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Management
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First and most important question…..
treat or don’t treat?
→confirmed epilepsy?
→trigger or provoking factors ?
→bothersome?
→Patients view on treatment?
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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
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Commonly used AED’s
Carbamazepine Sodium Valproate
Leveitracetam
Lamotrigine
Phenytoin Topiramate
Zonisamide
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Common Rescue Medications
Midazolam / Diazepam / Clobazam
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Major drug related issues
Type of epilepsyAgeSex
Co-morbid problemsCompliance
Understanding of treatment Guidance (NICE, SIGN)
Drug interactions
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Aims of treatment
→Long term
→Single drug
→Lowest effective dose
→Established treatments first
→Minimise adverse effects
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Vigabatrin and visual field loss
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Foetal Valproate Syndrome
Women of childbearing age should not be started on
sodium valproate without specialist neurological
advice
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Epilepsy surgery
Resective Stimulation
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Resective
Young agePartial onset / 2nd generalised seizures
Resistance to AEDIdentifiable site of origin
Minimal risk to memory and speechConcordance of all factors
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Stimulation
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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
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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