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Titolo:
CURRENT TREATMENT STRATEGIES IN SELECTED SITUATIONS IN EPILEPSY
Autore:
TREIMAN DM;
Indirizzi:
UCLA,SCH MED,DEPT NEUROL,C-128 REED NEUROL RES CTR,710 WESTWOOD PLAZALOS ANGELES CA 90024 UCLA,DEPT VET AFFAIRS W LOS ANGELES MED CTR,NEUROL SERV LOS ANGELES CA 00000 UCLA,DEPT VET AFFAIRS W LOS ANGELES MED CTR,RES SERV LOS ANGELES CA 00000
Titolo Testata:
Epilepsia
, volume: 34, anno: 1993, supplemento:, 5
pagine: 190000017 - 190000023
SICI:
0013-9580(1993)34:<190000017:CTSISS>2.0.ZU;2-9
Fonte:
ISI
Lingua:
ENG
Soggetto:
1ST UNPROVOKED SEIZURE; PROPHYLACTICALLY ADMINISTERED PHENYTOIN; CONVULSIVE STATUS EPILEPTICUS; POST-TRAUMATIC SEIZURES; FOLLOW-UP; ADULT LIFE; CARBAMAZEPINE THERAPY; RECURRENCE; CHILDHOOD; PROGNOSIS;
Keywords:
SEIZURES; NEUROLOGICAL MANIFESTATIONS; STATUS EPILEPTICUS; ANTICONVULSANTS; HEAD INJURIES; PROPHYLAXIS; PREVENTION; PREGNANCY; AGING;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
71
Recensione:
Indirizzi per estratti:
Citazione:
D.M. Treiman, "CURRENT TREATMENT STRATEGIES IN SELECTED SITUATIONS IN EPILEPSY", Epilepsia, 34, 1993, pp. 190000017-190000023

Abstract

Several special situations in the management of epilepsy require specific treatment strategies. Recurrence rates after a single seizure vary between 26 and 71%. Antiepileptic drug (AED) therapy should be initiated after a first seizure only when a definitive diagnosis of epilepsy can be made. Although several AEDs have been shown to be antiepileptogenic in animal models, no data yet prove the efficacy of any AED in preventing the development of post-traumatic or postoperative epilepsy. Therefore, there is no rational basis for prophylactic treatment with AEDs. The incidence of epilepsy rises dramatically after the age of 50 years. Simultaneously, many physiological changes increase the potential for adverse effects and drug interactions when AEDs are used in the elderly. Careful attention to changing pharmacokinetic parameters is necessary when that group of patients is being managed. Pregnancy also brings about physiological changes that may either increase or decrease the seizure frequency. The risk of fetal malformations is approximately double in children born to mothers with epilepsy compared withchildren born to nonepileptic mothers. The risk is dose-dependent andincreases with the number of AEDs. All AEDs may cause fetal malformations; valproate and carbamazepine increase the risk of spina bifida. Nonetheless, the best AED for a woman who wants to become pregnant is the AED that best controls her seizures, which should be given at the lowest possible effective dose. Discontinuation of AEDs can be considered after 2-4 years of complete seizure control. Most of the risk of relapse occurs within the first 6 months. Status epilepticus (SE) is a medical emergency. The most common form of SE is generalized convulsivestatus epilepticus, in which the patient may present with either overt or subtle convulsions. Because of the potential for neuronal damage,all electrical as well as clinical seizure activity must be completely stopped for treatment of SE to be considered successful.

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Documento generato il 25/11/20 alle ore 09:19:25