Epilepsy Across the Lifespan

Epilepsy across the lifespan involves many factors, from changes in hormonal pathophysiology to late-onset epilepsy, with many modifiable factors as well as genetic variations with entities such as tuberous sclerosis and genetic generalized epilepsies. These are only a few of the diverse aspects of epilepsy. Many times, we simply consider epilepsy as focal or generalized. With changes in pharmacotherapy and more knowledge of the genome, we are expanding our armamentarium of treatments. Some will be very specific to a genetic variant, and others will be broader spectrum. Some seizure disorders will be more amenable to treatment. Others may be modifiable before epilepsy rears its ugly head.

In Catamenial Epilepsy, Dr. Yeo and others review hormonal pathophysiology and multiple types of catamenial epilepsy, thereby providing a rationale for various treatments. They clarify the various phases of the menstrual cycle when seizures have the potential to be exacerbated and which treatments might be more applicable at those times. Although clear treatments that are FDA approved do not exist, the article reviews the past literature to provide guidance on nonhormonal and hormonal treatments.

In Late-Onset Epilepsy, Dr. Sarkis addresses the fastest growing age group for epilepsy, the elderly, with multiple effective treatments and how to potentially modify this fast-growing sector of epilepsy. Mid-life factors, which in some cases maybe modifiable, are identified. Associations with cerebrovascular disease, tumors, traumatic brain injury, and dementia are reviewed. Neoplastic antibodies and autoimmune encephalopathies have been identified in some individuals. Public health benefits may ensue by identifying comorbid conditions and trying to avoid drug-drug interactions. Pros and cons of various antiseizure medications are considered.

In Tuberous Sclerosis Complex by Dr. Islam, genetic variants of TSC1 and TSC2 are discussed, and with our increased knowledge of genetics, more and more potential treatments are evolving. Diagnostic clinical criteria from the general physical exam and the neurologic exam are explained. Screening exams for surveillance and early clinical identification are outlined. Surgical, pharmacologic, and the newer mTOR inhibitors are discussed as is psychiatric involvement. A team approach is advised.

In Genetic Generalized Epilepsies, Dr. Myers reviews the electroclinical diagnostics of generalized epilepsies from absence to myoclonic to generalized tonic-clonic seizures, potential treatments and more importantly treatments that might worsen these types of epilepsy. Genetics are reviewed. Clinical and EEG characteristics are identified and discussed

With both classic and modern diagnostic techniques for epilepsy including pathophysiology, EEG diagnosis, and genetic predispositions, modifications can be made in epilepsy treatments with a very optimistic prognosis for many people with epilepsy. Team approaches utilizing neurologists, epileptologists, geneticists, psychologists, psychiatrists, nurses, and social workers are of utmost importance. Expanding treatment options exist. Knowledge is a wonderful thing.