COMMENTARY

Seizure Calendars for the 21st Century

Andrew N. Wilner, MD

Disclosures

December 28, 2009

In This Article

Introduction

A seizure calendar is an essential tool for the management of epilepsy.[1] Whether patients are treated with antiepileptic medications, surgery, diet, or the vagus nerve stimulator, a written record saves time in the clinic and provides a rational basis for medication adjustment. Because patients with epilepsy often have memory difficulties, documentation of seizures is particularly important. Patients tend to remember their most recent or most severe seizure, often forgetting prior seizures or long periods of time when they were seizure free. A seizure calendar does not guarantee complete accuracy, as patients may not be aware of all their seizures, but a written record is better than no record at all.

State of the Art

A seizure calendar may be as simple as a blank calendar with an "X" to mark the occurrence of a seizure, or may have more sophisticated coding (ie, "X" is a convulsion, "Y" a partial complex seizure, "Z" an aura). Seizure calendars may also include other important events besides seizures, such as intercurrent illness, symptoms of toxicity, sleep deprivation, stress, mood, or missed medication. Close examination of a seizure calendar may reveal patterns susceptible to therapeutic intervention. For example, the calendar may reveal that seizures tend to cluster on the weekends, perhaps related to sleep deprivation or missed medication. Seizures may tend to be more frequent around the menstrual cycle, indicating a need for perimenstrual medication adjustment. Typically, patients keep a seizure calendar on a piece of paper, which they bring to clinic visits. However, countless times seizure calendars are "left on the refrigerator" or otherwise forgotten, and patients and physicians are forced to make clinical decisions without reliable information.

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