1 / 19

Difficult epilepsies - medical treatment

Difficult epilepsies - medical treatment. Dr Rajat Gupta Consultant Paediatric Neurologist Birmingham Children’s Hospital. What are difficult epilepsies? Overview of AEDs Some more common epilepsy syndromes – difficult and not so difficult! Common pitfalls INTERACTIVE.

MikeCarlo
Download Presentation

Difficult epilepsies - medical treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Difficult epilepsies - medical treatment Dr Rajat Gupta Consultant Paediatric Neurologist Birmingham Children’s Hospital

  2. What are difficult epilepsies? • Overview of AEDs • Some more common epilepsy syndromes – difficult and not so difficult! • Common pitfalls • INTERACTIVE

  3. Severe paediatric epilepsy syndromes • Those epilepsy syndromes whose natural history is one of ensuing mental retardation usually with accompanying seizures and sometimes accompanying motor abnormality

  4. Early infantile epileptic encephalopathy (Otahara’s syndrome) • Early myoclonic encephalopathy • West syndrome and infantile spasms • Lennox-Gastaut syndrome • Severe myoclonic epilepsy of infancy • Myoclonic astatic epilepsy of childhood • Other, potentially malignant syndromes

  5. Medications • Standard medications: • Sodium valproate for generalised seizures • Carbamazepine for partial seizures • Ethosuximide for absences • Newer medications: • Lamotrigine - Topiramate - Levetiracetam • Vigabatrin - Oxcarbazepine - Rufinamide • Stiripentol - Zonisamide - Gabapentin • Tiagabine • Older Drugs: • Phenytoin - Phenobarbitone - Benzodiazepines • Steroids

  6. UK NICE recommendations for the use of new antiepilepticdrugs - 2002 New antiepileptic drugs should beconsidered within their licensed indications: • If establisheddrugs (typically carbamazepine or valproate) have failed. • Ifthe most appropriate older drug is contraindicated. • If an olderdrug could interact with other medications (including the oralcontraceptive pill). • If the older drugs are already known tobe poorly tolerated by the individual. • If the patient is awoman of childbearing potential (although the safety of newerantiepileptic drugs in pregnancy remains unclear).

  7. Seizures induced or aggravated by AEDs

  8. Juvenile myoclonic epilepsy • 5-10% of all epilepsy • Peak 12-16 years • Generalised TC seizures in 90%, juvenile onset absences in 10-30% • Sleep deprivation • Photosensitivity in 70-80% • 60-80% recurrence following AED withdrawal • Valproate, lamotrigine

  9. Typical absence epilepsy of childhood • >5% of all children with epilepsy • 3-12 years • male/female = 1:3 • Prompt onset and cessation of impaired consciousness. Often accompanied by eyelid flutter or automatisms. • Valproate, ethosuximide • Remit 75%, TC seizures 40%, 30% cognitive impairment

  10. West’s syndrome (Infantile spasms, LDs, hypsarrhythmia) • 1-5% of all childhood epilepsy • 3-12 months • 70-80% symptomatic, 20-30% cryptogenic • 50% of prenatal origin (malformations, ischaemia, infections, Trisomy 21). TS common cause. • Rarely, Leigh’s encephalopathy, pyridoxine dependency, NKH • Poor prognosis • 70-80% severe developmental delay • 50-60% other epilepsies (Lennox-Gastaut synd) • Vigabatrin, valproate, lamotrigine, steroids, nitrazepam

  11. Tuberous sclerosis

  12. Lennox-Gastaut syndrome • 3% of childhood epilepsy • Onset 1-7yrs (peak 3-5yrs) • Axial tonic spasms, atonic seizures, atypical absences • Slowing and plateauing of cognitive development • Cases usually symptomatic • 20% progress from West syndrome • Polypharmacy common

  13. Sturge-Weber syndrome • variable natural history • Early onset resistant partial seizures with hemiplegia and behavioural deterioration may respond to early partial resection or hemispherectomy

  14. Differential diagnoses of epilepsy 1 • Many, especially in childhood and adolescence • Misdiagnosis most commonly due to inadequate history taking and incorrect interpretation of signs (stiffening, jerking, urinary incontinence) or an abnormal EEG • Misdiagnosis results in • inappropriate management, including investigations, treatment and counselling • unnecessary stress and psycho-social problems

  15. Jitteriness and benign myoclonus of early infancy Benign paroxysmal torticollis Gastro-oesophageal reflux (Sandifer’s syndrome) Hyperekplexia Tics and ritualistic movements, self-gratification Daydreaming Blue breath-holding attacks, pallid syncopal attacks / reflex anoxic seizures Vasovagal attacks Differential diagnoses of epilepsy 2

  16. Careful and detailed history taking remains • the cornerstone of accurate diagnosis in epilepsy • Holistic approach to management is important • Advice is always available

More Related