EPILEPSY

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EPILEPSY
Deborah Thomson NOVEMBER 2003
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EPILEPSY

• 1 ADULTS
• SPONTANEOUS ABNORMAL ELECT DISCHARGE
• VARIETY OF FORMS
• CONSISTENT FOR PATIENT

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CEREBRAL PATHOLOGY

• 5 gt 21
• 10 45 - 55
• IGE (ideopathic generalised epilepsy)
  rare gt25 years

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CAUSES

• PHYSICAL
• METABOLIC
• INFECTION
• GENETIC

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HISTORY

• VERY IMPORTANT
• PRODROME
• AURA
• EYE WITNESS
• MEMORIES
• SEQUELAE
• MEDICAL HISTORY
• TRIGGERS

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EXAMINATION AND INVESTIGATIONS

• NEUROLOGICAL EXAMINATION
• BLOOD
• EEG
• ECG
• MRI / CT

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DIFFERENTIAL DIAGNOSIS

• VASOVAGAL
• PSYCHOGENIC
• NORMAL PHENOMENA (déjà vu)
• CARDIAC ARRYTHMIAS
• OTHER CARDIAC DISORDERS

• HYPOGLYCAEMIA
• TIA
• TICS
• MIGRAINOUS AURA
• PANIC ATTACKS

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CLASSIFICATION

• PARTIAL SEIZURES
• GENERALISED SEIZURES
• UNCLASSIFIED EPILEPTIC SEIZURES

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MANAGEMENT OF FIRST FIT

• 60 OF ADULTS WHO HAVE 1 FIT WILL NEVER HAVE
  ANOTHER (90 if EEG normal)
• THEY ARE NOT EPILEPTIC AND DO NOT NEED
  ANTI-CONVULSANTS

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MANAGEMENT

• WHO TO REFER
• REGULAR REVIEW
• EDUCATION
• ROUTINE BLOOD TEST UNNECESSARY (phenytoin/carbamaz
  epine) compliance / concordance

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NEW GMS CONTRACT / SIGN 70

• RECORDS
  register of patients
  receiving AED
• MANAGEMENT
  - record of
  seizure frequency of 16 -
  record of medication review
  - those seizure free for 12 months
  Last recorded in 15 months
• TOTAL 16 POINTS

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FAQ

• HEREDITY
• PROGNOSIS
• DRIVING
• EMPLOYMENT
• LIFESTYLE
• FREE PRESCRIPTIONS AND BUS PASSES

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DRUG THERAPY

• BRAND NAME
• COMPLIANCE / CONCORDANCE
• START LOW DOSE THEN INCREASE
• CHECK BLOOD LEVEL IF INDICATED
• ABANDON DRUG IF POOR CONTROL despite
  maximum dose for gt 2 months
• TAIL OFF ONE DRUG WHEN ESTABLISHED ON NEXT
• MONOTHERAPY

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DRUG WITHDRAWL

• SHOULD TAKE gt 6 MONTHS
• WITHDRAW 1 DRUG AT A TIME
• NO DRIVING DURING WITHDRAWAL OR FOR 6 MONTHS
  AFTER
• DECREMENTAL DOSES EVERY 2 TO 8 WEEKS

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DRUGS WHICH EXACERBATE FITS

• A ANTIDEPRESSANTS ANTI PSYCHOTICS
  ANTIBIOTICS
  ANALGESICS
• B BUPROPION
• C oral CONTRACEPTIVES
• D nsaiDs
• OTHERS LITHIUM

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CONTRACEPTION AND ANTE NATAL CARE

• COCs
  POPs
• DEPO PROVERA give every 10 weeks
• IMPLANON not effective
• LEVONORGESTREL Increase dose - 1.5mg then
  75micrograms
• FETAL RISK OF AEDs
• FOLIC ACID 5mg daily 1st trimester
• SPECIALIST OBSTETRIC CARE

INCREASE DOSE
Affected by AEDs