Transcript managment

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
Carbamazepine
Lamotrigine
Phenytoin
Sodium Valproate
Commonly
used AED’s
Leveitracetam
Zonisamide
Topiramate
Common Rescue Medications
Midazolam / Diazepam / Clobazam
Major drug related issues
Type of epilepsy
Age
Sex
Co-morbid problems
Compliance
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 age
Partial onset / 2nd generalised seizures
Resistance to AED
Identifiable site of origin
Minimal risk to memory and speech
Concordance 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