The Evolution of Seizure to Epilepsy

From generation Z to baby boomers, from first-of-a-lifetime seizure to medically refractory or intractable epilepsy, individuals with seizures represent a large spectrum of disease with multiple unique challenges. In addition to having seizures, many of which occur without the awareness of the person experiencing them, most individuals with epilepsy have memory complaints, cannot drive, rely on others to help them through the day, and, for women, have concerns about the effect their seizures and antiseizure medications might have on their babies. All wonder why they have seizures and whether they may pass it on to their children. In this issue of Practical Neurology, we are excited to share developments in the evolving world of epilepsy that we hope will help you and your patients navigate these challenges more easily.

Christine Hung begins the journey with an article on The First Seizure addressing what does it mean for a patient, why did it happen, and is it likely to happen again. Next, Melissa Reider-Demer and Vishal Shah bring you up to speed on Telemedicine & Epilepsy, sharing their own experiences on how this new technology can be useful to you and your practice. Continuing the theme of seizure and epilepsy assessment, there is nobody better than Marc Nuwer to tell us all about The New CPT Codes for Video-EEG going into effect in January of 2020 and how to use them in practice. Next, Elina Nikkola and Vishal Shah update you on Genetic Mechanisms of Epilepsy, discussing available testing and use of genetic tools to guide treatment as we move forward with personalized medicine.

Shifting to the evolution of epilepsy treatment, Jeff Kennedy, an epileptologist, and Melissa Chen, a specialist in obstetrics and gynecology, unite to discuss Women & Epilepsy, including catamenial epilepsy and safe drugs to use in pregnancy. Together they run a women’s clinic at University of California, Davis, and here, they share the topics they frequently face when interacting with their patients.

Lyn Clarito picks up the baton with Developments in Medical Treatment of Epilepsy, going over the latest drugs and how best to use them. She is followed by Vishal Shah and Melissa Reider-Deimer, who come together again with Dawn Eliashiv to review the latest data on Neurostimulation & Epilepsy. Although resection continues to remain the best option for seizure freedom, not everyone is a surgical candidate. But gone are the days when we could offer surgery only to patients with mesial temporal lobe epilepsy. With various neurostimulation techniques we can now drastically reduce epilepsy severity and improve quality of life for the vast majority of people with medically refractory epilepsy.

Finally, Chrystal Reed shifts gears to tell us about Epilepsy & Memory and the role interictal discharges or antiseizure medications play in this complex relationship. It’s a fascinating topic, and research on this topic is extensive and ongoing.

We have come such a long way from thinking seizures were demonic possession, and even though we are still far from truly understanding underlying mechanisms, we have developed many tools to help individuals with a single seizure as well as those with ongoing epilepsy. It is a pleasure to share those tools with you in this issue.

Inna Keselman, MD, PhD
Assistant Professor
Department of Neurology
University of California, Los Angeles
Los Angeles, CA