By Laura Parker Define an epileptic seizure epilepsy and status epilepticus Name common causes and factors that may predispose an individual to epileptic seizures Recognise the symptoms a patient may present with who has epilepsy ID: 268328
Download Presentation The PPT/PDF document "Epilepsy" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Epilepsy
By Laura ParkerSlide2
Define an epileptic seizure, epilepsy and status
epilepticus
Name common causes and factors that may predispose an individual to epileptic seizuresRecognise the symptoms a patient may present with who has epilepsyKnow the acute management of status epilepticusRecognise the impact a diagnosis of epilepsy may have on the patient as a whole (driving, occupation, contraception, pregnancy)Understand the role of AEDs in the management of epilepsy
Learning OutcomesSlide3
“An epileptic seizure is the transient occurrence of signs or symptoms due to abnormal electrical activity in the brain, leading to a disturbance of consciousness, behaviour, emotion, motor function or sensation”
NICE 2009
DefinitionSlide4
Epilepsy is a common neurological disorder characterised by recurrent seizures
Status Epilepticus is a state of continued seizure (or recurrent seizures with failure to regain conciousness) lasting > 30 minutes
DefinitionSlide5
ILAE (2006 revision of 1981 classification)Focal Onset
Begins in a focal area of the cerebral cortex
Symptoms will vary dependent on area of cortex affectedGeneralized Onsetonset recorded simultaneously in both cerebral hemispheresClassification of SeizuresSlide6
Simple (3%)Preservation of consciousness
Experienced as an aura alone
>30 minutes = simple status epilepticusComplex (20%)Loss of consciousness, but usually w/o loss of postural controlFocal OnsetSlide7Slide8
Primary generalized tonic-clonic seizures (60%)Absence seizures
Myoclonic seizures
Clonic seizuresTonic seizuresAtonic seizuresGeneralized OnsetSlide9
3-5% population have 1 or 2 seizures0.5% population have epilepsy
2 incidence peaks
Childhood / adolescenceMiddle AgeEpidemiologySlide10Slide11
No apparent cause in >50% cases
Genetic
Congenital brain malformationsFebrile convulsionCranial InfectionTraumaSOLCVA
Alzheimer's
Metabolic disturbance
Drugs, Alcohol Withdrawal
Aetiology of Epileptic SeizureSlide12
Missed medication
New medication
PhotosensitivitySleep deprivationTriggersSlide13
Presenting Symptoms
Motor
Sudden FallsJerky movementsCognitive
Blank spells
Disorientated
Déjà vu
Dissociation
Loss of language skills
Perception
Hallucinations
Mood
Elation / depression
Fear
Misc
Loss of continence
Epigastric fullnessSlide14
Key Questions
Any warning?
Precipitants?What happens and how long does it last?LOC / loss of awareness? Post-ictal?Frequency of episodes?Any response to treatment?
History Taking Slide15
Dilated pupils, hypertension, tachycardia, extensor plantar response are suggestive of seizure
May find evidence of stigmata to diagnose cause / syndrome / associated condition
SignsSlide16
Migraine
Syncope
Pseudo-seizureTIAHypoglycaemiaSleep disorders
DifferentialsSlide17
Bedside
Obs
BMsECGBloodsFBC, U&Es, LFTs, CRP, Ca, Mg, PO4, Glucose, Prolactin
InvestigationsSlide18
ImagingCT head
MRI
Special testsEEGLPInvestigationsSlide19
ManagementSlide20
A
B
CDEMEDICAL EMERGENCYMORTALITY RATE 10-15%CALL FOR HELP ASAPStatus EpilepticusSlide21
No Access
PR Diazepam 10-20mg
AccessIV Lorazepam 4mg bolus rpt after 10 minutesStatus EpilepticusSlide22
Phenytoin infusion 15-18mg/kg @ 50mg / minute
GA
PropofolMidazolamThiopentone Status EpilepticusSlide23
Avoid Triggers
Swimming
DrivingAEDsLong Term ManagementSlide24
Anti-Epileptic Drugs
Phenytoin
PhenobarbitoneTopiramateSodium ValporateCarbamazepineLamotrigineSlide25
Acute toxicity
Idiosyncratic toxicity
Chronic toxicityAnti-Epileptic DrugsSlide26
The risk of recurrence in the 2 years after a first unprovoked seizure is 15-70%Abnormal EEG
Abnormal brain imaging
Focal onset> 1 unprovoked seizure2/3s people with active epilepsy have epilepsy controlled with AEDsAnti-Epileptic DrugsSlide27
Psychological InterventionsKetogenic diet
Vagal nerve stimulators
Resective SurgeryOther Management OptionsSlide28
ContraceptionAEDs are liver enzyme inducers
Pregnancy
Risk of anti-epilepsy drugs in pregnancyCleft lip/palate, CV malformationsNeural tube defectsRisk of fits during pregnancyEpilepsy in WomenSlide29
Life expectancy is reduced by up to 10 years for people with symptomatic epilepsy and up to 2 years for idiopathic epilepsy
In the UK 1,150 people died of epilepsy related causes in 2009
SUDEP accounts for ~ half of ALL epilepsy related deathsPrognosisSlide30
Clinical ScenarioSlide31
A
62 year old man presents to A&E after his wife called an ambulance when he woke her up having
“a fit”. He was shaking and jerking all over his body, would not respond to her and had soiled himself. He was brought to A&E and despite the paramedics giving 10mg of PR diazepam, he is still fitting….………Slide32
How would you manage this patient initially?Slide33
His seizures
terminate. He is drowsy and
postictal. You obtain history from his wife that he has been complaining of a headache for the last few weeks and the last 2 days has had some blurred vision. He went to bed early last night after he vomited. His wife tells you he seemed more confused yesterday and she was worried but he refused to see his GP. Normally fit and well. No regular mediations and no allergies. Examination when he is more alert is mostly unremarkable except for an element of subtle left sided weakness and poor co-ordination……..Slide34
What are your differentials? How would you investigate this man?
What would your long term management plan be for him?
What is the classification system for epilepsy?What is the current DVLA advice on driving with epilepsy?QuestionsSlide35
Define an epileptic seizure, epilepsy and status
epilepticus
Name common causes and factors that may predispose an individual to epileptic seizuresRecognise the symptoms a patient may present with who has epilepsyKnow the acute management of status epilepticusRecognise the impact a diagnosis of epilepsy may have on the patient as a whole (driving, occupation, contraception, pregnancy)Understand the role of AEDs in the management of epilepsy
Learning OutcomesSlide36
Thank You For Listening
Are There Any QuestionsSlide37
Driving
GROUP 1
GROUP 21st Unprovoked seizure6 months from date of seizureRisk of recurrence >20% 12 monthsDiagnosis of epilepsy
12 months seizure free
6 months if “permitted seizure”
Following withdrawal meds
6 months seizure free
12 months following seizure
1
st
unprovoked seizure
5 years seizure free on no anticonvulsants
Diagnosis Epilepsy
10 years seizure free on no anticonvulsantsSlide38Slide39
NICE
guidance epilepsy http://guidance.nice.org.uk/CG137
Berg et al, Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009, Epilepsia, 51(4):676–685, 2010Moran et al, Epilepsy in the United Kingdom: seizure frequency and severity……, Seizure, 6, 425-433, 2004Crash course neurology 3rd edition TurnerBrown et al, Epilepsy needs revisited; a revised epilepsy needs document for the UK, Seizure 1998DVLA guidance https://www.gov.uk/current-medical-guidelines-dvla-guidance-for-professionals-conditions
References