Oral Anticonvulsants Used in the Chronic Management of Seizure Disorders

Epilepsy affects approximately two million people in the U.S. About five percent of physician visits and 20% of neurological visits are by people seeking medical advice for the treatment of seizures.1 Approximately two-thirds of epileptic seizures begin in childhood; however, the incidence increases again after age 60, with a peak incidence in persons greater than 70 years of age.2 The term epilepsy is derived from Greek words meaning to “seize upon” or “take hold of.” The medical definition of epilepsy is an intermittent derangement of the nervous system caused by a sudden, excessive, disorderly discharge of cerebral neurons.2 Seizures refer to any paroxysmal disturbance in consciousness, behavior, or motor activity.1 The clinical presentations of epileptic seizures are classified by symptomatology and electrophysiologic findings according to the International Classification of Epileptic Seizures.3 The classification is as follows:4 I. Partial seizures (seizures begin locally) A. Simple (without impairment of consciousness) 1. With motor symptoms 2. With special sensory or somatosensory symptoms 3. With psychic symptoms B. Complex (with impairment of consciousness) 1. Simple partial onset followed by impairment of consciousness with or without automatisms 2. Impaired consciousness at onset with or without automatisms C. Secondarily generalized (partial onset evolving to generalized tonic–clonic seizures) II. Generalized seizures (bilaterally symmetrical and without focal onset) A. Absence B. Myoclonic C. Clonic D. Tonic E. Tonic–clonic F. Atonic G. Infantile spasms III. Unclassified seizures IV. Status epilepticus