SLIME TEACHING Dr Rochelle Velho FY1 Overview Epilepsy Case Based Discussions epilepsy Seizure vs Epilepsy LINK Abnormal metabolic state Other LINK Epidemiology Common in LEDCs and MEDCs ID: 261825
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Slide1
EPILEPSY
SLIME TEACHING
Dr Rochelle Velho
FY1Slide2
OverviewEpilepsy
Case Based DiscussionsSlide3
epilepsy Slide4
Seizure vs Epilepsy
LINK
Abnormal metabolic state
Other
LINKSlide5
EpidemiologyCommon in LEDCs and MEDCs Global prevalence: 0.5-1% - active epilepsyUK:65 people probable 1st
seizure every day
Lifetime risk = 5%Slide6
Aetiology
Dx
Slide7
ILAE Clinical ClassificationSee references [2] and [3]Partial seizures Generalised primary and secondary seizures
Unclassifiable seizureSlide8
Elements of a seizure Slide9
CasesDiagnosis and ManagementSlide10
Case 1 80y old female presented to A and E with her son. She was ‘feeling off’ since breakfast and ‘had a funny taste in her mouth’. During lunch, he observed that she LOC, became ‘stiff all over’ and then started ‘jerking all over’ for a 2-3 minutes. Since the episode his mum has been ‘acting confused and has been drowsy’ (~2 hours). She doesn’t remember.Slide11
MANAGEMENTExaminationObs, Cadio, Respiratory, AbdoNeuro UL, LL and CNsInvestigationsBedside: Bloods, BM, Urine dip, (BCM)
EEG
Radiology
: consider CT, MRI for new epileptic ?tumours ?hippocampal sclerosisSlide12Slide13
Generalised Seizure Tonic Clonic?Slide14
Management (continued..)ConservativeAvoid triggers, sleep deprivation, Dx/AlcoholCounselling lifestyle, Driving (DVLA), workPharmacological Anti-epileptic drugsSurgical Neurosurgical resection e.g. medical refractory TLESlide15
Pharmacological Management AED
Route
Uses
Side-effects/cautions
Sodium Valproate
PO, IV
Generalised > focal epilepsies
Vomiting, Alopecia, Liver toxicity, Pancreatitis/Pancytopenia, Retention of fat,
Oedema
,
Ataxia, Tremor/Teratogenic,
Encephalopathy
VALPROATE
Carbamazepine
PO
Focal/
Cross-
Dx
reactivity,
nausea, vomiting, bone marrow dysfunction
Leviteracetam
PO, IV
Generalise/
Focal
/
Status
Epilepticus
Aggression, deranged liver function
Phenytoin
PO, IV
Generalise/
Focal
/
Status
Epilepticus
Ataxia, deranged liver function
Benzodiazepine
PO, IV
Generalise/
Focal
/
Status Epilepticus
Sedation, respiratory depressionSlide16
Case 2 7y old girl presented to A and E with her teacher. She was in art class this morning and suddenly fell onto the floor, no warning. Then after 10s she got up and carried on painting. Since the episode, the girl cannot remember. She has a history of not concentrating in class. Slide17
ManagementHx (mum): Happened last year after crazy golf party and at Guy Fawkes night.ExaminationObs (apyrexial), Cadio, Respiratory, Abdo
Neuro UL, LL and CNs
Investigations
Bedside
: Bloods, BM, Urine dip, (BCM)
EEG photosensitivity and sleep studiesSlide18
Generalised Seizure Absence?Slide19
Management (continued..)ConservativeAvoid triggers, sleep deprivation, Dx/AlcoholCounselling parents, school, fertility when olderPharmacological Anti-epileptic drug – 1st
Valproate and 2
nd
Lamotrigine
Slide20
Thank-you for listening! Any questions?? Slide21
References Oxford Handbook 8th EditionKumar and Clarke Clinical Medicine The diagnosis and management of the epilepsies in adults and children, national institute Primary care NICE guidelines for epilepsy in adultsMRI of the brain, Volume 2 y William G. Bradley, Michael Brant-
Zawadzki
, Jane
Cambray-Forker
Crawford P, et al. Best practice guidelines for the management of women with epilepsy. The Women with Epilepsy Guidelines Development Group. Seizure 1999;8:201–17. Slide22
Tailored information and discussion on a person’s relative risk of SUDEP should be provided.The risk of SUDEP can be minimised by optimising seizure control and being aware of potential consequences of nocturnal seizures.Where families/carers have been affected by SUDEP, healthcare professionals should contact them to offer their condolences and referral to bereavement counselling.
Sudden unexpected death in epilepsy (SUDEP)
[2004]Slide23
EPILEPSY IN WOMENSlide24
Epilepsy in Women Sexuality FertilityContraceptionPregnancyRare
Catamenial
epilepsySlide25
SexualityLibido may be affectedMinority of epileptic women Slide26
Fertility< fertility in epileptic womenPolycystic ovary syndrome (PCOS) - more common in epileptic womenEspecially on Sodium Valproate
PCOS (
hyperandrogenism
syndrome)
Multiple ovarian cysts
Anovulatory
cycles
Obesity etc
Cause of female sub-fertility....Slide27
ContraceptionContraindicatedRecommended
Hormonal forms of contraception affected by enzyme-inducing AEDs (e.g. Phenytoin)
>dose of COCP may be ineffective
POP and
Levonorgestrel
implants
ineffective
COCP decreases effect of
Lamotrigine
Nonenzyme
-inducing AEDs (e.g. sodium
valproate
) do not affect hormonal contraception
Non-hormonal methods (copper
coil
) and IUD
Can use morning after pill if not on enzyme inducing
AEDSlide28
PregnancyPreconception Counselling (5% Risk feotal abnormality) Major malformations are during first few weeks so...Highly Teratogenic AEDs changed before conception (Valproate)
Folic acid 5 mg/day
peri-conceptially
and throughout pregnancySlide29
Pregnancy (continued)Vitamin K given last month;Haemorrhagic disease of newborn more prevalent (AED exposure)Majority – normal vaginal deliveriesReview AED dose post-partum Breast feeding encouraged, no AEDs proven to be harmful to baby