Last reviewed: November 2017
Last updated: November  2017

Important updates

Revised "Operational classification of seizure types by the International League Against Epilepsy"

  • The classification has been revised. Seizures are divided into those of focal, generalized, unknown onset, with subcategories of motor, nonmotor, with retained or impaired awareness for focal seizures.

  • Levels of classification to aid in the diagnosis include seizure type, epilepsy type (focal, generalized, combined generalized and focal, unknown), and epilepsy syndrome.

Original source of update

First-line monotherapy in children and adults with focal-onset seizures or generalized tonic-clonic seizures with or without other generalized seizure types

  • This 2017 Cochrane review supports:

  • The use of carbamazepine and lamotrigine as first-line treatments for adults and children with focal-onset seizures.

  • The use of levetiracetam as a suitable alternative if carbamazepine and lamotrigine are unsuitable or not tolerated.

See Management: approach

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • movement of one side of the body or one specific body part
  • premonitory sensation or experience (fear, epigastric sensation, déjà vu, jamais vu)
  • automatisms (picking at clothes, smacking of the lips)
  • temporary aphasia
  • staring and loss of contact with the environment

Other diagnostic factors

  • postictal focal neurological deficit (Todd paralysis, aphasia)
  • persistent focal neurological deficit
  • poor memory
  • stigmata of neurocutaneous syndromes

Risk factors

  • febrile seizure
  • head trauma
  • CNS infection
  • stroke
  • brain tumor
  • mental retardation (MR) and/or cerebral palsy
  • dementia
  • FHx of seizures
  • vascular malformations
  • male

Diagnostic investigations

1st investigations to order

  • blood glucose
  • CBC
  • electrolyte panel
  • toxicology screen
  • lumbar puncture and CSF analysis
  • CT head
  • MRI brain
  • EEG
Full details

Investigations to consider

  • serum prolactin
  • video/EEG long-term monitoring (LTM)
  • PET scan
  • single photon emission computed tomography (SPECT) scan
  • functional MRI scan
  • magnetoencephalography (MEG scan)
  • neuropsychological testing
  • Wada test
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Assistant Professor

Clinical Neurology

University of California, San Francisco

San Francisco

CA

Disclosures

VRR is an author of a number of references cited in this monograph. He received honoraria and travel expenses for speaking at educational events hosted by NeuroPace, Inc., manufacturer of the Responsive Neurostimulation (RNS) System, and is a paid consultant for them.

Associate Professor

Clinical Neurology

University of California, San Francisco

San Francisco

CA

Disclosures

JDH has received research grant support from UCB Inc, he has done consulting work for Lumetra Healthcare Solutions, California Medical Board, Freshblood Market Consultants, and given expert witness testimony for Actavis and Zydus Inc. He is also on the advisory board for Acorda Therapeutics.

Dr Vikram R. Rao and Dr John D. Hixson would like to gratefully acknowledge Dr Jeffrey Cohen, a previous contributor to this monograph. JC declares that he has no competing interests.

Peer reviewers VIEW ALL

Chief

Epilepsy Division

Brigham and Women's Hospital

Associate Professor of Neurology

Harvard Medical School

Boston

MA

Disclosures

At the time of review, EB declared that between 2004 and 2009, he received speaking honoraria from UCB Pharma, Novartis, Abbott Laboratories, GlaxoSmithKline, and Pfizer. He received consulting fees from UCB Pharma, Genzyme, and Spherics, and research funding from UCB Pharma. Unfortunately, we have since been made aware that EB is deceased.

Associate Professor

Pediatrics and Neurology

Baylor College of Medicine

Medical Director

Comprehensive Epilepsy Program

Texas Children's Hospital

Houston

TX

Disclosures

AAW declares that he has no competing interests.

Assistant Professor

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York

NY

Disclosures

Not disclosed.

Consultant Neurologist

Muscular and Neurodegenerative Diseases Unit

"G Gaslini" Institute

Genova

Epilepsy Centre

Federico II University

Napoli

Italy

Disclosures

PS declares that he has no competing interests.

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