Treatment of Epilepsy 2020

Abstract

In the super–aging society like Japan, neurologists are highly expected to treat patients with epilepsy, which incident and prevalence has bimodal peaks in the young and elderly population. In year 2020, various old and new generation anti–epileptic drugs (AEDs) become available. Monotherapy is recommended, but rational polypharmacy is the second choice when a few monotherapy trials fail. Medical treatment should be tailored to each patient by taking account of epilepsy/seizure classification, comorbidity such as cognitive impairment, psychiatric symptoms and visceral impairment, drug–interaction profile, side–effect profile, and medical cost, in reference to the available guidelines. When the patient is considered medically intractable, neurologists should refer the patient to epileptologists in the epilepsy center for the re–evaluation of the diagnosis and the work–up for epilepsy surgery using the state–of–the art examinations such as the long–term video–EEG monitoring.