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Epilepsycomprises a group of chronic syndromes that involve recurrent seizures. Approximately 1% of the world’s population hasepilepsy; the second most common neurologic disorder after stroke. Although standard therapy permits control of seizures in 80% of these patients, there are an estimated 500,000 people in the United States who suffer from uncontrolled epilepsy.

Seizures are finite episodes of brain dysfunction resulting from abnormal transient discharge of cerebral neurons. The causes of seizures are many. They include the full range of neurologic diseases, such as tumor, head trauma, and stroke. In some patients, the cause of seizures may be less obvious or unknown, such as a congenital abnormality or genetic factor. In other patients, seizures may be caused by an underlying acute toxic or systemic metabolic disorder (e.g., infections, hypoglycemia, hypoxia, poisoning), in which case appropriate therapy is usually directed toward the specific abnormality. Classification of seizure types with clinical descriptions are listed in Table 14–1.

Table 14–1. Seizure Classification

Effective antiseizure drugs have, to varying degrees, selective depressant actions on the abnormal neuronal discharge. However, they vary in their mechanisms of action and in their effectiveness in specific seizure disorders. In most seizure disorders, however, the choice of medication depends on the empiric seizure classification. In this chapter, we will discuss the various drugs used to treat seizures based on their drug class and mechanism of action (Table 14–2) and adverse effects (Table 14–3). We will then discuss their clinical uses in treating epilepsy, based on empiric seizure classification (Figure 14–1).

Table 14–2. Drug Classification and Mechanism of Action of Common Antiseizure Drugs

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