EPILEPSY

1. EPILEPSY

2. Diagnosis • Refer to specialist ? < 28 days • 50% of referred pts don’t have epilepsy • 20% of pts on epilepsy medication have been misdiagnosed • Diagnosis may have profound psychological social and financial implications • Inability to drive, unemployment, low self esteem, discrimination

3. History • Eye witness account • Dates and times of seizures • What where they doing • Any mood changes – extreme excitement, anxiety, anger. • Any loss of consciousness or confusion • Skin colour changes – pale, flushed, blue.

4. History • Alteration of breathing – noisy or difficult • Did body stiffen, jerk or twist • Incontinence • Bite tongue or cheek • How long was seizure • How where they afterwards – tired, confused. • How long till normal

5. Examination • Blood pressure • Pulse, heart sounds, carotid bruits. • Cranial nerves • Fundi • Tone power coordiantion

6. Investigations • Fasting blood sugar • Fbc • U&E • LFT’s • TFT’s

7. Advice • Bathing • Swimming • Driving most stop till sees specialist • Other high risk activities • Document discussion in notes • Recurrence risk is 30% over next 6/12

8. Goals of therapy • Complete freedom from seizures • No side effects of medication • No impact on quality of life • Least medication necessary

9. Epilepsy • Prevalence 4-10 per 1000 population • 50% female • Life long condition

10. New contract • Compile a register of patients with epilepsy receiving drug treatment • Review them annually • Record seizure frequency and date of last seizure • Aim to achieve seizure freedom in 705 of patients.

11. Special issues for Women • Fertility • Contraception • Preconceptual counselling • Management of pregnancy • Risk to developing foetus • Menopause

12. Adolescence • Ensure handover from paediatric service to adult service occurs • Effect of menstrual cycle on seizures – clustering round menstruation