Transcript EPILEPSY
EPILEPSY Diagnosis • Refer to specialist ? < 28 days • 50% of referred pts don’t 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 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. 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 Examination • Blood pressure • Pulse, heart sounds, carotid bruits. • Cranial nerves • Fundi • Tone power coordiantion Investigations • Fasting blood sugar • Fbc • U&E • LFT’s • TFT’s 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 Goals of therapy • Complete freedom from seizures • No side effects of medication • No impact on quality of life • Least medication necessary Epilepsy • Prevalence 4-10 per 1000 population • 50% female • Life long condition 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. Special issues for Women • • • • • • Fertility Contraception Preconceptual counselling Management of pregnancy Risk to developing foetus Menopause Adolescence • Ensure handover from paediatric service to adult service occurs • Effect of menstrual cycle on seizures – clustering round menstruation