Antiepileptic Drug Selection
In most cases, initial antiepileptic drug (AED) therapy is selected from a relatively short list of AEDs determined primarily by the suspected epilepsy syndrome, as previously described in Chapter 71….
Drug-Resistant Epilepsy
Most patients with epilepsy achieve seizure control with medications. However, about 30% of patients have drug-resistant epilepsy. Drug-resistant epilepsy, often known as medically intractable epilepsy, is defined as continued seizures…
Initial Treatment of Epilepsy
A. When choosing initial antiepileptic drug (AED) therapy for a patient with epilepsy, assess whether the suspected diagnosis is a focal or generalized epilepsy. In focal epilepsies, there is felt…
Evaluation of Adult With First Seizure
Evaluation of the patient with a first seizure is focused on determining (1) the risk of recurrence and whether antiepileptic drug (AED) therapy is warranted to reduce this risk, and…
Intracranial Hypotension
Intracranial hypotension, or low cerebrospinal fluid (CSF) pressure, should be suspected in a patient with a positional headache that worsens within 15 minutes of standing and improves with recumbency. The…
Trigeminal Neuralgia
Trigeminal neuralgia, also known as tic douloreux, manifests as recurrent attacks of abrupt, unilateral, severe stabbing (or electric-like) pain in the distribution of the trigeminal nerve. Typically, the mandibular or…
Trigeminal Autonomic Cephalalgias: Treatment
Trigeminal autonomic cephalalgias (TACs) encompass a group of primary headache disorders characterized by unilateral headache with ipsilateral cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial sweating,…
Migraine Headache: Prophylactic Treatment
Prophylactic therapy for migraine is aimed at reducing the frequency, and possibly severity, of recurrent migraine headaches. To maximize tolerability, it is important to start with low doses and titrate…
Migraine Headache: Acute Treatment
Acute treatment of migraine should target both head pain and, if present, associated symptoms such as nausea and vomiting. The latter may limit absorption of oral medications; in these cases,…
Postconcussive Syndrome
While the initial neurologic symptoms following concussion typically resolve quickly, many will have symptoms that evolve over the ensuing 1–3 days. The majority of patients experience a complete recovery in…
