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Dang K. Nguyen, MD; Susan S. Spencer, MD

Arch Neurol. 2003;60:929-935.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

Great progress has been seen in the treatment of epilepsy during the past decade, with the marketing of 8 new anticonvulsants and an innovative neurostimulation device. This plethora of options creates dilemmas for physicians faced with treatment decisions. This article reviews recent advances in epilepsy treatment, in the context of available evidence.

UNCERTAINTIES ABOUT RESEARCH DESIGNS

Randomized controlled trials are the essential evidence on which to judge the efficacy of a treatment. All new antiepileptic drugs (AEDs) or devices have been marketed only after rigorous randomized controlled trials. The most common designs for initial AED efficacy trials are "add-on" trials in which patients with refractory epilepsy receiving stable AED therapy are randomized to addition of a study drug or a placebo. This approach is open to criticism. Patients with refractory disease represent a small segment of the epileptic population, and results may not be generalizable. Furthermore, . . . [Full Text of this Article]

PHARMACORESPONSIVE EPILEPSIES

Initiation of Treatment

Choice of AED

PHARMACORESISTANT EPILEPSIES

Primary Generalized Epilepsies

Partial Seizures

INDIVIDUAL MEDICAL OPTIONS FOR PHARMACORESISTANT SEIZURES

Felbamate

Gabapentin

Lamotrigine

Topiramate

Tiagabine

Vigabatrin

Oxcarbazepine

Levetiracetam

Zonisamide

INDIVIDUAL SURGICAL OPTIONS FOR PHARMACORESISTANT SEIZURES

Resective Surgery

Multiple Subpial Transections

Gamma-Knife Surgery

Vagus Nerve Stimulation

Deep Brain Stimulation

CONCLUSIONS

From the Department of Neurology, Yale School of Medicine, New Haven, Conn. Dr Spencer has received honoraria for speaking and educational programming from Novartis, Ortho-McNeil Pharmaceutical, Inc, Glaxo-Wellcome, and Pfizer Inc, and research support from Cyberonics, Inc.

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ABSTRACT | FULL TEXT