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Some treatments cause seizure aggravation in idiopathic epilepsies (especially absence epilepsy)
Epilepsia, 08/14/09

Somerville ER – Seizure aggravation by antiepileptic drugs (AEDs) is a rare phenomenon, occurring mostly in generalized epilepsies treated with drugs that are more efficacious against partial seizures. It can largely be prevented by accurate syndromic diagnosis and the treatment of generalized epilepsies with drugs that are effective against primary generalized seizures and avoiding those that are not.

Exclusive Author Commentary
Ernest R Somerville, 08/17/09

The important messages for clinical practice are: 1. Seizure frequency fluctuates widely, even in the absence of any change in therapy. So when a change in therapy is made and seizures deteriorate, it is probably not due to the therapy change. 2. Accurate seizure diaries are important to establish the patient's baseline seizure frequency, so that increases or decreases after a change in therapy can be evaluated. 3. It is important to establish whether the seizures are focal or generalized and, if generalized, to avoid drugs that are most effective in focal seizures (such as carbamazepine and oxcarbazepine).

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