Approach to epilepsy: overview and update of diagnosis and management

Comprehensive Summary

The article “Approach to epilepsy: overview and update of diagnosis and management” by Mohammad Kahrom, published in the Internal Medicine Journal (2026), provides a comprehensive and up-to-date review of contemporary epilepsy care, with a strong focus on practical decision-making for clinicians. The paper outlines epilepsy as a heterogeneous neurological disorder defined not only by recurrent seizures but also by underlying etiologies, comorbidities, and long-term psychosocial consequences. It reviews current diagnostic standards, emphasizing the importance of a detailed clinical history, seizure semiology, electroencephalography (EEG), and high-resolution neuroimaging in establishing an accurate diagnosis and differentiating epilepsy from mimics such as syncope or psychogenic non-epileptic seizures. The author also discusses advances in classification systems, particularly the International League Against Epilepsy (ILAE) framework, which integrates seizure type, epilepsy type, and etiology to guide management. Treatment strategies are reviewed in depth, including first-line and second-line antiseizure medications, individualized drug selection based on seizure type and patient characteristics, and the growing role of non-pharmacological interventions. These include epilepsy surgery, neuromodulation techniques (such as vagus nerve stimulation and deep brain stimulation), and lifestyle modifications. The paper highlights the need for early identification of drug-resistant epilepsy and timely referral to specialized epilepsy centers to improve long-term outcomes.

Outcomes and Implications

Clinically, this review reinforces the importance of early, accurate diagnosis and individualized treatment planning in the management of epilepsy. By integrating updated classification systems and emerging diagnostic tools, clinicians can reduce misdiagnosis rates and optimize therapy selection, thereby improving seizure control and minimizing medication-related adverse effects. The emphasis on recognizing drug-resistant epilepsy has significant implications, as delayed referral for surgical or device-based interventions remains a major contributor to poor patient outcomes. The paper also underscores epilepsy as a chronic condition requiring multidisciplinary care, addressing not only seizure control but also cognitive, psychiatric, and social dimensions of the disease. This holistic approach supports a better quality of life, reduced morbidity, and improved long-term prognosis. From a health systems perspective, the review advocates for standardized care pathways and increased awareness among general physicians, which could lead to earlier intervention, reduced healthcare burden, and more equitable access to advanced epilepsy therapies.