logging in or signing up Treatment of Epilepsy neurology1 Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 837 Category: Science & Tech.. License: All Rights Reserved Like it (1) Dislike it (0) Added: February 28, 2011 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Treatment of Epilepsy: Dr Rahul Chakor Associate Prof of Neurology T. N. Medical College B. Y. L. Nair Ch Hospital Neurologist & Epileptologist Prince Aly Khan Hospital Masina Hospital Treatment of EpilepsyOutline: Outline Is it a seizure Is it epilepsy Type of seizure Type of Epilepsy Etiology Electroclinical Syndrome Management Issues Antiepileptic Drug ChoiceIs it a seizure: Is it a seizure Epileptic Seizure - Occasional, sudden, episodic, localized or generalized discharge of cortical neurons Abrupt, stereotype disturbance in sensory, motor, psychic, autonomic functions Non epileptic seizures – Psychogenic seizures SyncopePsychogenic Seizures: Psychogenic Seizures Young women Gradual in onset Non stereotype Longer duration No self injury, no tongue bite In presence of observers Never in sleep Gain Stressors, abuse Resistant to antiepileptic therapySyncope: Syncope In upright posture Lasts for < minute Sweating, pallor, No tongue bite May have few clonic jerks, incontinence Never in sleepUncertain diagnosis: Uncertain diagnosis Unwitnessed episodes No positive evidence of seizure Better to err on side of caution Diagnosis of possible seizure Err on side of not treating if single eventType of seizure: Type of seizure Focal – Begins in a localized region of brain Simple – preserved consciousness Complex – impaired consciousness Sensory Motor Special sensory Psychic AutonomicEpilepsy: Epilepsy Recurrent unprovoked seizures Enduring tendency of brain to cause seizures Usually genetic or combination of genetic and environmental factors Structural lesion Abnormal CNS examinationSingle Seizure: Single Seizure Not epilepsy May be symptomatic seizure (Alcohol, hypoglycemia, encephalitis, neurocysticercosis) First seizure in a patient who has Epilepsy Should be investigated for the cause Long term AED prophylaxis may not be neededManagement Issues: Management Issues Type of epilepsy Etiology of Epilepsy Anti epileptic choiceType of epilepsy: Type of epilepsy Generalized Focal Idiopathic Absence, Myoclonic, GTCs Centrotemporal, Occipital Symptomatic West syndrome, Lennox Gastaut syndrome Temporal, frontal, Occipital etcElectroclinical Diagnosis: Electroclinical Diagnosis Childhood Absence Epilepsy Juvenile Myoclonic Epilepsy IGE with GTCs only Benign Focal Epilepsy with centrotemporal spikesElectroclinical Diagnosis : Electroclinical Diagnosis May not be possible though desirable Seizure classification is a must Focal Generalized Onset in a focal region Onset is bilateral generalized Aura (psychic, deja, vu, jamais vu) Sudden onset loss of consciousness Generalized tonic activity Visual hallucinations (colored balls) Absence seizures with staring lasting few seconds Focal motor onset with Jacksonian march Generalized myoclonus Focal epileptiform abnormalities on EEG Generalized epileptiform activityEvaluation: Evaluation History - (from the patient and a reliable eyewitness) is the key to diagnosis Neurologic examination EEG- routine, video EEG Neuroimaging - CT, MRITreatment: Treatment General principles Efficacy Safety and tolerability Dosing and titration Treatment in Children, young women, pregnancy, elderlyIs treatment necessary: Is treatment necessary Uncertainty (? Possible seizures) Single seizure Very infrequent seizures The key – candid discussion with patient and familySingle unprovoked seizure: Single unprovoked seizure Normal examination Normal EEG and MRI Risk of recurrence ≈ 50% in 3 yrs Usually not to treat Informed decision with patient and familyGeneral principles: General principles Monotherapy Initial choice of AED based on seizure & epilepsy New vs old AEDsSlide 20: Efficacy spectrum of AEDs in different seizure types lacosamideChoice of AED: Choice of AED Partial GTCs Myoclonic Absence Epileptic Spasms Multiple types CBZ CBZ VLP VLP ACTH VLP OXC OXC LEV LEV VLP LEV PHT PHT CLZ BZD LCM PB LEV TPM VLP ZNS LTG BZD VLP LCSBroad Spectrum AEDs: Broad Spectrum Not Broad Spectrum VLP LEV TPM BZD PB LTG ZNS CBZ OXC PHT PG GBP Broad Spectrum AEDsThank You: Thank You You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.