Initial Management of Epilepsy

A 29-year-old woman presents for evaluation. The previous evening, her husband, who was in the next room, heard unusual sounds and found her lying on the bed look-ing dazed. She was confused for a few minutes but quickly returned to normal. On questioning, she recalls an unwitnessed event about 1 month previously; at that time, she awoke feeling mildly confused, had sore muscles, and discovered she had bitten her tongue. How should she be evaluated and treated? The clinic a l problem Epilepsy, which is defined as two or more seizures that are not provoked by other illnesses or circumstances, affects about 45 million people worldwide. In the United States, the prevalence of epilepsy is approximately 6 to 8 per 1000 population, and the incidence is approximately 26 to 40 per 100,000 person-years, with higher rates among infants and persons older than 60 years of age.1-3 Approximately 70 % of adults with new-onset epilepsy have partial (focal) seizures.3 In the majority of cases (62%), the cause is unknown. Stroke (9.0%), head trauma (9.0%), alcohol (6.0%), neurodegenerative disease (4.0%), static encephalopathy (3.5%), brain tumors (3.0%)