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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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