Epilepsy: Practical Pearls

Abstract

Epilepsy is a common yet frequently misdiagnosed neurological disorder, with significant implications for morbidity, mortality, and quality of life. Despite advances in diagnostics and therapeutics, clinical decision-making in epilepsy continues to be challenged by early diagnostic uncertainty, inappropriate drug selection, and delayed referral for surgical evaluation. This presentation, “Epilepsy: Practical Pearls,” focuses on concise, high-yield clinical principles that guide everyday practice for physicians and subspecialists managing seizure disorders.

Key themes include the critical distinction between a single seizure and epilepsy. Practical approaches to first seizure evaluation are discussed, highlighting the primacy of clinical history over EEG and neuroimaging. The session also reviews rational interpretation of EEG and the importance of epilepsy-protocol MRI in identifying structural etiologies. Syndrome-based diagnosis, as recommended by the International League Against Epilepsy, is underscored as essential for appropriate antiseizure medication selection as well as calculation of prognosis.

Special emphasis is placed on avoiding drugs that may worsen seizure types, recognizing drug-resistant epilepsy early, and timely referral to specialized epilepsy centers. Surgical options, particularly in focal epilepsies, are highlighted as potentially curative but underutilized interventions. Additional focus is given to status epilepticus management and consideration of autoimmune, genetic, and structural etiologies in refractory cases.

The presentation aims to enhance clinical accuracy, reduce diagnostic errors, and promote evidence-based, patient-centered epilepsy care through practical, immediately applicable clinical pearls.

Bangladesh J Medicine 2026; Vol. 37, No. 2(1): pp. 190