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The management of epilepsy in children and adults

Piero Perucca, Ingrid E Scheffer and Michelle Kiley
Med J Aust 2018; 208 (5): 226-233. || doi: 10.5694/mja17.00951
Published online: 19 March 2018

Summary

 

  • The International League Against Epilepsy has recently published a new classification of epileptic seizures and epilepsies to reflect the major scientific advances in our understanding of the epilepsies since the last formal classification 28 years ago. The classification emphasises the importance of aetiology, which allows the optimisation of management.
  • Antiepileptic drugs (AEDs) are the main approach to epilepsy treatment and achieve seizure freedom in about two-thirds of patients.
  • More than 15 second generation AEDs have been introduced since the 1990s, expanding opportunities to tailor treatment for each patient. However, they have not substantially altered the overall seizure-free outcomes.
  • Epilepsy surgery is the most effective treatment for drug-resistant focal epilepsy and should be considered as soon as appropriate trials of two AEDs have failed. The success of epilepsy surgery is influenced by different factors, including epilepsy syndrome, presence and type of epileptogenic lesion, and duration of post-operative follow-up.
  • For patients who are not eligible for epilepsy surgery or for whom surgery has failed, trials of alternative AEDs or other non-pharmacological therapies, such as the ketogenic diet and neurostimulation, may improve seizure control.
  • Ongoing research into novel antiepileptic agents, improved techniques to optimise epilepsy surgery, and other non-pharmacological therapies fuel hope to reduce the proportion of individuals with uncontrolled seizures. With the plethora of gene discoveries in the epilepsies, “precision therapies” specifically targeting the molecular underpinnings are beginning to emerge and hold great promise for future therapeutic approaches.

 

  • Piero Perucca1,2
  • Ingrid E Scheffer3,4
  • Michelle Kiley5

  • 1 Royal Melbourne Hospital, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC
  • 3 Epilepsy Research Centre, Austin Health, University of Melbourne, Melbourne, VIC
  • 4 Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
  • 5 Royal Adelaide Hospital, Adelaide, SA

Correspondence: piero.perucca@mh.org.au

Acknowledgements: 

This work was supported by the Melbourne International Research Scholarship and the Melbourne International Fee Remission Scholarship from the University of Melbourne and the Warren Haynes Neuroscience Research Fellowship from the Royal Melbourne Hospital Neuroscience Foundation (P Perucca); and by a National Health and Medical Research Council (NHMRC) Program Grant (1091593, 2016–2020) and an NHMRC Senior Practitioner Fellowship (1104831, 2016–2020) (IE Scheffer).

Competing interests:

P Perucca has received honoraria from Eisai. IE Scheffer serves on the editorial boards of and ; may accrue future revenue on a pending patent on a therapeutic compound; has received speaker honoraria from Athena Diagnostics, UCB, GlaxoSmithKline, Eisai, and Transgenomic; has received scientific advisory board honoraria from Nutricia, UCB and GlaxoSmithKline; has received funding for travel from Athena Diagnostics, UCB and GlaxoSmithKline; and receives research support from the NHMRC, the Australian Research Council, the National Institutes of Health, the Health Research Council of New Zealand, March of Dimes, the Weizmann Institute of Science, Citizens United for Research in Epilepsy (CURE), the United States Department of Defense and the Perpetual Charitable Trustees.

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