Epilepsy
Epilepsy is characterized by chronic seizures. It is characterized by Idiopathic (75%), Recurrent (2 or more), unexplained seizures. Epilepsy is the chronic condition of recurrent seizures (a single seizure does not diagnose epilepsy, not drug/substance/infection induced). The choice of drugs is very complex and is done by the neurologist.
It affects 1% of all people by age 20y and 3% by age 75% (increases past 50s due to increased incidence of neurodegenerative conditions).
All antiepileptic drugs are teratogenic. Valproate is the most teratogenic and can cause thrombocytopenia. Lamotrigine can cause Stevens-Johnson syndrome (start gradually…)
Sudden unexpected death in epilepsy (SUDEP) can occur in uncontrolled epilepsy as a result of nocturnal seizure-associated apnoea or asystole.
- Differentials for epilepsy
- Migraine headache: Aura symptoms, no impaired consciousness, headache
- Stroke: older patient, findings on CT, impairment lasts longer
- Febrile seizure: Very high fever (>104 F or 39 C) in young child; does not require treatment
- Syncope: prodromal dizziness, sweating, No post-ictal symptoms, normal serum creatinine
- Psychogenic non-epileptic syndrome(PNES): Conversion-like syndrome, not really seizures. ****lasts longer than 5 minutes, normal serum creatinine, dx of exclusion
- Risk factors for Psychogenic non-epileptic syndrome(PNES)
- Psychiatric History (OCD, PTSD)
- Female sex
- Sexual abuse history
- Management after the second unexplained seizure
- EEG (30-minute EEG; 5-7 day continuous video EEG)
- Antiepileptic drugs
- Symptom monitoring for patients with well-documented focal lesions
- Can consider surgery for patients with well documented focal lesions
- What should you do for females of reproductive age before starting antiepileptic drugs?
- Pregnancy determination test
- Counseling (contraception, pregnancy, and breastfeeding)
- Most AEDs except Carbamazepine and Valproate are present in breast milk
- Lamotrigine is not harmful to infants
- Enzyme-inducing AEDs may make progesterone-only contraceptives unreliable
- Oestrogen-containing contraceptives lower Lamotrigine levels and dosage might need to be increased
- Strictly avoid Valporate and polytherapy before and during conception
- Patient education while on anti-epileptic drugs
- Avoid becoming drunk, especially drinking sprees during weekends
- Eat at regular intervals
- Manage stress (physical or mental) as it may precipitate fits
- Avoid sleep deprivation
- Never swim alone
- Avoid operating heavy or sharp edged machinery
- To prevent burns, make protective shields around braziers (”Jikos”)
