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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 studystandard 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