Lewis, Steven L. MD, FAAN
Since the publication of the last CONTINUUM issue devoted to Epilepsy, our understanding of the pathophysiology, neurophysiology, genetics, imaging, and medical and surgical management of seizures and epilepsy syndromes has significantly evolved. In this issue of CONTINUUM, Guest Editors Gregory D. Cascino, MD, FAAN, and Erik K. St. Louis, MD, FAAN, have gathered an expert and institutionally diverse faculty to help us incorporate the current state of the art of diagnosis and management of epilepsy into our practices.
In this issue of CONTINUUM, Guest Editors Gregory D. Cascino, MD, FAAN, and Erik K. St. Louis, MD, FAAN, have gathered an expert and institutionally diverse faculty to help us incorporate the current state of the art of diagnosis and management of epilepsy into our practices.
This issue begins with a discussion by Drs Anne Berg and John Millichap about the International League Against Epilepsy 2010 Revised Classification of Seizures and Epilepsy. The modernized classification system takes into account the newest information about causes of epileptic syndromes—eg, “idiopathic,” “symptomatic,” and “cryptogenic” are replaced by “genetic,” “structural/metabolic,” and “unknown” in the new system. This new classification scheme even seemsto present a more intuitive terminology—eg, the reintroduction of the term “focal seizures” instead of “partial seizures,” and “with impairment of consciousness” instead of “complex partial.” We can only hope that in a future revision of the revision, the ubiquitous seizure “semiology” will simply become seizure “symptomatology.”
Next, Drs Rama Maganti and Paul Rutecki discuss EEGs and epilepsy monitoring. In their concise and thorough overview of the role of EEG in epilepsy diagnosis, the authors provide practical illustrative examples of ictal and nonictal EEG patterns as well as benign variants. Inthe next article, Dr Fernando Cendes discusses the role of neuroimaging in patients with epilepsy, including particularly instructive examples of imaging of malformations of cortical development (causes of epilepsy that are increasingly recognized as important to all neurologists, whether treating children or adults).
Next, Drs Jacqueline French and Deana Gazzola review principles of antiepileptic drug (AED) treatment, providing their expert opinion on strategies for AED selection and, if necessary, drug combinations. Their article is complemented by the subsequent article by Drs Tracy Glauser and Tobias Loddenkemper, who tackle the management of childhood epilepsy. This article will even be of interest to those of us whose practice is confined to adults, especially given their extensive table-based summary and overview of AEDs used in patients of all ages.
In the next review, Drs Leslie Rudzinski and Kimford Meador discuss the neuropsychological (both cognitive and psychiatric) comorbidities in patients with epilepsy—symptoms that are increasingly recognized as affecting our epilepsy patients’ qualities of life. Next, Dr Page Pennell thoroughly reviews the issues specific to women with epilepsy, including the most current information relevant to AED treatment and pregnancy. Dr Selim Benbadis then discusses the diagnosis and treatment of nonepileptic behavioral disorders (psychogenic non epileptic events or episodes), emphasizing the importance—and practical difficulty—in accessing appropriate mental health referral and follow-up for these patients.
Drs John Miller and Shahin Hakimian then review the contemporary surgical treatments of epilepsy, emphasizing recognition and early referral of appropriate surgical candidatesby the treating neurologist. Thisis followed by a discussion by Drs Christopher DeGeorgio and Scott Krahl on neurostimulation for drug-resistant epilepsy, including a discussion of the onlycurrently US Food and Drug Administration–approved device (vagus nerve stimulation) and other devices on the horizon. Next, Drs Mackenzie Cervenka and Eric Kossoff provide a thorough and practical review of various dietary treatment options, and their benefits and risks, for intractable epilepsy. Finally, Drs Lawrence Hirsch and Nicolas Gaspard present the current state of the art in the diagnosis and management of both convulsive and nonconvulsive status epilepticus.
In this issue’s Ethical Perspectives section, Drs Courtney Wusthoff and Donald Olson discuss and analyze the ethical challenges that arise when considering genetic testing of a child with epilepsy. In the Practice section, Dr L. James Willmore discusses the process of informed decision sharing and documentation in regard to AED choice as well as the issues involved in drug monitoring, and Dr Jeffrey Buchhalter discusses diagnostic coding in epilepsy.
As with every CONTINUUM issue, there are ample opportunities for CME. Reading the material, answering the Multiple-Choice Questions crafted by Drs Ronnie Bergen and Adam Kelly, and reviewing the explanatory discussions will assess and enhance your knowledge of the material, and you will be able to earn up to 10 AMA PRA Category 1 CME Credits™. An alternative opportunity allows you to obtain up to 12 AMA PRA Category 1 CME Credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for self-assessment by completing and submitting the Self-Assessment Pretest before reading the material and completing the postreading Multiple-Choice Questions. The Patient Management Problem, written by Drs Cascino and St. Louis, describes the case of a 21-year-old woman from her first witnessed seizure to her progression to medically refractory epilepsy. By following her case and answering multiple-choice questions corresponding to important diagnostic and therapeutic decision points along her course (reinforcing many of the issues addressed throughout the issue), you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I thank Drs Cascino and St. Louis and their expert team of authors for providing us with such clear and practical information that we can use to provide the most contemporary diagnostic and management approaches to our patients with epilepsy.
—Steven L. Lewis, MD, FAAN