Epilepsy Classification and Antiseizure Medications
Focal vs generalized seizures, EEG patterns, and ASM titration schedules.
ILAE 2017 Classification
Seizures are classified by onset: Focal, Generalized, or Unknown.
- Focal Onset: Aware vs Impaired Awareness; Motor vs Non-motor.
- Generalized Onset: Motor (e.g., tonic-clonic) vs Non-motor (absence).
First-Line Antiseizure Medications (ASMs)
| Seizure Type | Preferred ASMs |
|---|---|
| Focal | Lamotrigine, Levetiracetam, Carbamazepine, Oxcarbazepine |
| Generalized (Tonic-Clonic) | Valproate, Lamotrigine, Levetiracetam |
| Absence | Ethosuximide, Valproate |
Common Clinical Mistakes
- Premature anchoring on common diagnoses without evaluating red flags.
- Over-reliance on neuroimaging while neglecting detailed physical exams.
- Suboptimal dosing of first-line agents before declaring treatment failure.
Frequently Asked Questions
- When is immediate specialist referral required?
- Urgent referral is indicated for sudden onset of severe symptoms, rapidly progressive deficits, or when standard therapies fail.
- What are the primary outcome measures in recent clinical trials?
- Most contemporary trials focus on slowing disease progression (e.g., EDSS in MS, UPDRS in Parkinson's) and reducing relapse/event rates.
- How does this condition impact patient life expectancy?
- While highly variable, modern disease-modifying therapies have significantly improved long-term survival rates across neurodegenerative and neuroimmunological disorders.