Optimizing Management of Medically Responsive Epilepsy

Derek Bauer, MD; Mark Quigg, MD, MSc, FANA, FAES Epilepsy p. 343-361 April 2019, Vol.25, No.2 doi: 10.1212/CON.0000000000000709
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PURPOSE OF REVIEW: This article reviews the management of patients with medically responsive epilepsy, including discussion of factors that may lead to transient breakthrough seizures and patient and physician strategies to maintain freedom from seizures.

RECENT FINDINGS: Imperfect adherence, unanticipated changes in ongoing medical therapy, inadvertent use of proconvulsants or concurrent medications that alter epilepsy medication kinetics, and a variety of seizure precipitants such as stress or sleep deprivation may alter long-term seizure control.

SUMMARY: The majority of patients with epilepsy are medically responsive. Many potential factors may lead to breakthrough seizures in these patients. Identification of these factors, patient education, and use of self-management techniques including mindfulness therapy and cognitive-behavioral therapy may play a role in protecting patients with epilepsy against breakthrough seizures.

Address correspondence to Dr Mark Quigg, Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA 22908, quigg@virginia.edu.

RELATIONSHIP DISCLOSURE: Dr Bauer is a site subinvestigator for GWEP-1521, a double-blind, randomized, placebo-controlled study to investigate the efficacy and safety of cannabidiol as add-on therapy in patients with tuberous sclerosis complex who experience inadequately controlled seizures. Dr Quigg has received research/grant support as principal investigator of studies from the National Institutes of Health/National Institute of Neurological Disorders and Stroke, the University of Virginia Brain Institute, and ZETO Inc. Dr Quigg has received publishing royalties from Elsevier and has given expert medical testimony.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Bauer and Quigg report no disclosures.

© 2019 American Academy of Neurology