EPILEPSY

1
EPILEPSY
2
Diagnosis

• Refer to specialist ? lt 28 days
• 50 of referred pts dont 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
• UE
• LFTs
• TFTs

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