Solitary Epileptic Seizures in the Clinical Practice

An epileptic seizure may be conceptualized as a paroxysmal pathological process in the brain of a heterogeneous etiology with heteromorphic clinical and electrophysiological manifestation.The cases of epileptic seizures are classified according to The International Classification of Epileptic Seizures (ICES) published for the first time by The International League Against Epilepsy (ILAE) in 1970 and revised in 1981 (Commission on Classification and Terminology of the International League Against Epilepsy, 1981). This classification is a clinical one related to semiology of the seizures not to their etiology. Therefore it is necessary to exclude an acutely occurring cause responsible for occurrence of the seizure. In such cases we talk about the so-called acute symptomatic seizures. The underlying cause may be structural (e.g. head trauma), metabolic, toxic (e.g. alcohol), or an acute CNS infection, etc.. The most frequent acute symptomatic seizures are the febrile seizures. In fact, the acute symptomatic seizures occur more frequently than epilepsy (“unprovoked” seizures). The risk of occurrence during one’s life is very high approximately 5% in males and 2.5% in females. If the acutely occurring cause has been withdrawn or cured without a residuum in the form of a brain lesion, the seizures do not recur (Dasheiff, 1987; Fromm, 1987). The antiepileptic medication is necessary for suppressing the seizures in the acute stage but usually there is no need for treatment continuation after the complete cure of the underlying disease. If the acutely occurring cause was not responsible for epileptic seizure we talk about a so-called unprovoked seizure. If the unprovoked epileptic seizure occurs in relation to a preceding neurological insult, the disorders is regarded as secondary to this insult; we call it the late symptomatic epileptic seizure or late symptomatic epilepsy in case of seizure recurrence. A general principle of treatment for the symptomatic (secondary) epileptic seizures has been a primary effort for resolution of the underlying disease that is the etiological factor responsible for the seizures. Given that it is impossible, the antiepileptic treatment in accordance with the treatment guidelines for individual seizure types (together with adherence to right living, behavioural precautions and concomitant solutions of the social and psychological issues) is indicated (Hovorka et al. 2004a; Hovorka et al. 2004b; Ošlejšková, 2007). Approximately 5% of the population experiences one unprovoked epileptic seizure in the lifetime (Forsgren et al., 1996; Hauser et al. 1993). The febrile seizure before the age of 5 occurs in approximately 5% of population (Hauser et al. 1996). Only about 25% of people experiencing the first unprovoked seizure see the doctor and nearly always the seizure is a generalized tonic-clonic one. Most of the people have no