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• Vol.44 No.11
• CLINICA NEUROL, 44: 861−864, 2004
• Vol.44 No.11 contents

The 45th Annual Meeting of the Japanese Society of Neurology

Treatment guidelines for adult epilepsy

Yushi Inoue, M.D., Fumihiro Nakamura, M.D. and Takuji Nishida, M.D.

National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders

We reviewed the treatment strategies and choices of drugs for adult patients with epilepsy. As evidence from controlled studies for the older drugs is scarcely available from the literature, we added a clinical study performed in our hospital and an expert consensus study. Published randomized clinical studies revealed carbamazepine (CBZ) to be the treatment of choice, but provided little evidence for the differences in efficacy between phenytoin (PHT), valproate (VPA), phenobarbital (PB) and zonisamide (ZNS). The clinical study in our patients with intractable localization-related epilepsy indicated the superior efficacy of CBZ and PHT over VPA or ZNS. Sixty-nine experts converged on the opinion that monotherapy should be started with VPA for seizures of both idiopathic and symptomatic generalized epilepsy, and with CBZ for seizures of localization-related epilepsy. When the trials with 2-3 monotherapy failed, surgery should be considered for localization-related epilepsy. We proposed practical guidelines for treatment of patients with adult epilepsy, including rehabilitation and care for improvement of quality of life.

(CLINICA NEUROL, 44: 861−864, 2004)
key words: adult epilepsy, international classification, treatment guideline, antiepileptic drugs, epilepsy surgery

(Received: 14-May-04)