Diagnosis and treatment of partial seizures

Partial seizures are manifestations of abnormal epileptic firing of brain c ells in a localised area or areas of the brain. The diagnosis of partial se izures entails initially an electroencephalogram (EEG), a detailed history from the patient and eyewitnesses, as well as computer tomographic (CT) or preferably magnetic resonance imaging (MRI) scans. Video EEG to record icta l events may be necessary to establish the correct diagnosis. Partial seizures are classified according to the International Classificati on of Epileptic Seizures and International Classification of Epilepsies and Epilepsy Syndromes. It is important to try to decide how the seizure event fits into this system in order to successfully evaluate and optimise treat ment as well as to give detailed information to the patient about their sei zures and prognosis. Once the decision to treat seizures has been made, the physician must choos e which is the most appropriate medication to begin with. Often carbamazepi ne or valproic acid (sodium valproate) are rated as first-line drugs, but f actors such as adverse effect profiles, age, possibility of pregnancy conco mitant diseases and medication also need to be considered. Most of the newe r anticonvulsants appear to have good efficacy and fewer adverse effects th an their older counterparts, but the higher costs may inhibit their wider u se, especially in poorer countries.