Date post: | 12-Jan-2016 |
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Management
First and most important question…..
treat or don’t treat?
→confirmed epilepsy?
→trigger or provoking factors ?
→bothersome?
→Patients view on treatment?
Treatment
Anti-Epilepsy Drug
Therapy
Surgery
Alternative Therapies
Up to 70 - 80% chance of seizure freedom
Available for refractory patients only: resective or stimulation
Most commonly used (esp paeds) ketogenic diet
Commonly used AED’s
Carbamazepine Sodium Valproate
Leveitracetam
Lamotrigine
Phenytoin Topiramate
Zonisamide
Common Rescue Medications
Midazolam / Diazepam / Clobazam
Major drug related issues
Type of epilepsyAgeSex
Co-morbid problemsCompliance
Understanding of treatment Guidance (NICE, SIGN)
Drug interactions
Aims of treatment
→Long term
→Single drug
→Lowest effective dose
→Established treatments first
→Minimise adverse effects
Vigabatrin and visual field loss
Foetal Valproate Syndrome
Women of childbearing age should not be started on
sodium valproate without specialist neurological
advice
Epilepsy surgery
Resective Stimulation
Resective
Young agePartial onset / 2nd generalised seizures
Resistance to AEDIdentifiable site of origin
Minimal risk to memory and speechConcordance of all factors
Stimulation
Ketogenic diet
→high-fat, low-carbohydrate “long-chain triglyceride diet”
→3 / 4 g of fat for every 1 g of carbohydrate and protein
→mechanisms unknown but Ketones are thought to be the more likely mechanism with higher ketone levels often leading to improved seizure control
→Research in adults limited
→In paeds 50% have up to 50% seizure reduction
Ultimate Treatment Aim
For patients to be seizure free on appropriate medication, with little or no side-effects form their AED
→70% of patients will become seizure free optimal therapy→80% controlled on single drug→10 – 15% controlled on polytherapy