P EPILEPSY SD

Dr a and iyer

Rx of ep

When to start Rx

If 2nd unprovoked szr

Sprinkle capsules

Benign focal now. Called self limiting focal now

Absence. Ethos or valproate. Avoid cbz

Sanad study

Epileptic spasm. Previously infantile spasm. West. TS. Vigabatrin. 

ACTH or pred. 2 wks then stop

Also kg diet

Doose syndromes

Initial west then LG

Cbd. Soon for Dravet and LG

Cbd. Epidiolex. GW pharmaceutical

Artisanal cannabis being used by parents

PolyRx. Avoid 3 or more drugs at Any one time

Drug res ep. If 2 aed failed

Eg no szr free in 12 mo

Think KGD. Ep Sx. VNS. Immunomodulatn

KG diet

SpeciList diet

3 to 1 fat to carb ratio

GLUT1. Long term

Movie. First do no harm

Kgd Not in mcad

Immmodulation

Limboc encephalitis

FIRES

Rasmussen ep partls continuA

Cstd ig plSmapharesiis

Surgical referral criteria

CESS

Altered awareness. 

Seizures are cortical

TLS. 

Temporal lobe Sx

Gelastic szr. Hypothal hamartoma. Rage. May need surgical resection

SEEG

VNS. LGS. Myoclonus astatitoc ep

Dacrocystic szr. Mad chuckle. 

//////////////////////////////////////////////////////////

To be seen within 2 weeks 

See video

Ep nurse specialist 

YP is 12-18

Child 1 mo to 12 yrs

To refer under 2 yr old ep to terty unit so that neurologist can optimise ep control and neurocogn dvptw

Always rule out long qtc on seizure as next one may kill.  ECG essential

MRI is essential. Not to miss subtle lesion eg. Cortical dysplasia 

Also MR I if not responding to first line aed as May be evolving lesional epilepsy

Consistent aed supply. Try to stick to the brand as well

Buccolam if previous prolonged or serial convulsive szr 

Medicolegal firms are using nice Apls guidance

OPEN UK ep network 

CG137

MHRA guidance on sod valproate 

Pregy prevention program 

Valproate decision on teenage girl is with parents. We give options 

MHRA guideline.  Pragmatic for sev LD pts who are unlikely to have consented sex

//////////////////////////////////////////////////

.Shuddering episodes

Non epileptic seizure

Stereotyped vocal seizure.  Hello are you hypnotised.  Brain tumour frontal lobe

Benign tonic up gaze of infancy.  

Referral pathway of fits faints and funny turns

After 1st seizure only 40 pc will have recurrence.  60 pc will never recur

Day dream. 

Tics 

Migraine 

Enough traction to merit a referral

Breath holding causing opisthotonos decerebrate.  Breath hold with valsalva

Lamotrigine rash

Epilepsy 12

///////////////////////////////////////////////////////////////

ombined genl and focal ep

Metabolic panel

EIEe panel. 

LG usually tonic.  Not myoclonic

Video eeg

1 ha photic stimulus

Causing myoclonic jerks.    Batten late infantile

Angel an have absence and tonic clonic

Doose not photosens

Infantile epileptic encephalopathy. 

///////////////////////////////////

Complex cases

Focal seizure.  Gulp vomit retch clutches blanket

Temporal lobe ep

Seizure.  Beginning. Middle.  End.  

Frontal lobe usually no aura.  Gets out of it suddenly.  Remember.  Are you hypnotised boy

Routine erg is for 20 min

Focal cortical dysplasia.  Temporal lobe

Fcd treated surgically.  Slowly weaned off serial aed

If not self limiting think NRI structural. 

If structural think surgical referral. Local CESS team

Focal.  Frontal and temporal are common

Convulsive SE

5 min rule. 

After 4 min most will continue

CSE

Case risk is syndrome dependent eg v high in dravet s

20 pc case may be de novo ep

Ilae se

Refractory SE

Super refractory cse

Par aldehyde and phenytoin should be given at same time

Call anaesthetist if starting phenytoin

Cluster seizures have to be treated individualistic ally after d/w terty neurologist

Phenytoin can cause profound hypotension needed dopamine support

////////////////////////////////////////////////////////////////

Lafora disease

NHLRC1 mutation

Life limiting

Transition

From pond to sea

In spl school children can be looked upto age 19 

Perampanel

Transition clinic more like Handover clinic 

Transition.  Ready.  Steady. Go

Works well for mainstream children but not on ones with high LD burden

////////////////////////////////////////////////////////////

Difficult epilepsy

May need portacath

Accepting stockpile explanation

Ss issue.  If aed compliance problems

If po aed completely refused sometimes may need peg

Sometimes 3 days in ward to be observed her aed compliance

Young Epilepsy. Detailed look at

/////////////////////////////////////////////////////////////