n CME : Your SA Journal of CPD - Management of refractory epilepsy : main article

Abstract

The epilepsies are common. <BR>Approximately 70% of patients will attain freedom from seizures for at least 5 years. <BR>Those destined to remit usually do so in the first few years after presentation. <BR>The anti-epileptic drugs (AEDs) do not alter the course of epilepsy and are therefore symptomatic treatment only. <BR>For patients with focal epilepsy with or without secondary generalisation, there are no clear differences in efficacy between all of the AEDs, except ethosuximide (used only for absence seizures). <BR>The newer generation AEDs have not reduced the burden of patients with medically refractory seizures. <BR>Medically refractory seizures usually impair quality of life substantially, increase mortality and result in considerable direct and indirect costs to society. <BR>Early referral of patients with medically refractory seizures is required if patients with non-epileptic seizures are to be identified to prevent unnecessary, prolonged treatment with AEDs and if patients with epilepsy are to gain the most from epilepsy surgery. <BR>Epilepsy surgery is an effective treatment option for some patients who have medically refractory epilepsy. <BR>Surgery is usually offered when risks of the procedure are low.