Seizure EEG and treatment

[95439]

I've been attempting to organize and classify all the major seizure types based on the ILAE's revised (2006) chart of seizures, so it includes the EEG findings and treatment for each type of seizure. Normally, I'm able to find everything I need with the internet and a few solid textbooks, but I've been working on this for a week now and am still missing some pieces.
Can anyone recommend a good textbook or website to get the DEFINITIVE EEG findings and Antiepileptic drug recommendations for each seizure type? The more common seizures are easy to find (complex partial, absence, etc..), it's the 'focal seizures with elementary sensory symptoms' (the more obscure seizure types) that I've had difficulty finding the definitive EEG and AED of choice for. Any recommendations would be greatly appreciated!!

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[neurologist]

The concepts of a "definitive EEG type" and "AED of choice" for every type of seizure is a problematic one.

Regarding the EEG issue, keep in mind that a "'focal seizure with elementary sensory symptoms" or purely "psychic symptoms" (deja vu, etc), or even focal motor symptoms, can have a completely normal scalp EEG due to the relatively small area of cortex involved and degradation of signal between brain and scalp electrode.

With regard to med choice, while there is some evidence-based direction or "experiential" guidance regarding med choices for particular epilepsy syndromes (JME, absence, etc), once you start moving toward the "splitter" end of the "lumper-splitter" continuum with regard to certain meds for certain seizures, things get more and more murky. We all know, for example, that VPA works great for JME while carmbamazepine would be a bad choice, but if you're looking for something like "what med is better for focal motor vs focal sensory seizures," well, good luck finding that. You're probably going to be hunting down very, very small series and case reports, not Level I RCT evidence.

 

[95439]

The concepts of a "definitive EEG type" and "AED of choice" for every type of seizure is a problematic one.

Regarding the EEG issue, keep in mind that a "'focal seizure with elementary sensory symptoms" or purely "psychic symptoms" (deja vu, etc), or even focal motor symptoms, can have a completely normal scalp EEG due to the relatively small area of cortex involved and degradation of signal between brain and scalp electrode.

With regard to med choice, while there is some evidence-based direction or "experiential" guidance regarding med choices for particular epilepsy syndromes (JME, absence, etc), once you start moving toward the "splitter" end of the "lumper-splitter" continuum with regard to certain meds for certain seizures, things get more and more murky. We all know, for example, that VPA works great for JME while carmbamazepine would be a bad choice, but if you're looking for something like "what med is better for focal motor vs focal sensory seizures," well, good luck finding that. You're probably going to be hunting down very, very small series and case reports, not Level I RCT evidence.

What about the SANAD study or the recommendations given by the International League Against Epilepsy? What source do you go to when you want to find the AED of choice for a particular type of seizure?