Ask the Neurologist: David M. Ficker, M.D.

December 2005, excerpted from The Update

Many new medications are now available to treat epilepsy and seizures. Since 1993, nine new medications have been approved in the United States. It has become clear from research and in clinical experience that not all medications work for all seizure types.

There are two major categories of epilepsies: partial in onset and generalized in onset. In partial epilepsy, seizures begin in a specific or focal area of the brain (such as the temporal lobe). In the generalized epilepsies, seizures do not arise in a focal region of the brain, but involve the entire brain at seizure onset.

The distinction between partial and generalized epilepsies is made by taking a complete history of the epilepsy (age on onset, types of seizures) and by using the electroencephalogram (EEG). The type of epilepsy affects the choice of medication because some seizure medications are not effective for generalized epilepsies. Thus, one of the potential reasons that an individual may continue to have seizures is the incorrect medication is chosen for the epilepsy type.

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