April 2019, Volume 25, Issue 2
BROWSE ISSUES

April 2019, Vol.25, No.2

Editor-in-Chief:

—STEVEN L. LEWIS, MD, FAAN

ISSN: 1080-2371

Online ISSN: 1538-6899

REVIEW ARTICLES
Epilepsy Overview and Revised Classification of Seizures and Epilepsies
Pack, Alison M.
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 306-321
doi: 10.1212/CON.0000000000000707
Evaluation of Seizure Etiology From Routine Testing to Genetic Evaluation
Schuele, Stephan U.
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 322-342
doi: 10.1212/CON.0000000000000723
Optimizing Management of Medically Responsive Epilepsy
Bauer, Derek; Quigg, Mark
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 343-361
doi: 10.1212/CON.0000000000000709
Identification and Treatment of Drug-Resistant Epilepsy
Yoo, Ji Yeoun; Panov, Fedor
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 362-380
doi: 10.1212/CON.0000000000000710
Antiepileptic Drug Treatment of Epilepsy in Children
Moosa, Ahsan N. V.
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 381-407
doi: 10.1212/CON.0000000000000712
Treatment of Women With Epilepsy
Sazgar, Mona
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 408-430
doi: 10.1212/CON.0000000000000713
Electroencephalography in Epilepsy Evaluation
Chen, Hai; Koubeissi, Mohamad Z.
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 431-453
doi: 10.1212/CON.0000000000000705
Epilepsy Emergencies: Status Epilepticus, Acute Repetitive Seizures, and Autoimmune Encephalitis
VanHaerents, Stephen; Gerard, Elizabeth E.
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 454-476
doi: 10.1212/CON.0000000000000716
Counseling and Management of the Risks of Living With Epilepsy
Noe, Katherine
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 477-491
doi: 10.1212/CON.0000000000000708
Nonepileptic Episodic Events
Hopp, Jennifer L.
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 492-507
doi: 10.1212/CON.0000000000000711
Update on Antiepileptic Drugs 2019
Abou-Khalil, Bassel W.
CONTINUUM: Lifelong Learning in Neurology
April 2019 - Volume 25 - Issue 2 - p 508-536
doi: 10.1212/CON.0000000000000715
Editor's Preface
Articles
Key Points
Abbreviations
Appendix
Issue Overview

Issue Overview

CONTINUUM: Lifelong Learning in Neurology April 2019 - Volume 25 - Issue 2 - [no page #] doi: 10.1212/01.CON.0000554808.11713.8f

Issue Overview

Epilepsy, Volume 25, Issue 2, April 2019

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Epilepsy issue, participants will be able to:

  • Review the updated International League Against Epilepsy seizure and epilepsy classification system, which now includes epilepsy syndrome and an emphasis on etiology, and understand how the classification system provides a framework for clinicians, researchers, and patients and their families
  • Evaluate a first seizure or established epilepsy to determine the seizure type, epilepsy syndrome, and etiology
  • Define medically responsive epilepsy and discuss strategies to maintain sustained seizure freedom in patients with medically responsive epilepsy
  • Define drug-resistant epilepsy, review the current diagnostic and therapeutic tools for surgical treatment of epilepsy, and discuss the current evidence in favor of treating patients with drug-resistant epilepsy with surgical treatment over continued medical treatment
  • Discuss the various factors that influence the initiation, selection, and discontinuation of antiepileptic drugs in children with epilepsy
  • Discuss the latest data regarding management of epilepsy in women
  • Recognize common interictal and ictal EEG findings in epilepsy
  • Describe the diagnosis and treatment for the epilepsy emergencies of status epilepticus, acute repetitive seizures, and autoimmune encephalitis
  • Discuss the aspects of epilepsy beyond seizure control that can adversely impact safety and quality of life
  • Discuss the classification, evaluation strategies, and treatment approaches for patients with nonepileptic episodic events
  • Discuss the spectrum of efficacy, clinical pharmacology, and modes of use for individual antiepileptic drugs
  • Recognize the legal risks and responsibilities in counseling patients with epilepsy about driving limitations
  • Discuss the importance of medication reconciliation and identify strategies to implement medication reconciliation

Core Competencies

This Continuum: Lifelong Learning in Neurology Epilepsy issue covers the following core competencies:

  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

Contributors

Cynthia L. Harden, MD, Guest Editor

Head of Clinical Epilepsy Development, Xenon Pharmaceuticals Inc, Burnaby, British Columbia, Canada; Attending Neurologist, 14th Street Medical Arts Center, New York, New York

Relationship Disclosure: Dr Harden is a full-time employee of Xenon Pharmaceuticals Inc and holds stock options of unknown value in Xenon Pharmaceuticals Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Harden reports no disclosure.

Erik K. St. Louis, MD, MS, FAAN, Guest Editor

Co-director, Mayo Center for Sleep Medicine; Associate Professor of Neurology, Consultant in Medicine and Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota

Relationship Disclosure: Dr St. Louis has served as a consultant for Axovant Sciences, Inc and has received research/grant support from Axovant Sciences, Inc; Mayo Clinic Center for Clinical and Translational Science; the Michael J. Fox Foundation; the National Institutes of Health/National Institute on Aging; National Heart, Lung, and Blood Institute; and Sunovian Pharmaceuticals Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr St. Louis reports no disclosure.

Bassel W. Abou-Khalil, MD, FAAN

Professor of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee

Relationship Disclosure: Dr Abou-Khalil has served on the editorial board of Clinical Neurophysiology and has received research/grant support from Biogen, the National Institute of Neurological Disorders and Stroke, SK-Pharma, Sunovion Pharmaceuticals Inc, and UCB SA.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Abou-Khalil discusses the unlabeled/investigational use of primidone for the treatment of essential tremor, valproate for the treatment of generalized myoclonic and generalized tonic-clonic seizures, gabapentin for the treatment of headache and sleep disorders, lamotrigine as a first-line treatment for epilepsy, zonisamide as initial monotherapy for epilepsy, and cannabidiol and clobazam for the treatment of focal seizures.

Derek Bauer, MD

Assistant Professor, Department of Neurology, University of Virginia, Charlottesville, Virginia

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.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Bauer reports no disclosure.

Amy Bennett, JD

Manager, Quality Improvement, American Academy of Neurology, Minneapolis, Minnesota

Relationship Disclosure: Ms Bennett reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Ms Bennett reports no disclosure.

Hai Chen, MD, PhD

Assistant Professor of Neurology, George Washington University, Washington, DC

Relationship Disclosure: Dr Chen reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Chen reports no disclosure.

Elizabeth E. Gerard, MD

Associate Professor of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Relationship Disclosure: Dr Gerard has received personal compensation as a lecturer for the Society for Maternal-Fetal Medicine, Society of OB/GYN Hospitalists, and UCB China, and has received research/grant support from the Eleanor Wood-Prince Grant from the Woman’s Board of Northwestern Memorial Hospital, the National Institute of Neurological Disorders and Stroke/National Institutes of Health, SAGE Therapeutics, and Sunovion Pharmaceutical Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gerard discusses the unlabeled/investigational use of immunosuppressant medications for the treatment of autoimmune encephalitis (cyclophosphamide, IV immunoglobulin, IV methylprednisolone/corticosteroids, plasma exchange, and rituximab) and the pharmacologic and nonpharmacologic therapies for the treatment of seizures and status epilepticus (convulsive and nonconvulsive), which include diazepam, fosphenytoin/phenytoin, levetiracetam, lorazepam, midazolam, phenobarbital, and valproate sodium/valproic acid. Dr Gerard discusses the unlabeled/investigational use of several agents for the treatment of refractory and super-refractory status epilepticus, which include corticosteroids/methylprednisolone, electroconvulsive therapy, hypothermia, isoflurane, IV immunoglobulin, ketamine, ketogenic diet, midazolam, pentobarbital, propofol, thiopental, transcranial magnetic stimulation, and vagal nerve stimulation.

Jennifer L. Hopp, MD, FAAN

Associate Professor of Neurology, University of Maryland School of Medicine; Director, Epilepsy Division, University of Maryland Medical Center, Baltimore, Maryland

Relationship Disclosure: Dr Hopp has received grant/research support as a site principal investigator of the Established Status Epilepticus Treatment Trial from the National Institute of Neurological Disorders and Stroke and from SAGE Therapeutics. Dr Hopp has received personal compensation as a speaker for J. Kiffin Penry Epilepsy MiniFellow Network’s Epilepsy MiniFellowship and Residents Epilepsy Program. Dr Hopp receives publishing royalties from UpToDate, Inc and has given expert medical testimony for Venable LLP.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Hopp discusses the unlabeled/investigational use of sertraline for the treatment of psychogenic nonepileptic seizures.

Joseph S. Kass, MD, JD, FAAN

Associate Dean, Office of Student Affairs; Professor of Neurology, Psychiatry, and Medical Ethics; Director, Alzheimer’s Disease and Memory Disorders Center, Baylor College of Medicine; Chief of Neurology, Ben Taub General Hospital, Houston, Texas

Relationship Disclosure: Dr Kass serves as associate editor of medicolegal issues for Continuum, as an associate editor for Continuum Audio, as a neurology section editor of Ferri’s Clinical Advisor for Elsevier, and as co-editor of Neurology Secrets, Sixth Edition. Dr Kass has received personal compensation for CME lectures from Pri-Med LLC.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kass reports no disclosure.

Mohamad Z. Koubeissi, MD, FAAN

Professor, Department of Neurology; Director, Epilepsy Center, George Washington University, Washington, DC

Relationship Disclosure: Dr Koubeissi serves on the editorial boards of Epilepsy Currents and Functional Neurology and as the surgery and device editor of Epilepsy.com. Dr Koubeissi has received personal compensation for serving on the speakers’ bureaus of Sunovion Pharmaceuticals Inc and UCB SA, and has received publishing royalties from Springer for his book, Epilepsy Board Review.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Koubeissi reports no disclosure.

Ahsan N. V. Moosa, MD (Ahsan Moosa Naduvil Valappil, MD)

Staff Physician, Pediatric Epilepsy, Epilepsy Center, Cleveland Clinic; Assistant Professor of Medicine, Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio

Relationship Disclosure: Dr Moosa reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Moosa reports no disclosure.

Katherine Noe, MD, PhD, FAAN

Associate Professor of Neurology, Mayo Clinic College of Medicine, Phoenix, Arizona

Relationship Disclosure: Dr Noe has received research/grant support from NeuroPace, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Noe reports no disclosure.

Alison M. Pack, MD, MPH

Associate Professor of Neurology, Columbia University Irving Medical Center, New York, New York

Relationship Disclosure: Dr Pack receives research/grant support from the National Institutes of Health/National Institute of Neurological Disorders and Stroke as co-investigator of a multicenter study and receives royalties from UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Pack reports no disclosure.

Fedor Panov, MD

Assistant Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai; Associate Director, Adult Epilepsy Program, Mount Sinai, New York, New York

Relationship Disclosure: Dr Panov has received personal compensation as a consultant for NeuroPace, Inc and Zimmer Biomet.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Panov reports no disclosure.

Mark Quigg, MD, MSc, FANA, FAES

Professor, Department of Neurology, University of Virginia, Charlottesville, Virginia

Relationship Disclosure: 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: Dr Quigg reports no disclosure.

Rachel V. Rose, JD, MBA

Attorney, Rachel V. Rose Attorney at Law PLLC; Affiliated Faculty, Baylor College of Medicine, Houston, Texas

Relationship Disclosure: Ms Rose serves on the editorial board of BC Advantage and receives book royalties from the American Bar Association.

Unlabeled Use of Products/Investigational Use Disclosure: Ms Rose reports no disclosure.

Mona Sazgar, MD, FAES

Clinical Professor, Department of Neurology, University of California, Irvine, Orange, California

Relationship Disclosure: Dr Sazgar has received personal compensation for serving on the scientific advisory board for UCB SA and for serving on the speaker’s bureau of Eisai Co, Ltd; Sunovion Pharmaceuticals Inc; and UCB SA. Dr Sazgar has received grants or research support from Biogen, Sunovion Pharmaceuticals Inc, and UCB SA as the principal investigator for clinical trials and has received publishing royalties from Springer for her book Controversies in Caring for Women with Epilepsy.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Sazgar discusses the unlabeled/investigational use of acetazolamide, clobazam, depot-medroxyprogesterone acetate, and progesterone products for the treatment of women with catamenial epilepsy.

Stephan U. Schuele, MD, MPH, FAAN

Professor of Neurology and Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Relationship Disclosure: Dr Schuele has received personal compensation for serving on the speaker’s bureau of Eisai Co, Ltd and Sunovion Pharmaceuticals Inc. Dr Schuele serves on the board of directors of the American Clinical Neurophysiology Society and the Epilepsy Foundation Greater Chicago, and on the editorial board of Journal of Clinical Neurophysiology. Dr Schuele has received research/grant support from the Danny Did Foundation and the National Institutes of Health and has been asked to provide expert medical testimony in cases involving sudden unexpected death in epilepsy.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Schuele reports no disclosure.

Alan Z. Segal, MD, FAAN

Associate Professor of Clinical Neurology, Weill Cornell Medical College, New York, New York

Relationship Disclosure: Dr Segal reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Segal reports no disclosure.

Anant M. Shenoy, MD, FAAN

Chief of Neurology, Mount Auburn Hospital, Cambridge, Massachusetts

Relationship Disclosure: Dr Shenoy reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Shenoy reports no disclosure.

Stephen VanHaerents, MD

Assistant Professor of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Relationship Disclosure: Dr VanHaerents has received research/grant support from the Citizens United for Research in Epilepsy, National Institute of Mental Health, National Institute on Aging, National Institutes of Health, and SAGE Therapeutics. Dr VanHaerents has received travel honoraria from NeuroPace and SAGE Therapeutics.

Unlabeled Use of Products/Investigational Use Disclosure: Dr VanHaerents discusses the unlabeled/investigational use of immunosuppressant medications for the treatment of autoimmune encephalitis (cyclophosphamide, IV immunoglobulin, IV methylprednisolone/corticosteroids, plasma exchange, and rituximab) and the pharmacologic and nonpharmacologic therapies for the treatment of seizures and status epilepticus (convulsive and nonconvulsive), which include diazepam, fosphenytoin/phenytoin, levetiracetam, lorazepam, midazolam, phenobarbital, and valproate sodium/valproic acid. Dr VanHaerents discusses the unlabeled/investigational use of several agents for the treatment of refractory and super-refractory status epilepticus, which include corticosteroids/methylprednisolone, electroconvulsive therapy, hypothermia, isoflurane, IV immunoglobulin, ketamine, ketogenic diet, midazolam, pentobarbital, propofol, thiopental, transcranial magnetic stimulation, and vagal nerve stimulation.

Ji Yeoun Yoo, MD

Assistant Professor, Icahn School of Medicine at Mount Sinai, New York, New York

Relationship Disclosure: Dr Yoo has received publishing royalties from Elsevier for the book Rowans Primer of EEG and has received personal compensation as a lecturer for the Korean Epilepsy Society and for serving on the advisory board of Zimmer Biomet. Dr Yoo has received research/grant support from the NeuroNEXT Program of the National Institutes of Health/National Institute of Neurological Disorders and Stroke.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Yoo reports no disclosure.

Self-Assessment and CME Test Writers

James W. M. Owens Jr, MD, PhD

Associate Professor of Neurology, Adjunct Associate Professor of Pediatrics, University of Washington School of Medicine, Seattle, Washington

Relationship Disclosure: Dr Owens serves as CME co-editor for Neurology and receives publishing royalties from UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Owens reports no disclosure.

Allyson R. Zazulia, MD

Professor of Neurology and Radiology, Associate Dean for Continuing Medical Education, Washington University, St. Louis, Missouri

Relationship Disclosure: Dr Zazulia reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Zazulia reports no disclosure.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings. For detailed instructions regarding Continuum CME and self-assessment activities, visit continpub.com/CME.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

© 2019 American Academy of Neurology.