Overview

Differentiation of seizure etiology and type is critical for the appropriate management of seizures. Once it is established whether or not a seizure is epileptic, it is necessary to “distinguish between epileptic seizures that are epilepsy and those that are not epilepsy,” says Jerome Engel, Jr., MD, PhD. For seizures associated with epilepsy, the goals of therapy are no seizures and no side effects as soon as possible. If initial monotherapy is unsuccessful in achieving these goals, the selection of adjunctive or second-line therapy will be explored. However, patients whose seizures are refractory to more than 2 regimens should be referred to an epilepsy treatment center, where surgery may be an option.

This activity will also explore the concerns of special populations with epilepsy, such as children, women of child-bearing age, and elderly patients.

J.C. is a 20-year-old college student who presents after experiencing a seizure while on a hiking trip with friends. Her friends report that she appeared to stare into the distance for a few moments, and then her arms and legs began to “twitch.” She is moderately dehydrated, but otherwise healthy and has no history of seizures. EEG and MRI are normal. Which of the following is the most likely diagnosis for J.C. at this time?

References

International League Against Epilepsy (ILAE). Epilepsia. 2005;46(4):470-472.
Hauser WA et al. Epilepsia. 1991;32:429-445.
Blume WT et al. Epilepsia. 2001;42:1212-1218.
Engel JE Jr. Epilepsia. 2006;47(9):1558-1568.
Strandberg M et al. Epileptic Disord. 2008;10;83-92.
Duncan J. Curr Opin Neurol. 2009;22:179-184.
Wakamoto H et al. Pediatr Neurol. 2008;38:181-188.
French JA et al. Neurology. 2004;62:1252-1260.
Stefan H, Feuerstein TJ. Pharmacol Ther. 2007;113:165-183.
FDA Approves BANZEL™ (rufinamide) as Adjunctive Treatment for Severe Epilepsy Disorder [press release].
Woodcliff Lake, NJ: PRNewswire; November 14, 2008.
Brodie MJ et al. Epilepsia. 2009;50:1899-1909.
Luszczki JJ. Pharmacol Rep. 2009;61:197-216.
Kwan P, Brodie MJ. CNS Spectr. 2004;9(2):110-119.
Spencer S, Huh L. Lancet Neurol. 2008;7:525-537.
Engel JE Jr et al. Neurology. 2003;60:538-547.
Uthman BM et al. Neurology. 2004;63(6):1124-1126.
Snead OC, III. Pediatr Res. 2004;55:368-369.
Mosek A et al. Seizure. 2008; Aug 1 [Epub ahead of print].
Benn EK et al. Epilepsia. 2008;49:1431-1439.
Kerner JA, Ting G. Epilepsy. Decision Resources Inc. http://www.decisionresources.com/stellent/groups/public/documents/abstract/dr_009624.hcsp, 2005.
Accessed March 24, 2008.
Glauser TA et al. Epilepsia. 2006;47:1094-1120.
Glauser TA et al. Neurology. 2006;66:1654-1660.
Kaaja E et al. Neurology. 2003;60:575-579.
Kluger BM, Meador KJ. Semin Neurol. 2008;28:328-335.
Vajda FJ. Expert Opin Pharmacother. 2008;9:1859-1868.
Jetter GM, Cavazos JE. Semin Neurol. 2008;28:336-341.
Ramsay RE et al. Neurology. 2004;62:S24-S29.

The materials presented here are used with the permission of the authors and/or other sources.
These materials do not necessarily reflect the views of PeerView Press or any of its supporters.

This activity is supported by educational grants from Eisai Inc., Pfizer, Inc., Valeant Pharmaceuticals, Cyberonics Inc., Shire, and UCB, Inc.

Eisai Inc., Pfizer, Inc., Valeant Pharmaceuticals, Cyberonics Inc., Shire, and UCB, Inc.

Please contact info@peerviewpress.com with any questions, comments, or feedback about our programs.

About This PeerView CME/CNE/CPE Activity

The Semel Institute for Neuroscience and Human Behavior at UCLA and the Institute for Medical Education are responsible for the selection of this report's topics, the preparation of editorial content, and the distribution of this report. The preparation of PeerView reports is supported by educational grants subject to written agreements that clearly stipulate and enforce the editorial independence of the Semel Institute for Neuroscience and Human Behavior at UCLA, the Institute for Medical Education, and PVI. For approved prescribing information, please consult the manufacturer's product labeling. No endorsement of unapproved products or uses is made or implied by coverage of these products or uses in our reports. Readers should verify all information and data in this report before treating patients or employing or relying on any therapies described in the educational report. No responsibility is taken for errors or omissions in original reports.

Hardware/Software Requirements:
PeerView Press requires minimum browser versions of: 6.x from Microsoft and Netscape; 2.x from Mozilla Firefox; or 3.x from Safari. Certain activities may require additional software to view. That software may be: Adobe Reader®, and Adobe® Flash® Player.

PVI, PeerView Institute for Medical Education, 315 Bleecker Street, Suite 182, New York, NY 10014
Copyright © 2000-2009, PeerView Press

Improving Epilepsy Management Throughout the Disease Continuum

Program Description & Educational Objectives

In this activity, an expert in epilepsy management discusses epilepsy diagnosis, treatment, and considerations for special populations with epilepsy.

Upon completion of this activity, participants will be able to:

Differentiate between epileptic and nonepileptic seizures, and determine when it is appropriate to make a diagnosis of epilepsy and/or begin pharmacotherapy after the occurrence of an epileptic seizure
Develop and implement appropriate first-line pharmacotherapy for patients with epilepsy, based on updated safety and efficacy data as well as patient and seizure characteristics
Understand optimal management of seizures that are refractory to treatment, including referral to epilepsy treatment centers and surgery
Manage epilepsy in children, women, and the elderly based on unique safety and dosing or disease-related concerns, including the potential for drug-drug interactions, the avoidance of disturbing side effects, or seizure type

Target Audience

This activity has been designed to meet the educational needs of physicians, nurses, pharmacists, and other clinicians active in the care of patients with epilepsy.

Requirements for Successful Completion

In order to receive credit, participants must view the activity and complete the post-test and evaluation form. There are no pre-requisites and there is no fee to participate in this activity or to receive CME/CNE/CPE credit. Statements of Credit are awarded upon successful completion of the post-test and evaluation form.

Media:: Internet
Physicians' and Nurses' Release and Expiration Dates:: September 30, 2009 - September 29, 2010
Pharmacists' Release and Expiration Dates:: December 08, 2008 - December 07, 2009
Time to Complete:: 60 minutes

Faculty & Disclosure

Course Director

Jerome Engel, Jr., MD, PhD
Jonathan Sinay Distinguished Professor of Neurology, Neurobiology, and Psychiatry & Biobehavioral Sciences
David Geffen School of Medicine at UCLA
Los Angeles, California

Jerome Engel, Jr., MD, PhD, has a financial interest/relationship or affiliation in the form of:
Consultant for Johnson & Johnson Inc. and Novartis AG.
Honoraria from Eisai Inc.; Ortho-McNeil-Janssen Pharmaceuticals, Inc.; and UCB, Inc.

CME Reviewers

Matthew A. Howard, III, MD
Professor of Neurology
University of Iowa College of Medicine
Iowa City, Iowa

Matthew A. Howard, III, MD, currently has no financial interests/relationships or affiliations in relation to this activity.

Andrew F. Leuchter, MD
Professor, Department of Psychiatry and Biobehavioral Science
David Geffen School of Medicine at UCLA
Director, Laboratory of Brain, Behavior, and Pharmacology
Semel Institute for Neuroscience and Human Behavior at UCLA
Los Angeles, California

Andrew F. Leuchter, MD, has a financial interest/relationship or affiliation in the form of:
Consultant for Aspect Medical Systems; AstraZeneca, Ltd.; Eli Lilly and Company; GlaxoSmithKline; MEDACorp; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Shire Pharmaceuticals Group plc.; and Takeda Pharmaceuticals North America, Inc.
Grant/Research Support from Aspect Medical Systems; Eli Lilly and Company; MedAvante, Inc.; Merck & Co., Inc.; National Center for Complementary and Alternative Medicine; National Institute of Mental Health; Pfizer Inc.; Novartis Pharmaceuticals Corporation; VivoMetrics; and Wyeth Pharmaceuticals Inc.
Speakers Bureau participant with Eli Lilly and Company and Wyeth Pharmaceuticals Inc.
Shareholder in Aspect Medical Systems
Advisory Board for Aspect Medical Systems; AstraZeneca, Ltd.; Eli Lilly and Company; GlaxoSmithKline; MEDACorp; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Shire Pharmaceuticals Group plc.; and Takeda Pharmaceuticals North America, Inc.

CNE Reviewer

Andrew Leuchter, MD
David Geffen School of Medicine at UCLA
Semel Institute for Neuroscience and Human Behavior at UCLA
Los Angeles, California

Content Director

Annette Wiggins
PVI, PeerView Institute for Medical Education, Inc.

Annette Wiggins currently has no financial interests/relationships or affiliations in relation to this activity.

Sponsorship, Credit & Support

Physicians

This program was developed and reviewed by faculty members of the David Geffen School of Medicine at UCLA. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Institute for Medical Education and the Semel Institute for Neuroscience and Human Behavior at UCLA, in association with PVI, PeerView Institute for Medical Education. The Institute for Medical Education takes responsibility for the content, quality and scientific integrity of this CME activity.

The Institute for Medical Education designates this educational activity for a maximum of 1.0 hour of AMA PRA Category 1 Credit^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

Nurses

The Semel Institute at UCLA is an accredited provider for continuing education credits for nurses (provider number CEP381). This course meets the qualifications for 1.0 hour of credit as required by the Board of Registered Nursing.

Pharmacists

Amedco is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Participants will earn 1.0 contact hours or 1.0 CEUs for completing the program. Participants must attend the entire program and complete an evaluation form. Statements of Credit will be provided to participants within 4 weeks of the end of the program. UAN(s): 453-999-08-475-H01-P.

This activity is supported by an educational grant from Eisai Inc. Pfizer, Inc. Valeant Pharmaceuticals Cyberonics Inc. Shire UCB, Inc.

Sign-up for e-mail alerts