling. A significant percentage of patients with epilepsy will require antiepileptic drug therapy to enter a seizure remission, ie, an established period of time seizure-free. The majority of patients who receive antiepileptic drug therapy will experience a marked reduction in seizure tendency. The goal of treatment is to render the individual seizure-free without producing antiepileptic drug toxicity. Monotherapy with a nonsedating antiepileptic drug medication is preferred. Parenteral antiepileptic drug therapy is necessary for treating generalized convulsive status epilepticus. This discussion will focus on the appropriate use of antiepileptic drugs in the management of the adult patient with seizures and epilepsy.