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The Medical Treatment of Chronic Active Epilepsy 

The Medical Treatment of Chronic Active Epilepsy
Chapter:
The Medical Treatment of Chronic Active Epilepsy
Author(s):

Simon Shorvon

DOI:
10.1093/med/9780199659043.003.0023
Page of

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date: 07 December 2021

Chronic epilepsy can be defined as epilepsy in which seizures are still occurring five or more years after the initiation of therapy. Therapy in this situation is more difficult and less successful than treatment in newly diagnosed epilepsy. In this chapter, the choice of antiepileptic drug and the strategies for medical therapy are outlined. The choice of antiepileptic drug depends on seizure type, tailoring the drug to individual patient profiles, side effects, and pharmacokinetics. The lack of any difference in efficacy and the limitations of the concept of drug resistance are discussed. A protocol for medical treatment is given. This should be based on a thorough assessment in which: diagnosis is reviewed and aetiology established, seizures classified, and a review made of previous drug history, compliance, seizure precipitants and non-pharmacological factors. The treatment plan should consist of a sequence of n=1 drug ‘trials’. The plan should document the proposed sequence of antiepileptics to trial, the duration of the trial and which background medication to continue and to withdraw. Non-pharmacological measures, lifestyle measures and surgical therapy should be considered. The chapter ends with an outline of prognosis and the patterns of relapse and remission of seizures in chronic epilepsy.

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