Elsevier S & T

The Comprehensive Evaluation and Treatment of Epilepsy: A Practical Guide

Schachter, Steven C.; Schomer, Donald L.

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Table of contents

Cover
Contentsv
Contributorsxv
Prefacexvii
Chapter 1. Classification of Seizures and the Epilepsies1
How Are Seizures Classified?1
How Can the Physician Distinguish between Simple Partial and Complex Partial Seizures?1
What Are the Types of Generalized Seizures?3
What Is an Epileptic Syndrome?11
What Are the Categories of Idiopathic-Related Partial Epilepsies?13
What Are the Categories of Generalized Epilepsies and Syndromes?18
References32
Chapter 2. Radiographic Assessment of Patients with Epilepsy37
Should Every Patient Who Has a Seizure Have an Imaging Workup?37
What Imaging Methods Are Indicated and What Should the Physician Order When Performing a Workup on a38
What Type of Lesion Is Neuroimaging Most Likely to Show?46
When Should the Physician Order a SPECT or PET Scan?51
How Should the Physician Interpret the Findings When Functional Imaging Methods Are Used?51
How Can Lesions Be Differentiated by a Combination of Magnetic Resonance Imaging Modalities?53
What Is the Optimal Radiographic Evaluation of a Patient with Epilepsy?55
When Are Follow-up Scans Indicated?56
Are There Any New Imaging Methods or Techniques for the Evaluation of Patients with Epilepsy?57
References59
Chapter 3. Treatment of Seizures61
What Are the Goals of Therapy?61
How Does Diagnosis of the Patient's Seizure Type Influence the Choice of Therapy?61
When Should Treatment Be Started?62
What Can Be Done, as Treatment Is Initiated, to Maximize the Likelihood of a Successful Outcome?62
What Are the Results of AED Therapy?64
Is Noncompliance with AED Therapy a Significant Problem?68
What Are the Typical Side Effects of AEDs?68
What Are the Advantages of Monotherapy over Polytherapy?69
What Are the Roles of AED Levels and Blood Tests?71
When Can AEDs Be Discontinued?72
Is AED Treatment during Pregnancy Safe? What Are the Safest AEDs in General?72
What Are the Other Elements of Treatment besides Medical Therapy?73
Conclusion74
References74
Chapter 4. Definition and Overview of Intractable Epilepsy75
When Is Epilepsy Considered Intractable?75
How Do Physicians' and Patients' Perspectives on Intractable Epilepsy Tend to Differ?76
How Does AED Therapy Affect the Prognosis for Patients with Specific Epilepsy Syndromes?78
How Many Medications Should Be Tried before a Patient Is Evaluated for Surgery?80
How Long Should Drug Therapy Be Tried before Surgery Is Considered?82
What Factors Contribute to Incomplete Seizure Control or Disabling Side Effects?82
When Should the Diagnosis of Nonepileptic Seizures Be Considered?83
What Factors Contribute to Incorrect Classification of Seizures?84
Why Do Patients Sometimes Not Comply with Treatment?85
How Do Lifestyle and Living Conditions Affect Seizure Control?85
What Special Resources Do Comprehensive Epilepsy Centers Offer?86
How Does Uncontrolled Epilepsy Affect the Patient?86
References88
Chapter 5. Psychosocial Aspects of Epilepsy91
What Is the Patient's Perspective on Epilepsy?91
What Is the Spectrum of Epilepsy?92
What Factors Affect a Person's Coping and Adjustment to Seizures?92
What Psychosocial Interventions Are Appropriate for Patients Whose Epilepsy Has Not Been Confirmed?96
What Seizure Variables May Affect the Patients' Psychosocial Adjustment?97
What Impact Do Seizures Have on Patients' Daily Lives?98
What Treatment Options Exist for Psychosocial Problems?100
What Psychosocial Issues Need to Be Addressed before and after Epilepsy Surgery?106
What Community Resources and Supports Are Available to Persons with Epilepsy and Their Families?107
Conclusion109
References109
Chapter 6. Neuropsychological Assessment and Application to Temporal Lobe Epilepsy111
What Is Neuropsychology?111
What Is the Role of Neuropsychology in the Care of Patients with Epilepsy?112
How Does Temporal Lobe Epilepsy Affect Cognitive Status?112
How Does Temporal Lobe Epilepsy Affect Emotional and Psychological Status?113
What Does Comprehensive Neuropsychological Evaluation Entail?114
What Are Specific Considerations in the Neuropsychological Evaluation of Patients with TLE?114
What Neuropsychological Tests Are Used in the Evaluation of Patients with Epilepsy?116
What Role Does Neuropsychology Play in the Care of Patients Who Are Undergoing Surgical Resection?120
What Is the Intracarotid Amobarbital Test?120
How Is the Intracarotid Amobarbital Test Administered?121
What Is Cortical Mapping?122
What Neuropsychological Changes Are Associated with Surgery for Seizures?124
How Does Surgery for the Treatment of Epilepsy Affect the Patient's Emotional–Psychological State?125
Conclusion125
References126
Chapter 7. Psychiatric Considerations in Patients with Epilepsy131
Does Epilepsy Predispose Patients to Particular Psychiatric Illnesses or Behavioral Problems?131
Are There Differences between Ictal and Interictal Behavioral Symptoms?132
How Do Psychiatric or Behavioral Symptoms Vary in Patients with Simple as Opposed to Complex Partial132
Are There Differences between Temporal and Frontal Lobe Epilepsies?134
Why Is Depression a Serious Complication of Epilepsy?135
What Types of Psychosis May Develop in Patients with Epilepsy?136
What Other Psychiatric Symptoms May Develop in Epilepsy?137
Have Specific Behaviors Been Described during the Interictal Period in Patients with TLE?138
Are Temper Problems or Aggression Associated with TLE?139
Can Epilepsy Contribute to Creative Behavior?140
How Do Physicians Distinguish Psychogenic Nonepileptic Seizures from True Epileptic Seizures?140
What Constitutes an Appropriate Evaluation for the Epilepsy Patient with Psychiatric Symptoms?141
Which Psychotropic Medications May Be Helpful for Patients with Epilepsy?143
In Addition to Medication, What Psychiatric Interventions Can Be Helpful for Epilepsy Patients?145
What Effect Does Epilepsy Surgery Have on Psychiatric Symptoms?146
What Effects Do Antiepileptic Medications Have on Psychiatric Symptoms in Epilepsy?146
References147
Selected Readings147
Chapter 8. Status Epilepticus149
What Is Generalized Convulsive Status Epilepticus and What Causes It?149
What Complications Can Occur with Convulsive Status Epilepticus?152
What Are the Other Types of Status Epilepticus?154
How Is Status Epilepticus Diagnosed?159
How Are Anticonvulsants Used to Treat Status Epilepticus?161
When Should Electroencephalography Be Used?167
When and How Should the Patient's Condition Be Reevaluated during Treatment?168
References169
Chapter 9. Diagnosis and Management of Nonepileptic Seizures173
What Are Nonepileptic Seizures?173
Why Is an Understanding of Nonepileptic Seizures Important?173
What Causes Nonepileptic Seizures?174
What Clues to the Diagnosis of Nonepileptic Seizures May Be Provided by the Patient's History?174
Do Nonepileptic Seizures Have Characteristics That Suggest the Diagnosis?175
Are Any of These Clinical Characteristics Diagnostic for Nonepileptic Seizures?176
Do Nonepileptic Seizures Sometimes Coexist with Epilepsy?177
How Can One Make a Definitive Diagnosis of Nonepileptic Seizures?178
What Is the Diagnostic Role of Prolactin Determinations?180
If Intensive EEG–Video Monitoring Is Not Available, What Alternatives Can Be Used?180
Do Patients with Nonepileptic Seizures Have a Typical Psychologic Profile?181
What Are the Most Common Psychiatric Diagnoses Associated with Nonepileptic Seizures?181
What Is the Best Approach to Treatment?182
What Is the Outlook for Patients with Nonepileptic Seizures?183
References183
Chapter 10. Ambulatory Electroencephalographic Monitoring: Technology and Uses185
What Is the History of Ambulatory Electroencephalographic Monitoring?185
How Did the Event Recording System Evolve?185
How Does An Ambulatory EEG Monitoring System Differ from an Inpatient System?186
What Are the Clinical Applications of Ambulatory Monitoring?187
How Effective Is Ambulatory Outpatient EEG Monitoring?188
What Advances in Ambulatory Outpatient EEG Monitoring Can Be Expected in the Future?192
References195
Chapter 11. The Surgical Treatment of Epilepsy197
Who Is a Candidate for Epilepsy Surgery?197
How Do Surgeons Know that Lobectomy Will Help to Control or Eliminate Seizures?197
How Is a Cortical Excision Performed?198
How Much Brain Tissue Should Be Removed?199
What Is the Likelihood of Success in Arresting or Reducing Seizure Activity with Cortical Excisions200
What Are the Possible Complications of Surgery?200
Will a Person Who Undergoes Lobectomy for Seizures Be "Different" after Surgery?201
What Is a Hemispherectomy?201
What Is a Callosotomy?202
How Is Callosal Sectioning Carried Out?203
What Are Implanted EEG Electrodes?203
How Are Depth Electrodes Implanted?204
What Are the Risks of Implanting Electrodes?205
Conclusion205
References206
Chapter 12. Endocrine Aspects of Partial Seizures207
How Do Hormones and Epilepsy Interact?207
Catamenial Epilepsy: What Is It and How Should It Be Evaluated and Treated?208
How Should Catamenial Epilepsy Be Evaluated?210
Menarche, Pregnancy, Menopause: Do They Affect Seizures?211
In What Other Ways May Hormones Affect Seizures?213
How Does Partial Epilepsy Affect Endocrine Reproductive Function in Women?213
How Should Women with Epilepsy and Reproductive Dysfunction be Evaluated?215
How Does Epilepsy Affect Women's Sexuality?217
How Do Seizures Affect Reproductive Endocrine Function in Men?218
What Effects Do Seizures Have on Hormone Production Acutely, and What Clinical Relevance Do These Ef219
Of What Clinical Utility Is Postictal Prolactin Testing, and How Should It Be Done?220
Is the Checking of Other Hormone Levels Postictally Worthwhile?221
Are Any Other Hormonal Systems Clinically Affected by Partial Seizures?221
What Is the Effect of AEDs on Sexuality in Men and Women and on Reproduction in Men?222
What Are the Laboratory Findings in Hyposexual Patients Who Are Given AEDs?223
How Can AED-Related Hyposexuality Be Treated?223
What Additional Effects May AEDs Have on Reproductive Function in Women?224
Which Other Hormonal Systems Are Affected by AEDs?225
Can Hormones Be Used to Treat Epilepsy?226
References228
Chapter 13. Epilepsy and the Elderly233
How Common Is Epilepsy in the Elderly Population?233
What Are the Most Common Causes of Seizures and Epilepsy in Older Age Groups?233
What Types of Strokes Are Most Likely to Cause Seizures?237
How Do Seizures Present In Older People?237
What Is the Differential Diagnosis of Transient Alterations in Function in This Population, and What238
What Are the Most Important Elements of the History and Physical Examination, and What Ancillary Dia243
When Should Older Patients Receive Therapy after a First Seizure?244
What Considerations Apply to Choice of AEDs in the Elderly? What Potential Adverse Effects and Drug245
In What Ways Do Pharmacokinetic Factors Change with Aging? What Are the Implications for the Way AED247
What Is the Prognosis of Epilepsy in Elderly Patients?248
How Should Long-Standing, Apparently Stable Epilepsy in the Elderly Be Treated? When Can AEDs Be Wit248
Is Surgical Treatment for Medically Intractable Epilepsy a Possibility in Elderly Patients?249
What Are the Causes, Manifestations, and Risks of Status Epilepticus in the Elderly, and How Should250
What Are the Implications of Epilepsy and AED Therapy for Independent Function in Older Persons?251
References251
Chapter 14. The Team Approach to the Treatment of Epilepsy255
What Is the Team Approach to the Management of Epilepsy?255
What Is the Physician's Role on the Team?256
What Is the Nurse's Role as a Member of the Team?257
What Role Does the Psychiatrist Play as a Member of the Team?258
What Is the Psychologist's or Neuropsychologist's Role as a Member of the Team?258
What Is the Social Worker's Role on the Team?259
What Role Does the Neurosurgeon Play on the Team?259
What Practical and Economic Advantages Do Comprehensive Epilepsy Management Teams Offer?259
Index261

Book details

Vendor Elsevier S & T
SKU 9780126213553
ISBN-13 9780080529462
Author Schachter, Steven C.; Schomer, Donald L.
Category Medical
Subject Diagnosis

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Epilepsy is, after headache, the second most common neurological disorder. This book clarifies the many courses of action to take in treating patients with epilepsy. It presents current knowledge about seizures and epilepsy in a comprehensive, socially conscious, and clear manner. The editors have provided this information in a comprehensive, easy-to-use, and practical form.
This short, simple pedagogical guide to the diagnosis and management of epilepsy is an important reference work for all medical schools, hospitals, clinics, and primary care centers.

This book integrates the latest research into essential reviews on:
* Initial management of patients with seizures
* Neuroradiological evaluation of epilepsy
* Psychosocial aspects of epilepsy
* Neuropsychologic problems associated with epilepsy
* Psychiatric disorders
* Diagnosis and treatment of status epilepticus
* Nonepileptic seizures
* Ambulatory EEG monitoring
* Epilepsy surgery
* Endocrine aspects of partial seizures
* Epilepsy in the elderly

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