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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.

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EPILEPSY

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  1. EPILEPSY

  2. 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

  3. 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.

  4. 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

  5. Examination • Blood pressure • Pulse, heart sounds, carotid bruits. • Cranial nerves • Fundi • Tone power coordiantion

  6. Investigations • Fasting blood sugar • Fbc • U&E • LFT’s • TFT’s

  7. 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

  8. Goals of therapy • Complete freedom from seizures • No side effects of medication • No impact on quality of life • Least medication necessary

  9. Epilepsy • Prevalence 4-10 per 1000 population • 50% female • Life long condition

  10. 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.

  11. Special issues for Women • Fertility • Contraception • Preconceptual counselling • Management of pregnancy • Risk to developing foetus • Menopause

  12. Adolescence • Ensure handover from paediatric service to adult service occurs • Effect of menstrual cycle on seizures – clustering round menstruation

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