Racionalna obravnava epilepsij = Rational management of epilepsies
Vodušek, David B.
After the first seizure, its cause (which may be a serious disease) needs to be determined. The actual diagnostic procedure depends on the clinical contextand should as a rule be performed by a ...neurologist. In patienis suspected to have epilepsy, the primary concern is often to distinguish epileptiform phenomena from syncope, intoxication, involuntary movements, dissomnias, parasomnias and psychogenic disorders. Knowledge of the clinical characieristics of the disease is of primary importance and electroencephalography is the most useful test. At least 50% of these patientswill require more than one recording session and some diagnostic dilemmas can only be resolved by prolonged EEG-video monitoring. Early on in the diagnostic procedure neuroimaging should be performed, MRI if possible. Further differential diagnostics will be narrowed down if identification of the particular epileptic syndrome in the individual patient has been made previously (on account of the clinical picture, EEG and neuroimaging). The diagnostics should be performed by a neurologist, and in complex cases by a neurologist-epileptologist. For some patients additional specialists, in particular a psychiatrist, will need to be consulted. After the diagnosis of epilepsy the possibility of causal therapy should be considered. In the absence of this possibility the patient needs to be counselled (regarding driving, etc.), and in most cases antiepileptic treatment will be necessary. Valproate and carbamazepine are the first choice drugs. The former has a wide applicability in primary generalized epilepsies, but is also effective for partial epilepsies. Carbamazepine is usually the first choice drug for partialepilepsies. Carbamazepine should not be used for absences (picnolepsy) and myoclonic epilepsies). (Abstract truncated at 2000 characters)
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