Epilepsy is characterized by abnormal electrical discharges in the brain that cause seizures. It can be caused by genetic or structural factors. There are several types of seizures including generalized tonic-clonic, absence, myoclonic, simple partial, and complex partial. Diagnosis involves determining if events are true epileptic seizures and identifying any underlying cause. Treatment typically involves antiepileptic drugs to control seizures, with the goal of monotherapy using the drug with the best safety and tolerability profile for the individual patient. Combination therapy may be used if one drug is ineffective. Managing medications and potential interactions is important long-term.
seizure among children is always difficult to differentiate It is always good to have basic knowledge about seizure in children if you are working in small KLinik kesihatan orr PPAT/RSAT.
Headache Attributed to Nonvascular, Noninfectious
Intracranial Disorders
Headache Attributed to Trauma or Injury to the Head
and/or Neck
Headache Attributed to Infection
Headache Attributed to Cranial or Cervical Vascular
Disorders
Headache Associated with Disorders of Homeostasis
Headache Caused by Disorders of the Cranium, Neck,
Eyes, Ears, Nose, Sinuses, Teeth, Mouth, or Other
Facial or Cranial Structures
Headaches and the Cervical Spine
Migraine
Chronic Daily Headache
Cluster Headache
Other Trigeminal Autonomic Cephalalgias
Other Primary Headaches
seizure among children is always difficult to differentiate It is always good to have basic knowledge about seizure in children if you are working in small KLinik kesihatan orr PPAT/RSAT.
Headache Attributed to Nonvascular, Noninfectious
Intracranial Disorders
Headache Attributed to Trauma or Injury to the Head
and/or Neck
Headache Attributed to Infection
Headache Attributed to Cranial or Cervical Vascular
Disorders
Headache Associated with Disorders of Homeostasis
Headache Caused by Disorders of the Cranium, Neck,
Eyes, Ears, Nose, Sinuses, Teeth, Mouth, or Other
Facial or Cranial Structures
Headaches and the Cervical Spine
Migraine
Chronic Daily Headache
Cluster Headache
Other Trigeminal Autonomic Cephalalgias
Other Primary Headaches
the causes, pathophysiology, clinical manifestations, diagnosis and treatment of epilepsy has been discussed in detail with the perspective of a subject called pathophysiology in both medical sciences as well as the pharmaceutical sciences
Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
the causes, pathophysiology, clinical manifestations, diagnosis and treatment of epilepsy has been discussed in detail with the perspective of a subject called pathophysiology in both medical sciences as well as the pharmaceutical sciences
Not epileptic
•Wrong seizure type (semiology)
•Wrong epileptic syndrome
•Wrong interpretation of EEG and imaging
When to start a drug?
•Which drug and in what dose?
•When to change the drug?
•When (and how) to add a second drug (and which one)?
•When to stop the drug(s)?
•When to consider alternative therapies, including surgery?
Bioinformatics tools for the diagnostic laboratory - T.Seemann - Antimicrobi...Torsten Seemann
"Bioinformatics tools for the diagnostic laboratory" presented at the Australian Society for Antimicrobials 2016 annual conference in Melbourne Australia. Slides are aimed at a biological / pathology / clinican audience. Some material has been re-imagined from Nick Loman's ECCMID 2015 talk.
Microbiome Isolation and DNA Enrichment Protocol: Pathogen Detection Webinar ...QIAGEN
This slidedeck presents an easy-to-use workflow that allows selective isolation of microbial DNA from samples that are intrinsically rich in host DNA. This protocol includes steps for efficient depletion of host DNA while providing optimized conditions specific for bacterial lysis. This workflow is also specific for the identification of live bacteria, avoiding false results due to nucleic acids from dead bacteria. Enriched microbial DNA can be directly used in other molecular methods such as whole genome sequencing, qPCR and microarray assays.
Epilepsy is a common neurological disorders in which there will be an abnormal electrical activities in the brain causing a brief disruption in the communication system of the brain cells.
Epilepsy has a very common symptoms of seizures. A seizure is a sudden rise in electrical activity of the brain. It can involve a part of the brain or the entire brain.
To know more details --> https://www.icliniq.com/articles/neurological-health/what-exactly-is-epilepsy
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. ‘Sacred illness’
• ‘Sacred illness’: 600 BC
• Hippocrates 400 BC: It is thus with regard to the disease called
sacred: it appears to me to be in no way more divine nor more
sacred than other diseases [...].
The brain is the cause of this affliction [...].
Alexander the Great Julius Caesar Napoleon F. Dostoyevsky
3. Epileptic seizure
Abnormal synchronous
discharge of the cortex
leading to transient
dysfunction of the brain
A seizure can be evoked
by any pathology
affecting the brain,
transient or permanent
Epileptic seizure =
symptom
4. Acute symptomatic seizure versus
epilepsy disease
Acute symptomatic seizure: symptom of a
transient pathological state of the brain
Withdrawal of alcohol, drugs
Hypoglycemia
Fever etc.
Epilepsy disease: lasting epileptic dysfunction
of the brain → spontaneous seizures
5. Types of seizures
Generalised seizures
Tonic - clonic
Tonic
Clonic
Atonic
Absence
Myoclonus
Focal (partial)
seizures
Simplex partial
Complex partial
Partial onset with
secondary
generalisation
Seizures of undetermined type
6. Generalised tonic-clonic seizure
(grand mal)
The most common seizure
Acute symptomatic seizures are
generalised tonic-clonic seizures
Course:
Cry, loss of consciousness, fall
Tonic phase- generalised muscle
contraction, apnoea
Clonic phase- rhythmic
contraction of muscles, tongue
bite, foaming, enuresis
Terminal sleep and gradual
regaining of consciousness
(transient confusion)
7. Absence
Cognitive dysfunction with a
sudden onset and end,
lasting 5-10 seconds
Stare, expressionless face;
arrest of ongoing activity;
generally no motor
phenomena
EEG: generalised 3 Hz spike
and wave activity
Occurs in genetic (idiopathic)
epilepsies, mostly in children
8. Myoclonic seizure
Sudden, quick, arrhythmic
muscle contraction, twitch
of a limb; no loss of
consciousness
EEG: generalised
polyspike and wave activity
Occurs in genetic (idiopathic)
epilepsies
Not only an epileptic
phenomenon- it can be the
sign of diffuse
encephalopathies
9. Simplex partial seizures
No loss of consciousness
Symptoms depend on area
of brain involved:
Motor
Sensory
Autonomic
Psychosensory
It can be the introductory
phase of a complex partial
or generalised tonic-clonic
seizure (‘aura’)
10. Complex partial seizures
Origin is most often in the temporal
lobe
A common seizure type in
adulthood
Can be introduced by a simplex
partial psychosensory seizure:
olfactory hallucination
déjà vu, jamais vu
feeling of alienation
Loss of consciousness: stare,
‘going blank’
Automatisms:
oral automatisms
fiddling with the hands
12. Genetics
Risk of a non-provoked
seizure in offsprings of a
parent with epilepsy: 6%
Idiopathic generalised
epilepsies: 9-12%
Over 140 single gene
diseases are accompanied by
epilepsy
Inborn metabolic, storage
diseases
Mitochondrial diseases
Neurocutaneous diseases
Chromosomal diseases
Tuberous sclerosis
13. Benign centrotemporal epilepsy
Age of onset: 3-15 years
Seizure types: facial, oro-bucco-
pharyngeal motor and sensory
simplex partial seizures; speech
arrest
Nocturnal seizures
Mild disease, therapy not always
needed
No neurological or mental
alterations
EEG: centrotemporal spike
waves
Spontaneous remission by
puberty
14. Childhood absence epilepsy
Age of onset: 3-10 years
Seizure types: absence; often in clusters; hyperventillation and
fotostimulation are provoking
No neurological or mental alterations
EEG: generalised 3 Hz spike and wave activity
Good response to treatment
Spontaneous remission by puberty
15. Juvenile myoclonic epilepsy
Most common form of idiopathic
generalised epilepsy
Family history positive in 40%
Age of onset: 15-18 years
Seizure types:
myoclonic
generalised tonic-clonic
absence
EEG: generalised 3-4 Hz spike
and wave, polyspike and wave,
hyperventillation and
fotostimulation are provoking
Good response to treatment, but
needs life-long treatment
16. Common causes of symptomatic
epilepsies
Head injury
Tumors
Infarcts, hemorrhages
Blood vessel malformations
Infections
Cortical dysgenesis
Cause of newly diagnosed
epilepsies is unknown in 60-
65% (cryptogenic).
17. Temporal lobe epilepsy
Most common epilepsy in adulthood;
can be heralded by a few seizures in
childhood, but typical age of onset is
20-22 years
Seizure types:
olfactory hallucination (simplex
partial)
psychosensory seizures (simplex
partial)
complex partial
generalised tonic-clonic
Febrile convulsions in childhood
Hippocampal sclerosis
Often refractory to therapy
Characteropathy, memory
dysfunction
18. West syndrome
Age of onset: 3-5 months
Seizure types: infantile spasms
Causes: inborn metabolic, storage diseases, perinatal
hipoxic brain damage
Cryptogenic in 40-50%
Neurological symptoms, mental retardation; bad
prognosis; can transform into Lennox-Gastaut
syndrome
EEG: hypsarrhythmia
19. Lennox-Gastaut syndrome
Age of onset: 1-8 years
Seizure types: atonic, axial
tonic, myoclonic, atypical
absence, tonic-clonic
Injuries are common
Causes: same as in West
syndrome; can develop from
West syndrome
Neurological symptoms,
mental retardation
Unfavourable prognosis,
refractory to treatment
20. Diagnosis / differential diagnosis
Is it an epileptic
seizure? ?
Yes No
1. Seizure type?
2. Acute symptomatic
seizure or epilepsy?
Epilepsy
Idiopathic or
symptomatic?
Acute symptomatic seizure
Cause?
Symptomatic epilepsy
Cause?
Syncope?
TIA?
Psychogenic?
21. Epileptic seizure versus syncope
Syncope Tonic-clonic seizure
Position Upright Any
Facial colour Paleness Cyanosis
Onset Gradual; introduced by
dizziness, blurring of vision
Sudden; can start by ‘aura’
(simplex partial seizure)
Twitchings Rarely (‘convulsive syncope’) Always
Enuresis Rarely Often
Tongue bite No Often
Duration 10-20 seconds Few minutes
Postictal confusion No Yes
Perspiration Pronounced Not typical
22. Diagnostic steps
History
EEG
Negative EEG does not
exclude epilepsy
Pozitive EEG without clinical
signs does not prove
epilepsy
EEG after sleep withdrawal or
during sleep
Long-term EEG / video
monitoring
CT, MRI
Epilepsy is a clinical diagnosis.
23. Medical treatment of epilepsy
When do we start antiepileptic medication
(AED)?
Which AED to choose?
When and how do we switch AEDs?
When is polytherapy needed?
When can AEDs be discontinued?
Pregnancy
Driver’s licence
24. When do we start treatment?
More than one non-provoked, well-documented
seizure
AEDs are usually not started after the first seizure
(needs individual assessment)
Preventive treatment is not justified
29. Pharmacology of AEDs II.
Phenytoin 7-20 days
Phenobarbital 10-30
Primidon 2-5
Valproate 2-5
Carbamazepine 3-5
Ethosuximid 7-12
Clobazam 4-5
Lamotrigine 3-10
Topiramate 3-6
Gabapentin 2-5
Vigabatrin 2-5
Steady state Binding to plasma proteins
Pronounced
(>90%) binding
phenytoin
valproate
Moderate (30-80%)
binding
carbamazepine
clobazam
lamotrigine
No or minimal
(<20%) binding
gabapentin
vigabatrin
topiramate
ethosuximid
30. Side effects of AEDs
Allergy
Central nervous system side
effects (dose dependent)
drowsiness, headache
dizziness, dysequilibrium
cognitive dysfunction (memory)
Idiosynchratic reactions / chronic
side effects
bone marrow suppression
hepatic failure
rash
weight gain, weight loss
tremor
polycystic ovary syndrome
visual field defect
31. Selection of AEDs
Selection of AED is based on:
Seizure type / epilepsy syndrome
Other: side effects, pharmacology, drug interactions,
comorbidities
As there are no major differences among first-line AEDs, safety
and tolerability must be of paramount consideration in choosing
AED.
Matching drugs to patients (holistic approach):
Side effects
Work
Sleep
Mood
Well being
33. Therapeutic principles
Aim: maximal seizure control, minimal side
effects
Monotherapy
Usually gradual introduction of AED
Assessment of AED effect (seizure frequency)
After AED has reached steady state
Depends on the average time interval of seizures
before treatment
34. Possible causes of AED inefficacy
Inadequate dose → dose escalation
Lack of compliance → measure blood AED levels
False diagnosis: the patient doesn’t have epilepsy
‘Pseudoseizures’ → precise description of seizure, EEG
/ video monitoring
Inadequate selection of AED
True inefficacy of AED → AED switch
Other AED on monotherapy
AED combination
35. AED combinations
Rules of AED combination:
Establish optimal dose of baseline AED
Avoid combining similar modes of action
Add drug with multiple mechanisms
Titrate new drug slowly
Be prepared to reduce dose of original drug
Replace either drug if response is poor
Some effective combinations:
valproate-lamotrigine
valproate-carbamazepine/oxcarbazepine
valproate-topiramate
etc.
36. Drug interactions
Enzyme inductors
carbamazepine, phenytoin
phenobarbital, primidon
Increase of metabolism / decrease
of efficacy
valproate, lamotrigine, topiramate,
carbamazepine
oral contraception
oral anticoagulation
Enzyme inhibitors
valproate
Decrease of metabolism /
increase in efficacy - toxicity
lamotrigine, carbamazepine,
phenytoin
Does not cause interaction
lamotrigine, gabapentin, topiramate,
vigabatrin, tiagabin
37. Therapeutic success- remission rates
Partial epilepsies
First AED in monotherapy: 43%
Second AED in monotherapy: 7%
Other monotherapies: 2%
AED combination: 5%
Total in remission: 57%
Juvenile myoclonic
epilepsy
First AED (valproate) in
monotherapy: 85%
Altogether 65-70% of patients with epilepsy
respond well to AED treatment.
38. Discontinuation of AED
After 3-5 seizure free years
A decision of both the doctor and patient
AED should be very slowly tapered, lasting weeks-
months.
Discontinuation of AED is not recommended:
Earlier unsuccessful AED withdrawal
Earlier refractoriness to treatment
Known brain lesion
Juvenile myoclonic epilepsy
39. Epilepsy and pregnancy
Teratogenic risk
In normal population: 2-3%
In women on AEDs: 4-9%
Teratogenic risk is increased
High AED dose
Fluctuating plasma levels
Polytherapy
Occurrence of spina bifida in the family
Folic acid deficiency
40. Epilepsy and pregnancy: what to do?
Before conception:
Attain the best possible seizure control with the lowest possible
AED dose, preferably in monotherapy
Folic acid profilaction 4 mg/day
During pregnancy:
During first trimester supplement folic acid 4 mg/nap
Change medication only if seizure control worsens
Screening of fetal malformations (ultrasound on week 16 and
20, AFP)
In case of enzyme inductor AEDs, give vitamin K in the third
trimester
41. Epilepsy and breast feeding
Breast feeding is not contraindicated with
women on AEDs.
Sleep deprivation can provoke seizures.
42. Epilepsy and driving
Driving is prohibited for one year after a seizure
with loss of consciousness
Driving is permitted:
2-3 years of seizure free interval with patients on
AEDs
2-3 years of seizure free interval after withdrawal of
AEDs