doi:10.1684/epd.2016.0836 228 Epileptic Disord, Vol. 18, No. 3, September 2016 Correspondence: Evren Burakgazi Cooper Medical School of Rowan University Hospital - Neurology, 3 Cooper Plaza suite 320, Camden, New Jersey 08103, USA <burakgazi-dalkilic- evren@cooperhealth.edu> Seminar in Epileptology E D U C A T I O N Epileptic Disord 2016; 18 (3): 228-39 Treatment of epilepsy in adults Evren Burakgazi 1 , Jacqueline A. French 2 1 Cooper Medical School of Rowan University Hospital - Neurology, 3 Cooper Plaza suite 320, Camden, New Jersey, 2 NYU Medical Center - Neurology, New York, New York, USA Received September 10, 2015; Accepted April 1, 2016 ABSTRACT – Epilepsy is a chronic neurological disorder in adults and requires treatment with antiepileptic medication. While the majority of patients with epilepsy can be treated with medication, about one third will fail on medical treatment. Therefore, other treatment options such as surgery, devices, and the ketogenic diet are other options to consider, in addition to medical treatment. The treatment of epilepsy requires many other factors to be taken into consideration, and these include, but are not limited to, age, gender, coexistent medical conditions, and the use of conco- mitant medications. The goal of treatment is to provide optimal seizure control while using the least possible number of medications, particularly for young females at reproductive age or the elderly who may suffer from other medical diseases and receive other concomitant medications. Certain conditions may co-exist with epilepsy, such as migraine, mood disorder, and memory disturbances, therefore the decision to choose the most appropri- ate medication for epilepsy patients should also involve treatment of these conditions. Here, we review current clinical practice in epilepsy and focus on the most common problems and conditions that clinicians face on a daily basis to treat adult patients with epilepsy. Side effect profiles, spec- trum of efficacy and optimal choices per predominant type of seizures are summarized and can be used for educational purposes. Key words: epilepsy, treatment, adult, elderly, efficacy spectrum, protein binding, side effects Epilepsy is one of the most common chronic neurological conditions worldwide. The prevalence of epilepsy in the United States has been reported at 6 to 8 per 1,000 people, with an incidence of 26 to 40 per 100,000 person-years (Hauser et al., 1993). About 10% of people will have at least one seizure in their life- time, and about a third of them will go on to develop epilepsy (Hesdorffer et al., 2011). The inci- dence of epilepsy has a bimodal distribution, with the highest risk during infancy and old age. About two thirds of the epilepsies are localization-related or focal and a third are generalized (Sillanpää and Shinnar, 2010). When to treat The diagnosis of epilepsy is clin- ical and based on history-taking, from the patient and ideally from a witness. EEG, neurological examina- tion, and brain imaging studies are supportive for diagnosing patients with epilepsy (PWE). Epilepsy is defined as an enduring predisposi- tion of the brain to seizures (Fisher et al., 2005).