Presentation

1. EPILEPSY
BY SIMWANZA W.
WEBSTER

2. Definition
Chronic condition characterised by recurrent and unprovoked seizures
Can be primary or secondary
WEBSTER

3. Secondary Epilepsy causes
Infections
Post CVA
Post head injury
Cerebral palsy
Metabolic brain injury
Space occupying Lesion(SOL)
WEBSTER

4. Classification of epileptic
seizures
(I). Partial seizures
(a). Simple partial seizures-no loss of consciousness
(b). Complex partial seizures
-(i) with impairment of consciousness at onset
-(ii) with impairment of consciousness at end
(c). Partial seizure evolving to tonic-clonic fits
WEBSTER

5. Classification contin…
(II). Generalised seizures
-absence
-myoclonic
-tonic
-tonic-clonic
-atonic
WEBSTER

6. Classification continue
(III). Unclassified epileptic seizures
-usually used when an adequate description is not available
WEBSTER

7. Features suggestive of
idiopathic epilepsies
Childhood or teenage onset
Triggered by sleep deprivation or alcohol
Early morning tonic clonic seizures or myoclonic jerks
Short absence seizures
Photoparoxysmal response on EEG
Generalised 3/sec spikes and waves or polyspikes and waves on EEG
WEBSTER

8. Features suggestive of focal
epilepsies
History of potential cause
Aura
Focal motor activity seizure
Automatism
WEBSTER

9. Patient evaluation
Good history and physical examination
Investigations
-FBC
-Serum biochemistry
-EEG
-Brain Ctscan/MRI
-ECG
WEBSTER

10. Treatment
When do you start treatment?
WEBSTER

11. Anti epileptic drug(AED) to be given after 1st tonic-clonic fit if:
Pt has had previous myoclonic, absence or partial seizures
EEG shows unequivocal epileptic discharges
Pt has a congenital neurologic deficit
Pt considers risk of recurrence unacceptable
WEBSTER

12. AED
Comparative RCT suggest similar efficacy of phenytoin, carbamazepine,
sodium valproate, lamotrigine and oxycarbazepine
Lamotrigine and oxycarbazepine are better tolerated due to less Side
Effects.
Carbamazepine, sodium valproate, lamotrigine and oxycarbazepine are
1st line drugs
WEBSTER

13. Drug resistant epilepsy
Continuation of seizures despite optimal monotherapy with 2
successive 1st line AED or with one monotherapy and one combination
regimen
Failure to respond to 1st line may be due to:
-wrong diagnosis of epilepsy
-wrong choice of AED
-poor compliance
-underlying brain neoplasm
-covert alcohol or drug abuse
WEBSTER

14. Drug resistant focal epilepsy
Use vigabatrin, lamotrigine, gabapentin, topiramate,tiagabine
WEBSTER

15. Drug resistant idiopathic
generalised epilepsy
Use lamotrigine, topiramate, levetiracetam and sodium valproate
WEBSTER

16. SE
Rashes
Hypersensitivity reactions
Minor blood dyscrasias
Hyponatraemia
Elevation of liver enzymes
Wt gain
Sedation and dizziness
Osteopenia and ostomalacia
WEBSTER

17. Status Epilepticus
Seizure lasting ≥ 30min or 2 successive fits without regaining of
consciousness in the intervening interval
WEBSTER

18. Management
Secure airway and give oxygen
Assess cardiac and respiratory function
Secure IV line and collects blood for tests
Give lorazepam 4mg or diazepam 10mg IV
Transfer to HDU
Give IV AED eg phenytoin, sodium valproate or phenobarbital- pt may
need intubation
If still no response, intubate the pt and paralyse with anaesthetic drugs
WEBSTER

19. END
WEBSTER