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An update on the management of epilepsy

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An update on the management of epilepsy

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    1. An update on the management of epilepsy Dr Nicola Giffin Consultant Neurologist, RUH 21st Jan 2009

    2. Are you a GP? Yes No

    3. Are you confident with: (click for yes) Differentiating fits from faints? When to refer? Which investigations to initiate? DVLA regulations? Common side effects of medication? Stopping medication?

    4. Who should manage epilepsy? Confirming the diagnosis? Initiating treatment? Refractory cases? Pregnancy counselling? Stopping treatment?

    5. ‘Seizure’ ? epilepsy Fits v faints Epileptic v non-epileptic seizures Isolated/provoked seizures Primary generalised v focal onset seizures

    6. Investigations EEG v MRI

    7. Driving licence regulations After 1 seizure 1 year If LOC ?syncope ?seizure 6 months After withdrawl of medication Advised not to 6 months Continuing purely nocturnal seizures 3 years A provoked seizure No restriction

    9. SANAD study standard and new antiepileptic drugs Generalised epilepsy 715 pts, valp standard Rx Valp v lamot v top Valp best, (but teratogenicity) Partial epilepsy 1721 pts, carb standard Rx Carb v lamot v gaba v top Lamot best

    10. Amber drugs All anticonvulsants No shared care protocols now When should prescribing transfer?

    11. Stopping meds >2 yrs seizure free, ~ 50% risk of recurrence over 5 yrs Increased risk: Partial seizures Abnormal EEG Teenage onset SLOWLY

    12. Women’s things Contraception (Mirena coil and depo OK, 10 weeks) Teratogenicity Folic acid Valproate, lamotrigine, carbamazepine Pregnancy – drug doses UK preganacy and epilepsy register

    15. Epilepsy surgery Frenchay Causative lesion + refractory seizures

    16. 1. Which has the best evidence as most effective drug for primary generalized epilepsy? Lamotrigine Carbamazepine Valproate Keppra Phenytoin

    17. 2. Which is the most effective drug for partial epilepsy? Phenytoin Keppra Lamotrigine Valproate Carbamazepine

    18. 3. Drug levels are routinely useful for: Valproate Lamotrigine Phenytoin Carbamazepine

    19. 4. The ‘safest’ anticonvulsants in pregnancy are probably: Carbamazepine Lamotrigine Valproate Keppra

    20. 5. The most useful investigation for partial onset seizures is EEG MRI

    21. 6. The following interact with the OCP Valproate Carbamazepine Topiramate Phenytoin Lamotrigine Keppra

    22. ‘Take home’ messages A ‘seizure’ ? epilepsy Adult onset epilepsy – is there a lesion? Lamotrigine – probably best drug for partial ep Valproate (lamot in women) – probably best drug for generlaised ep

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