Nik Sanyal FY2 Be able to define what a seizure is and what epilepsy is Be able to define different types of epilepsy Be able to establish a management plan involving investigations and medications ID: 542571
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Slide1
Epilepsy: what I need to know
Nik
Sanyal
FY2Slide2
Be able to define what a seizure is and what epilepsy is
Be able to define different types of epilepsy
Be able to establish a management plan involving investigations and medications.Be able to explain to a patient the implications of epilepsy on their lifeIf time – discuss the special case of epilepsy in pregnancy.
AimsSlide3
A seizure
is an episode of uncontrollable electrical activity in the brain.Epilepsy is defined as a condition that causes a pre-disposition
to seziures – must have had 2+.It is important to remember that we can all have a seizure as we all have a seizure threshold. Can you think of anything that lowers the seizure threshold?
DefinitionSlide4
Subtypes
Epilepsy
Focal (Partial)
Generalised
Secondary generalised
Temporal lobe
Jacksonian
Simple motor
Absence
Myoclonic
Tonic
Clonic
Tonic-
clonicSlide5
http://
youtu.be/obbg1BFt26Q
- absencehttp://youtu.be/Nds2U4CzvC4 - tonic clonicSlide6
Is this the first time?
Was the
“seizure” witnessed?Does the person remember what happened before, during and after?Did they lose continence or bite their tongue?Which part of the tongue is bitten?
What happened after the seizure?
On any medication/relevant PMHx/social hx etc?Key things from historySlide7
Bedside:
BMs,
sats, obs, ECGBloods: FBC, U+Es, bone profile (LFTs + γ
GT - alcoholic), septic screen. Can any blood test distinguish a
pseudoseizure from a seizure?Imaging: CXR (if think seizure related to infection), CT/MRIMRI if <2 or focal neurologySpecial tests: EEG? How easy is one to get done?Useful to look for specific patternsNormal in some with epilepsy, abnormal in some without it.
InvestigationsSlide8
Initial – ABCDE – give oxygen + control seizures
Review status epilepticus
BMs!!!Alcohol withdrawal? – chlordiazopoxide + pabrinex
Septic screen if appropriate
Long-term management:Lifestyle adviceStart low and go slow with medicationControl with lowest dose of fewest drugsManagementSlide9
Medications
Focal
Generalised
First line: Carbamazepine
First line: Sodium valproate
Absence:
EthosuxomideSlide10
PCBRAS + OADEVICES
Side effects
Drug
Side effect
Sodium valproate
N+V
Weight gain
Inhibits CYP450
Lamotrigine
SJS + TEN, aggression, dizziness, tremors
Carbamazapine
Dry mouth, swollen tongueInduces CYP450 PhenytoinGum-hypertrophyCerebellar signs
Induces CYP450 Slide11
Ideal world – a woman with epilepsy will be planning a pregnancy in advance – clearly not always the case.
Risks of epilepsy in pregnancy – to mother and child
Drugs are all teratogenic but some are less teratogenic than others – best in pregnancy was lamotrigine
– convert to this.
Risk of seizure worse than teratogenicityTake folic acid – dose?Pregnancy + epilepsySlide12
Have to establish if Group 1 or 2 licence (1 is normal cars, 2 is lorries/buses/taxis
Group 1: can drive again if an
isolated seizure after 6 months or free of seizure for 1 year if recurrent. Unless having seizures
only when asleep
.Group 2: 5 years free if isolated or 10 years if they are recurrent.Advice re drivingSlide13
Clinical dx
therefore the history is vital!Think carefully of investigations – always ask “why am I ordering this?”Start low and go slowAdvise advance planning in young women of child-bearing age.
Counsel re impact on life – driving rules, avoiding triggers if appropriate, don’t go swimming alone.
Prognosis: 1st seizure = 10% recur if provoked, 50% if not.ConclusionsSlide14
Thank you
Good sites =
www.patient.co.uk + epilepsy society.Questions + resources