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CNSLF Med - Epilepsy (ii) (Withdrawing tx (individualise / discuss, what…
CNSLF Med - Epilepsy (ii)
Investigations
EEG
time of x axis + voltage on y
can see spike + wave discharges in epilepsy
MRI is generally imaging modality of choice in those with focal epilepsy or suspected focal
axillary tests
e.g. ECG, tilt-table testing, LP
if patient is obtunded (lethargic) + suspected meningitis
Aetiologies
unknown
genetic
hereditary
de novo mutations
acquired
cortical dysplasia (malformation)
complicated febrile convulsions
meningitis/encephalitis
head trauma
stroke
vasc anomaly
tumour
Intractable epilepsy
continued seizures despite tx with 2+ appropriate AEDs @ tolerated + adequate doses
<10% chance of seizure remission in this situation
management options
consider epilepsy surgery if focal
esp hippocampal sclerosis (type of temporal lobe epilepsy) - good surgical candidate
consider early
evaluation required, incl
video EEG monitoring
epilepsy protocol MRI
neuropsych
functional imaging
lifestyle/education - ketogenic diet
attention to other medical conditions
AEDs
tx co-morbidites e.g. depression
vagal N stim
hypothesis formed in mid 1980s, 1st human implant in 1988
2 RCTs in early 1990s
FDA approved in 1997
30-40% response, increases with time
AED burden may be reduced later
Single seizure
look for + define cause
risk of recurrence up to 50%
driving issues
decision to tx is individualised
is there an underlying lesion on imaging?
is there a epileptogenic pattern on EEG?
what are the potential consequences of a further seizure?
Withdrawing tx
individualise / discuss
what is the underlying epilepsy dx?
are there troublesome SEs?
what are the consequences of seizure recurrence?
driving issues?
try early in adolescence
Todd's paralysis
post-ictal paralysis
usually unilat - can be mistaken for stroke
patient with recover after hrs-days