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Epilepsy: what I need to know Epilepsy: what I need to know

Epilepsy: what I need to know - PowerPoint Presentation

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Epilepsy: what I need to know - PPT Presentation

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

epilepsy seizure management pregnancy seizure epilepsy pregnancy management tongue investigations cyp450 focal tonic generalised clonic years dose screen induces

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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