*This program is subject to change Ambulatory Video-EEG monitoring should be employed when monitoring can replace in-hospital video-EEG.
Capsule: Outpatient ambulatory video-EEG devices are now widely available. Are they a reasonable substitute for inpatient monitoring? Can they provide the same information? Should this be done first before considering in hospital assessment? Host: Mark Richardson, UK Con: Dana Ekstein, Israel Combination antiepileptic drug therapy should be offered after failure of a single antiepileptic drug.
Capsule: When combination therapy should be offered is a subject of debate. Though monotherapy has advantages, there is clear evidence from randomized trials that polytherapy affords improvement to many patients, and reduces mortality as well. If combination therapy is used, when should it be implemented? Host: Ivan Rektor, Czech Republic Yes: Martin Brodie, UK No: Elinor Ben-Menachem, Sweden Combination therapy should be used as first line treatment for status epilepticus (SE).
Capsule: Success rates diminish for treating SE with failure of each successive drug that is administered. Furthermore, the longer seizures last, the harder it is to control them. Can we improve outcome by aggressively using polypharmacy as initial therapy in SE? No: Alla Guekht, Russia Cryptogenic status epilepticus should be treated with immunomodulation as soon as it is diagnosed
Capsule: NORSE and FIRES are resistant to treatment with conventional antiepileptic drugs, and these conditions may require immune modulation for cessation of seizures. Should patients be presumptively treated with immunosuppressive agents early in the course of illness when status epilepticus has no known cause? Host: Joanna Jedrzejczak, Poland Antidepressant drugs should be avoided if possible in epilepsy
Capsule: Many antidepressant medications can provoke seizures in animals, and concerns have been raised that these drugs may trigger seizures in some patients. Is the efficacy of these agents sufficient to warrant their use, given potential risks? Host: Alla Guekht, Russia Yes: Ilan Blatt, Israel No: William Theodore, USA Psychotherapy improves outcome in psychogenic seizures
Capsule: Remission rates are quite high and patient adherence to therapy quite low in psychogenic seizures. Is there evidence that therapy provides long-term benefit? Yes: William Curt LaFrance, USA Should surgery to be offered to patients after failure of two antiepileptic drugs?
Capsule: The literature contains numerous reports of response to drug therapy in patients formerly considered drug resistant. On the other hand, epidemiological studies suggest that drug failure is quite likely once two agents have failed to control seizures. Are the ILAE guidelines supported by the evidence? Host: Manjari Tripathi, India Yes: Zeljka Petelin Gadže, Croatia No: Ettore Beghi, Italy The newer antiepileptic drugs are more effective than the established ones
Capsule: Over the past 20 years a number of new antiseizure drugs have been introduced around the world as adjunctive treatment and subsequently as monotherapy for pharmacoresistant and newly diagnosed epilepsy in children and adults. Have they improved overall outcomes in terms of seizure freedom and so proved value for money? Host: Michael Sperling, USA Yes: Andreas Schulz-Bonhage, Germany No: Martin Brodie, UK Epilepsy Cases Michael Sperling, USA