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DR. DIJESH SHAH

DR. DIJESH SHAH. M.S, M.Ch: D.N.B.(NEUROSURGERY) MERU NURSING HOME VIDYANAGAR BHAVNAGAR MOB. 9825205215. Epilepsy – The untold facts. Affects 50 million people worldwide, 40 million of them in developing countries In India, ONE in every 100 persons suffers from epilepsy.

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DR. DIJESH SHAH

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  1. DR. DIJESH SHAH M.S, M.Ch: D.N.B.(NEUROSURGERY) MERU NURSING HOME VIDYANAGAR BHAVNAGAR MOB. 9825205215

  2. Epilepsy – The untold facts • Affects 50 million people worldwide, 40 million of them in developing countries • In India, ONE in every 100 persons suffers from epilepsy But the majority of the affected people remain untreated Bull World Health Organ, 2001, vol.79, no.4, p.344-351. ISSN 0042-9686.

  3. The WHO defines epilepsy as "a chronic brain disorder of various etiologies due to excessive discharge of cerebral neurons." WORLD HEALTH ORGANIZATION. (1990);Geneva: Division of Mental Health

  4. Epilepsy – Predisposing Factors • Head injury • Brain infections • Encephalitis • Meningitis • Abscess and dementia • Genetic predisposition • Consumption of alcohol (25 units a week) • Recreational drugs (heroin and cocaine) • Poor sanitation • Malnutrition American Family Physician 2003; 32 (4);221-228 CMAJ • February 18, 2003; 168 (4)

  5. Common Classes of Seizures The International Classification of Seizures (By the International League Against Epilepsy)

  6. Partial Seizure Is of three major types : • Simple • Complex • Secondary generalized

  7. Generalized Seizure Is of five major types : • Tonic-clonic • Tonic • Atonic • Absence • Myoclonic

  8. Status Epilepticus • A condition in which a seizure persists for a sufficient length of time or is repeated so frequently that recovery between attacks does not occur • Duration of seizures qualifying as SE needs to be 30 minutes or less • Is a life-threatening emergency that requires prompt treatment Rinsho Shinkeigaku. 2003 Nov;43(11):799-801

  9. Epilepsy/convulsion. • Lateral position • Clear airway • Oxygen • Do not insert anything in mouth except padded mouth gag. • Allow limb movements. • Inj. Calmpose 1amp iv slowly(dilute in blood)

  10. precautions • Use bed with railings. • Use pads on joints. • Use padded mouth gag during attack. • Avoid working in dangerous area, near stove/gas. One may use gas on platform. • Strict no to driving.

  11. Currently usedAnti Epileptic Drugs (AED)An Overview

  12. Pharmacotherapy- Anti Epileptic Drugs (AED) • It is recommended that people with newly diagnosed epilepsy are treated with one type of drug at a time (monotherapy)1 • Polytherapy is adopted only in the proven failure of the advocated monotherapy1 • AEDs are initially started on a low dose (increased only when required). • The most suitable dose for a person is found by careful monitoring of their seizures. 1.Epilepsy Res. 2002 Nov;52(1):15-23

  13. Pharmacotherapy - Anti Epileptic Drugs (AED) AEDs are of two categories • First line drugs: prescribed on their own when anti-epileptic treatment is started • Second line drugs: usually only prescribed alongside first line drugs. If the first line drug does not stop seizures from happening a different first line drug might be tried. Or a second line drug may be added

  14. Anti Epileptic Drugs - Summary • New antiepileptic drugs include Lamotigine, Gabapentin, Topiramate, Oxcarbazepine, Levetiracetam & Tiagabine • Conventional drugs include Carbamazepine Phenobarbitone, Sodium valproate & Phenytoin • Conventional drugs are tolerated better when commenced at low dose and remain first line medications 1.Aust Fam Physician. 2003 Apr;32(4):221-8

  15. Anti Epileptic Drugs - Summary • No significant difference in efficacy between phenytoin, carbamazepine & valproate in preventing tonic clonic seizures • Valproate effective in absence seizures & myoclonic jerks • Carbamazepine superior to the other two in controlling simple partial seizures • Phenytoin less used as first line therapy because of cosmetic and dental side effects on long term use 1.Aust Fam Physician. 2003 Apr;32(4):221-8

  16. Surgical Managent. • Helps in cases of focal lesions i.e tumor, avm • Helps in case of temporal lobe seizures. • One may consider in case of intractable disease.

  17. Thank You !!!

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