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EPILEPSY

EPILEPSY. SLIME TEACHING Dr Rochelle Velho FY1. Overview. Epilepsy Case Based Discussions. epilepsy. Seizure vs Epilepsy. LINK. LINK. Abnormal metabolic state. Other. Epidemiology. Common in LEDCs and MEDCs Global prevalence: 0.5-1% - active epilepsy UK:

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EPILEPSY

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  1. EPILEPSY SLIME TEACHING Dr Rochelle Velho FY1

  2. Overview • Epilepsy • Case Based Discussions

  3. epilepsy

  4. Seizure vs Epilepsy LINK LINK Abnormal metabolic state Other

  5. Epidemiology • Common in LEDCs and MEDCs • Global prevalence: • 0.5-1% - active epilepsy • UK: • 65 people probable 1st seizure every day • Lifetime risk = 5%

  6. Aetiology • Dx

  7. ILAE Clinical Classification • Partial seizures • Generalised primary and secondary seizures • Unclassifiable seizure See references [2] and [3]

  8. Elements of a seizure

  9. CasesDiagnosis and Management

  10. 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.

  11. MANAGEMENT • Examination • Obs, Cadio, Respiratory, Abdo • Neuro UL, LL and CNs • Investigations • Bedside: Bloods, BM, Urine dip, (BCM) • EEG • Radiology: consider CT, MRI for new epileptic ?tumours ?hippocampal sclerosis

  12. Generalised Seizure Tonic Clonic ?

  13. Management (continued..) • Conservative • Avoid triggers, sleep deprivation, Dx/Alcohol • Counselling lifestyle, Driving (DVLA), work • Pharmacological • Anti-epileptic drugs • Surgical • Neurosurgical resection e.g. medical refractory TLE

  14. Pharmacological Management

  15. 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.

  16. Management • Hx (mum): Happened last year after crazy golf party and at Guy Fawkes night. • Examination • Obs (apyrexial), Cadio, Respiratory, Abdo • Neuro UL, LL and CNs • Investigations • Bedside: Bloods, BM, Urine dip, (BCM) • EEG photosensitivity and sleep studies

  17. Generalised Seizure Absence ?

  18. Management (continued..) • Conservative • Avoid triggers, sleep deprivation, Dx/Alcohol • Counselling parents, school, fertility when older • Pharmacological • Anti-epileptic drug – 1st Valproate and 2ndLamotrigine

  19. Thank-you for listening! Any questions??

  20. References • Oxford Handbook 8th Edition • Kumar and Clarke Clinical Medicine • The diagnosis and management of the epilepsies in adults and children, national institute Primary care • NICE guidelines for epilepsy in adults • MRI 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. 

  21. Sudden unexpected death in epilepsy (SUDEP) • 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. • [2004]

  22. EPILEPSY IN WOMEN

  23. Epilepsy in Women • Sexuality • Fertility • Contraception • Pregnancy • Rare  Catamenial epilepsy

  24. Sexuality • Libido may be affected • Minority of epileptic women

  25. Fertility • < fertility in epileptic women • Polycystic ovary syndrome (PCOS) - more common in epileptic women • Especially on Sodium Valproate • PCOS (hyperandrogenism syndrome) • Multiple ovarian cysts • Anovulatory cycles • Obesity etc • Cause of female sub-fertility....

  26. Contraception

  27. Pregnancy • Preconception 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 pregnancy

  28. Pregnancy (continued) • Vitamin K given last month; • Haemorrhagic disease of newborn more prevalent (AED exposure) • Majority – normal vaginal deliveries • Review AED dose post-partum • Breast feeding encouraged, no AEDs proven to be harmful to baby

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