Cloudy With a 60% Chance of Having Another Seizure in the Next 10 Years

—STEVEN L. LEWIS, MD, FAAN Epilepsy p. 304-305 April 2019, Vol.25, No.2 doi: 10.1212/01.CON.0000554664.33214.e0


This issue of Continuum is devoted to the diagnosis and management of our patients with epilepsy. I am delighted that both Drs Cynthia L. Harden and Erik K. St. Louis served as guest editors of this issue. At the same time, I feel that readers should be aware of the particular circumstances that led to having these two outstanding experts oversee this issue. About midway through the planning and creation of this issue, Dr Harden became Head of Clinical Epilepsy Development for a pharmaceutical company (see the “Contributors” page of this issue); in order to avoid even the perception of potential conflicts of interest, I, upon consultation with and at the recommendation of the Continuum Editorial Board, asked epileptologist Dr St. Louis, a member of the editorial board, to take over the guest editorship of this issue, which was immediately agreed to by Dr Harden. We hope readers concur that the resulting issue, representing the initial planning and guest editorship of Dr Harden, the subsequent editorial work by Dr St. Louis, and the authorship of each article by the remarkable team of invited epileptologists, provides a clinically practical and up-to-date overview of modern management of our patients with seizures and epilepsy.

The issue begins with the article by Dr Alison M. Pack, who provides a clear overview of the epilepsies and the important details of the revised classification of seizures and epilepsies, including that epilepsy can be diagnosed if a person has one unprovoked or reflex seizure and has a probability of at least 60% of having another seizure within the next 10 years. This subjective but practical forecasting now plays an important part in clinical epilepsy diagnosis.

Dr Stephan U. Schuele provides a contemporary overview of the evaluation of our patients’ seizure etiology, beginning with routine testing to the increasing role of genetic evaluation. In the next article, Drs Derek Bauer and Mark Quigg discuss a variety of strategies by which we can optimize the management of our patients who have medically responsive epilepsy.

In the following article, Drs Ji Yeoun Yoo and Fedor Panov review the identification and treatment of drug-resistant epilepsy and the important role all neurologists share in referring these patients to comprehensive epilepsy centers for further diagnostic evaluation and potential epilepsy surgery.

Dr Ahsan N. V. Moosa next provides a thorough review of the nuances of antiepileptic drug (AED) treatment for children with epilepsy. Additional recent Continuum articles on childhood epilepsy and epilepsy syndromes from the Child Neurology issue are referenced in the “Beyond the Page” section of this issue, and interested readers will find these articles of great additional value. With regard to the AED terminology, the Continuum editorial office is aware that drugs used in the management of seizures and epilepsy are not necessarily “antiepileptic,” but we have decided to interchangeably use the terms AEDs or antiseizure medications, depending on the preference of the article author.

Dr Mona Sazgar then discusses the important issues relevant to the treatment of women with epilepsy, including issues related to menses, pregnancy, and breast-feeding.

Drs Hai Chen and Mohamad Z. Koubeissi provide us with a concise but overarching and nicely illustrated overview of the role of EEG in epilepsy evaluation, which will be of value to readers irrespective of their degree of familiarity with EEG. Drs Stephen VanHaerents and Elizabeth E. Gerard then review the critically important epilepsy emergencies, including status epilepticus, acute repetitive seizures (and the newest terminology for these syndromes), and the autoimmune encephalitides.

Dr Katherine Noe next provides a very practical guide to help us counsel and manage our patients regarding the risks of living with epilepsy. Of course, not all events that look like seizures are epileptic in origin, and Dr Jennifer L. Hopp discusses the recognition, diagnosis, and management of these nonepileptic episodic events and the distinction between nonepileptic episodic events of physiologic (but nonepileptic) origin from psychogenic nonepileptic seizures.

An important aim in the creation of each Continuum issue is that it presents a fresh view of the topic, including brand new review articles authored by a new group of authors. The final review article in the issue, therefore, represents a unique circumstance in my tenure as editor-in-chief of Continuum. I had been so impressed by the encyclopedic and well-organized article “Update on Antiepileptic Drugs,” by Dr Bassel W. Abou-Khalil in the February 2016 Epilepsy issue, that I requested he update it to be relevant to readers in 2019. The resulting article, “Update on Antiepileptic Drugs 2019,” represents a remarkable and completely up-to-date compendium of practical information of essentially every AED currently available in our armamentarium.

In the Medicolegal Issues article, Dr Joseph S. Kass and Ms Rachel V. Rose provide a hypothetical but highly relatable case to inform us about the ethical and medicolegal issues we face daily when counseling our patients with epilepsy about driving.

In the Practice Issues article, Drs Anant M. Shenoy and Alan Z. Segal and Ms Amy Bennett provide practical tips and resources for medication reconciliation, so important for many of our patients, including our patients with epilepsy.

After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs James W. M. Owens Jr and Allyson R. Zazulia, you may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment and CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the Continuum Audio web platform or app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada.

My sincere thanks to Dr Harden for her skillful and dedicated planning of this issue and for her initial guest editing, and to Dr St. Louis, for also so capably and responsively taking on the seemingly never-ending tasks as subsequent guest editor. I also extend my thanks to the many expert epileptologists who provided such remarkable contributions to this issue, all to benefit the diagnosis and management of our patients with epilepsy.


  • My sincere thanks to Dr Harden for her skillful and dedicated planning of this issue and for her initial guest editing, and to Dr St. Louis, for also so skillfully and responsively taking on the seemingly never-ending tasks as subsequent guest editor.


© 2019 American Academy of Neurology.