Your SlideShare is downloading. ×
Management of epilepsy
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Management of epilepsy

1,808
views

Published on

Published in: Health & Medicine

0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,808
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
4
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. MANAGEMENT OF EPILEPSY
    DR . ANJANEYULU .SRIRAMA
    MD;(DM)
    DEPT . OF NEUROLOGY
    KING GEORGE HOSPITAL,VIZAG
  • 2. OVERVIEW
    Indications of treatment of epilepsy
    Various modalities of management
    AED’S classification , principles , SE’s,TDM.
    Management of generalized epilepsy
    Management of partial epilepsy
    RE
    surgical management
    VNS&KD
    SE
  • 3. TREATMENT OF EPILEPSY
    To control seizures with the most appropriate AED without causing any significant side effects.
    Treatment with AEDs should be started after confirming the diagnosis of epilepsy.
    Treatment should be initiated following the occurrence of 2 or more unprovoked seizures, after discussion about the risks and benefits .
  • 4.
  • 5. Seizures that may not require treatment
    Single seizure with unremarkable evaluation
    Febrile seizures
    Localization related benign epilepsies in children
    Benign familial neonatal seizures
    Simple partial seizures
    Post traumatic impact seizures
    Metabolic , Alcohol related, Drug related.
  • 6. Treatment Options
    6
  • 7. What Should Be Done During a Seizure?
    Prevent injury
    Do not hold or tie the person down
    Turn the person on the side to prevent aspiration/choking
    Do not place anything in the person’s mouth
    Do not pour any liquids in the person’s mouth
    Do not try to force the teeth apart
    Stay with the person until the seizure ends
    Time the seizure
    Note the type of movement the person is doing
  • 8. 8
    Antiepileptic drugs
  • 9.
  • 10.
  • 11.
  • 12. Third Generation AEDS
    CarisbamateEsclicarbazepine
    BrivaracetamCarabersat
    GanaxaloneHuperzine
    LacosamideLosigamone
    RemacemideRetigabine
    RufinamideSafinamide
    Lacosamide, Rufinamide , Esclicarbazepine and Retigabine have completed phase 2 and phase 3 trails.
  • 13. Step wise approach……
    Choose the best suitable drug.
    If poorly tolerated or fail to improve the seizures choose the alt drug.
    If the first one greatly improves but not completely.
    Combine with second drug with complimentary action.
    If needed 2 to 3 drugs.
    Withdraw slowly(25% every 4 to 6 wks).
    Started from a single drug ,Start low and go slow,Monitor regularly.
  • 14. How long AED ?
    JME ---- life long .
    SSECT -short term (6 months) AED treatment is as effective as one year treatment. (calcified lesion, might require long term AED).
    2 years seizure free period.
  • 15. Evidence and RecommendationsPartial onset seizures
  • 16. Evidence and RecommendationsGeneralized onset seizures
  • 17.
  • 18. FIRST LINE DRUGS
    Partial epilepsies-CBZ
    Generalized epilepsies-VPA
    ADD ON DRUGS
    Partial-PHB,CLB;/LEV,TPM
    Generalized-ZNS,LEV,LTG
    VPA+TPM=hyper ammonaemia
    LEV+ZNS=SZ++++.
  • 19. Brodie MJ, Schachter SC. Epilepsy, 2nd ed.Oxford, England, Health Press, 2009.
  • 20.
  • 21. Prognostic groups in epilepsy,refractory epilepsy
    Spontaneous remission (20–30%) - benign epilepsy with centrotemporal spikes or childhood absences.
    Remission on AEDs (20–30%) - most focal epilepsy and myoclonic juvenile epilepsy syndromes;.
    Persistent seizures under AEDs (30–40%) .
  • 22.
  • 23. Refractoriness
    Drug fails to reach the neuronal target (pharmacokinetic hypothesis).
    Drug fails to act at the neuronal target (pharmacodynamic hypothesis).
    Seizure phenotype and history of seizures determine the “level of refractoriness” (theinherent disease severity hypothesis).
  • 24. Diagnosis of Refractory Epilepsy
    Exclude false refractoriness related to -
    Nonepileptic seizures. (20%)
    Inadequate AEDs.
    Noncompliance .
    Seizure-precipitating factors.
  • 25. EPILEPSY SURGERY
    RE pts should be referred to specialized epilepsy centers to evaluate the possibility of surgical treatment.
    Earlier surgery increases chance for persistent seizure freedom .
    Better quality of life if operated at younger age .
    surgery should not be delayed.
  • 26. BENEFITS vs RISKS
  • 27.
  • 28.
  • 29.
  • 30. Types of surgical procedures for medically refractoryepilepsy
  • 31. Ketogenic diet
    Chronic ketosis.
    GABA synthesis increases.
    Hyperpolarize neurons and glia.
  • 32.
  • 33. KD –Indian experiance
  • 34. Vagal nerve stimulation
  • 35.
  • 36.
  • 37. STATUS EPILEPTICUS
    Medical emergency
    5% of all epileptic adult clinic patients will have at least one episode of SE in the course of their epilepsy , and in children the proportion is higher (10-25%).
    Mortality -20%-30% (dying of the underlying condition, rather than the SE itself.)
    Accounts for 11% in a developing country.(MEENA AK,2000).
  • 38. DEFINITIONS OF SE
    (nandagopal,post graduate medical journal,2006)
  • 39. Mayo Clin Protocol
  • 40. Treatments under Investigation
    • Polymers containing AEDs - 2- to 3-mm microspheres , placed near the epileptogenic zone.
    • 41. (1) new AEDs could be used which do not cross the BBB or show systemic toxicity.
    • 42. (2) useful when the epileptogenic zone is near eloquent cortex.
    • 43. (3) prevent noncompliance .
    • 44. Implanting wafers impregnated with chemotherapeutic agents into the resection cavity results in prolongation of survival without an increased incidence of adverse events .
    Studies in animals have been promising as the application of polymers containing phenytoin to the epileptogenic zone in mice has reduced epileptogenic indexes .
    Seizure detector coupled with a trigger AED infusion pump has been developed with success in the mouse .
  • 45. Thank you