Update on epilepsy

Increasing knowledge of prognostic factors and of treatment outcomes has led to major changes in the treatment of epileptic seizures. The management of first seizures can now be individualized, based on the probability of seizure recurrence and its expected repercussions. When a decision is made to treat initial or recurrent seizures, monotherapy with nonsedating AEDs is recommended. Therapy should also be optimized to achieve seizure control as early as possible. During AED therapy, clinical monitoring of drug reaction symptoms is preferred over routine laboratory testing. Laboratory monitoring is not cost-effective, and there is no proof that it can forecast drug reactions. The risk of congenital malformations in newborns prenatally exposed to AEDs is around 5%, which is 2 to 2.5 times that of the general population. Valproate and carbamazepine have recently been associated with a 1% risk of spina bifida. There are measures that can be used to reduce the risk of teratogenicity, the most important of which is using the least amount of AEDs necessary to control seizures during pregnancy. Although AEDs do reduce the efficacy of oral contraceptives, oral contraceptives are still reliable with certain precautions. For patients with intractable epilepsy, surgery should be considered to improve seizure control. Proper selection of candidates increases the probability of an excellent outcome in these patients, who otherwise have no hope of leading a normal life. Postsurgical outcome largely depends on the location, the extent, and the pathology of the epileptogenic tissues in the brain.