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An FP’s guide to caring for patients with seizure and epilepsy

The Journal of Family Practice. 2023 November;72(9):366-373,385 | doi: 10.12788/jfp.0685
November 13, 2023|The Journal of Family Practice
Francis G. Tirol, MD;Matthew R. Levine, MD;Tian Wang, MD;Yong Won Cho, MD, PhD;Gholam K. Motamedi, MD
Author and Disclosure Information

Department of Neurology, Georgetown University Hospital, Washington, DC (Drs. Tirol, Levine, Wang, and Motamedi); Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (Dr. Cho)
motamedi@georgetown.edu

The authors reported no potential conflict of interest relevant to this article.

Optimizing your care requires that you distinguish between provoked and unprovoked seizures and focus on key elements of the patient’s history.

PRACTICE RECOMMENDATIONS

› Consider treating a first-time seizure if electroencephalography shows particular epileptiform activity, if the neurologic exam or computerized tomography or magnetic resonance imaging results are abnormal, if the seizure is focal or nocturnal, or if there is a family history of seizures. A

› Consider valproate (except for women of childbearing age) and levetiracetam as first-line agents for generalized or unclassified epilepsy, and lamotrigine for focal epilepsies. A

Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

Epilepsy as a spectrum disorder

The higher prevalence of comorbid cognitive and psychiatric conditions in patients with epilepsy, affecting about half of patients, 52 suggests that seizures may constitute only one aspect of a multifaceted disease that otherwise should be considered a spectrum disorder. Among such conditions are memory deficits, depression, and anxiety. Conversely, epilepsy is more common in patients with depression than in those without. 52

Social impact of epilepsy

De-escalation of treatment offers an equivalent, resource-sparing alternative to traditional treatment of pediatric torus fractures of the distal radius.

Vehicle driving regulations. Patients with epilepsy are required to follow state law regarding driving restrictions. Different states have different rules and regulations about driving restrictions and reporting requirements (by patients or their physicians). Refer patients to the Department of Motor Vehicles (DMV) in their state of residence for up-to-date instructions.53 The Epilepsy Foundation (epilepsy.com) can serve as a resource for each state’s DMV website.

Employment assistance. Having epilepsy should not preclude patients from seeking employment and pursuing meaningful careers. The Americans with Disabilities Act (ADA) and the US Equal Employment Opportunity Commission (EEOC) forbid discrimination against qualified people with disabilities, including those with epilepsy, and require reasonable accommodations in the workplace (www.eeoc.gov/laws/guidance/­epilepsy-workplace-and-ada).54

CORRESPONDENCE
Gholam K. Motamedi, MD, Department of Neurology, PHC 7, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007; motamedi@georgetown.edu

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