BECAUSE: IT IS COMMON IT IS BADLY MANAGED IT CAN RUIN LIVES IT IS INTERESTING YOU CAN DO A LOT
plan Recognition & investigation Safety Advice Old & New drugs pregnancy Status epilepticus
6/100 WILL HAVE ONE SEIZURE 3/100 WILL HAVE TWO OR MORE 2-3X GREATER MORTALITY PSYCHOSOCIAL HANDICAP 20-30% intractable epilepsy is NOT ~50% of status is psychogenic SOME NASTY THINGS CAUSE SEIZURES SOME EPILEPSIES ARE INHERITED Some epilepsy can be cured – surgery! BLACKOUT ?CAUSE………….
Hughlings – Jackson (1870) born Green Hammerton Nr York. A convulsion is but a symptom, and implies only…. A disorderly discharge of nerve tissue on muscles. It occurs with all sorts of conditions of ill health, At all ages, and under innumerable circumstances.
Seizures are: SUDDEN. SHORT STEREOTYPED. Tongue biting Clustering, associations Where do they wake up?
POSITIVE SYMPTOMS usually A SEIZURE. NEGATIVE SYMPTOMS usually FOCAL ISCHAEMIA. MIGRAINE OFTEN A MIXTURE, + MARCH Multiple & stereotyped attacks RARE in TIA, (?monocular vision) In epilepsy & migraine pattern of spread NOT vascular territry. Altered awareness much more common in seizure & psychogenic Diplopia not seizure, Deja vue not vascular.
safety advice DVLA: THE LAW! Pilots, ships captains. Swimming, climbing, hang gliding, scuba diving. Machines? (unwarranted job discrimination) Too much restriction is usual. Sleep deprivation alcohol
Pregnancy: Advise in advance. Risk from uncontrolled seizures > teratogenicity. Lowest dose, single drug, avoid valproate. Folic acid 5mg daily, min 3/12 before trying. UK pregnancy register, RVH Belfast.
teratogenicity 0.5% all pregnancies Monot 4-6% Two 7-8% More 15-20%
status A-B-C, glucose, thiamine. Look for a cause? Alcohol, stroke, tumour, infection… Drug withdrawal Psychogenic NEAD.
Convulsive status epilepticus: Adult treatment protocol Brief Management Overview (see Detailed Management Outline for more information)Detailed Management Outline Oxygen GIVE glucose if BM is low (50ml of glucose 50% solution IV) (50% not suitable for children) GIVE thiamine if alcohol abuse suspected (10ml of Pabrinex IV over 10 minutes) Lorazepam 4mg IV If seizures persist after 10 minutes Lorazepam 4mg IV If seizures persist after 10 minutesConsider: Pseudostatus/Non Epileptic attacks FOSPHENYTOIN DOSE 15mg phenytoin equivalent (PE) per kg IVFOSPHENYTOIN (See Detailed Management Outline for administration details)Detailed Management Outline If seizures persist after 20minutes: Transfer to ICU Consider: Pseudostatus/Non Epileptic attacks Paraldehyde Phenobarbitone (on ICU) General anaesthesia with Thiopentone or Propofol FOSPHENYTOIN 750mg = 500mg PHENYTOIN EQUIVALENTS (PE) NB: THIS DOCUMENT ONLY APPLIES TO ADULTS SEE SEPARATE DOCUMENT FOR TREATMENT OF STATUS EPILEPTICUS IN CHILDREN
information British Ep Assoc. www.epilepsy.org.ukwww.epilepsy.org.uk The National Soc for Ep. www.epilepsynse.org.uk www.epilepsynse.org.uk DVLA: 01792-772151 www.gov.uk/at_a_glance/content.htm Smith & Wallace, A clinicians guide to epilepsy. Arnold 2001