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Update on Antiseizure Medications 2022
This article is an update from the article on antiepileptic drug therapy (now referred to as antiseizure medication therapy) published in the two previous Continuum issues on epilepsy and is intended to cover the vast majority of agents currently available to the neurologist in the management of patients with epilepsy. Treatment of epilepsy starts with antiseizure medication monotherapy. Knowledge of the spectrum of efficacy, clinical pharmacology, and modes of use for individual antiseizure medications is essential for optimal treatment for epilepsy. This article addresses antiseizure medications individually, focusing...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Approach to the Medical Treatment of Epilepsy
This article discusses the use of antiseizure medications in the treatment of focal and generalized epilepsies using an evidence-based approach. RECENT FINDINGS In recent years, several new antiseizure medications with differing mechanisms of action have been introduced in clinical practice, and their efficacy and safety has been evaluated in randomized controlled clinical trials. Currently, all antiseizure medications can prevent seizure occurrence, but they have no proven disease-modifying or antiepileptogenic effects in humans. The choice of therapy should integrate the best available evidence of efficacy, tolera...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Neuropsychiatric and Cognitive Comorbidities in Epilepsy
This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy. RECENT FINDINGS One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual d...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Seizures and Epilepsy in Childhood
This article highlights basic concepts of seizures and epilepsy in pediatric patients, as well as basic treatment principles for this age group. RECENT FINDINGS Epilepsy is the most common neurologic disorder in childhood. Accurate diagnosis is key; in older children, epileptic seizures need to be differentiated from various paroxysmal nonepileptic events, whereas in neonates, the majority of seizures are subclinical (electroencephalographic). Antiseizure medications remain the first-line treatment, but ketogenic diet and epilepsy surgery have also shown positive outcomes and can decrease drug burden. Genetic causes...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Women’s Issues in Epilepsy
This article highlights important developments in this field and reviews best practices in the management of women with epilepsy. RECENT FINDINGS Important external hormonal influences may impact women with epilepsy particularly in the context of gender-affirming medications, hormonal replacement therapy, and fertility therapies. Fertility for women with epilepsy is influenced by multiple variables; however, in the absence of preexisting fertility issues, epilepsy per se is not associated with significantly impaired fertility. Once women with epilepsy are pregnant, the majority have a stable course. Antiseizure medi...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Autoimmune-Associated Seizures
This article focuses on the seizure manifestations and presentations of autoimmune-associated epilepsy and acute symptomatic seizures in autoimmune encephalitis. It discusses the specificity of the various central nervous system autoantibodies and clarifies when their presence can be considered indicative of an immune etiology. Finally, current recommendations regarding patient selection for autoimmune antibody evaluation are reviewed, and an approach to immunotherapy is provided. RECENT FINDINGS Although autoimmune seizures are caused by a heterogeneous group of autoantibodies, key features reported in the literatu...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Genetic Epilepsy Syndromes
This article reviews the clinical features, typical EEG findings, treatment, prognosis, and underlying molecular etiologies of the more common genetic epilepsy syndromes. Genetic generalized epilepsy, self-limited focal epilepsy of childhood, self-limited neonatal and infantile epilepsy, select developmental and epileptic encephalopathies, progressive myoclonus epilepsies, sleep-related hypermotor epilepsy, photosensitive occipital lobe epilepsy, and focal epilepsy with auditory features are discussed. Also reviewed are two familial epilepsy syndromes: genetic epilepsy with febrile seizures plus and familial focal epilepsy...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Neuroimaging of Epilepsy
This article provides an overview of imaging modalities, important imaging pathologies, and the role each imaging modality can play in the diagnosis, evaluation, and treatment of epilepsy, including epilepsy surgery. RECENT FINDINGS The Harmonized Neuroimaging of Epilepsy Structural Sequences (HARNESS-MRI) protocol was proposed to standardize MRI imaging for all patients with seizures. The role of 7-Tesla MRI in finding previously occult epileptogenic lesions is under investigation, and the technique is increasingly used. Developing MRI postprocessing techniques can increase the sensitivity of MRI. Improvements in f...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

EEG Essentials
PURPOSE OF REVIEW EEG is the best study for evaluating the electrophysiologic function of the brain. The relevance of EEG is based on an accurate interpretation of the recording. Understanding the neuroscientific basis for EEG is essential. The basis for recording and interpreting EEG is both brain site–specific and technique-dependent to detect and represent a complex series of waveforms. Separating normal from abnormal EEG lies at the foundation of essential interpretative skills. RECENT FINDINGS Seizures and epilepsy are the primary targets for clinical use of EEG in diagnosis, seizure classification, and m...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Evaluation of First Seizure and Newly Diagnosed Epilepsy
This article focuses on the evaluation of children and adults who present with new-onset seizures, with an emphasis on differential diagnosis, classification, evaluation, and management. RECENT FINDINGS New-onset seizures are a common presentation in neurologic practice, affecting approximately 8% to 10% of the population. Accurate diagnosis relies on a careful history to exclude nonepileptic paroxysmal events. A new classification system was accepted in 2017 by the International League Against Epilepsy, which evaluates seizure type(s), epilepsy type, epilepsy syndrome, etiology, and comorbidities. Accurate classifi...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

An Ictal and Interictal Continuum
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Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: EDITOR’S PREFACE Source Type: research

Contributors
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Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: CONTRIBUTORS Source Type: research

Table of Contents
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Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2022 Category: Neurology Tags: Table of Contents Source Type: research

Issue Overview
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Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2022 Category: Neurology Tags: ISSUE OVERVIEW Source Type: research

Key Points for Issue
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Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2022 Category: Neurology Tags: KEY POINTS FOR ISSUE Source Type: research