Julia B. Toub, MD. Providence Neuroscience Symposium November 29, 2018
|
|
- Dina Turner
- 5 years ago
- Views:
Transcription
1 Julia B. Toub, MD Providence Neuroscience Symposium November 29, 2018
2 I have no financial relationships to disclose.
3 1. Seizure: the clinical manifestation of an abnormal and excessive synchronization of a population of cortical neurons. 2. Practical definition of epilepsy (2014) 2 unprovoked seizures separated by at least 24 hours. 1 unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years. EEG MRI Epilepsy Syndrome
4
5
6 Worldwide prevalence ~ 50,000,000, underestimated due to: Limited access to healthcare Social/cultural stigma ~3,000,000 Americans As common as breast cancer with a similar mortality 8-10% of the population will have a seizure at some point in their lives; 1-3% will be diagnosed with epilepsy. 4 th most common neurological disease after migraine, stroke, and Alzheimer s disease
7
8 Leah 44 y.o. female hx/o migraine w/aura and depression. New onset GTC out of sleep lasting 1 minute. + incontinence - tongue bite No personal history of seizure. FH: Brother with childhood seizures. SH: EtOH 1 glass of wine with dinner. Drives school bus. Remote concussion with indeterminate loss of consciousness. VS: T 37, BP 120/80, P 90 Meds: Nortriptyline, sumatriptan CT head: No acute abnormality. EEG: Sharply-contoured intermittent right frontal slowing. Arnold 52 y.o. male hx/o HTN, DM, chronic back pain. New onset GTC while at work lasting 2.5 minutes. + incontinence + tongue bite No personal or family hx of seizure. Remote concussion w/o LOC. FH: Dad with alcohol-withdrawal seizures. SH: EtOH 1-2 beers per night, no other drugs. Works in IT, desk job VS: T 37.5, BP 215/115, P 130 Meds: Metoprolol, linsinopril, ASA, tizanidine, tramadol, metformin. CT head: Chronic microvascular change. EEG: Rare intermittent generalized slowing.
9 Isolated unprovoked generalized tonic-clonic seizure: History CMP CBC Tox screen Driving restriction EEG (ideally within 24 hours of seizure) Pregnancy test CT/MRI: MRI ideal Provoked seizure: Remove offending agent Beware of seizure mimics Transient Ischemic Attack Metabolic Disturbance Sleep Disorders Syncope and Convulsive Syncope Non-epileptic spells Misdiagnosis is usually worse than delayed diagnosis
10 In many circumstances, we no longer wait for a second unprovoked seizure to evaluate and treat. In almost all cases, a patient with a single unprovoked seizure and one of the following should be started on antiepileptic medications: EEG WITH EPILEPTIFORM ACTIVITY Electroencephalogram within hours has a 70% yield Sleep deprived EEG has additional 13-31% yield ABNORMAL BRAIN MRI (3T PREFERRED) Prior stroke Prior evidence of trauma/encephalomalacia Malformation of cortical development Tumor NOCTURNAL SEIZURE
11 Provoked, no brain injury: 3% Provoked, brain injury: 10% Single, Unprovoked: 42% Recurrent, Unprovoked: 70-80% Pohlmann-Eden, BMJ, 2006
12 Psychiatric: Buproprion (common), Clozapine Analgesic: Tramadol (common), Tapentadol Antibiotics: PCN, Cephalosporins, Imipenem, Amphotericin B Pulmonary: Aminophylline Immunologic: Cyclosporin
13 Pre/peri-natal injury Febrile convulsions Developmental History Head trauma with loss of consciousness Family history of seizures (unprovoked) Brain tumor, stroke, or other cortical/structural brain lesion History of meningitis/encephalitis
14 Arnold 52 y.o. male hx/o HTN, DM, chronic back pain. New onset GTC while at work lasting 2.5 minutes. + incontinence + tongue bite No personal or family hx of seizure. Remote concussion w/o LOC. FH: Dad with alcohol-withdrawal seizures. SH: EtOH 1-2 beers per night, no other drugs. Works in IT, desk job VS: T 37.5, BP 215/115, P 130 Meds: Metoprolol, linsinopril, ASA, tizanidine, tramadol, metformin. CT head: Chronic microvascular change. EEG: Rare intermittent generalized slowing. Chronic microvascular ischemic changes on T2/FLAIR Probable provoked seizure Tramadol Hypertensive urgency No definte risk factors for seizure recurrence. Recs: Cerebrovascular risk factor control. Stop tramadol Driving restriction Monitor off AEDs
15 Arnold 52 y.o. male hx/o HTN, DM, chronic back pain. New onset GTC while at work lasting 2.5 minutes. + incontinence + tongue bite No personal or family hx of seizure. Remote concussion w/o LOC. FH: Dad with alcohol-withdrawal seizures. SH: EtOH 1-2 beers per night, no other drugs. Works in IT, desk job VS: T 37.5, BP 215/115, P 130 Meds: Metoprolol, linsinopril, ASA, tizanidine, tramadol, metformin. CT head: Chronic microvascular change. EEG: Rare intermittent generalized slowing. T2-weighted hyperintense (white) signal involving bilateral parietal and occipital lobes (PRES/RPLS) Probable provoked seizure Tramadol Hypertensive urgency MRI with PRES/RPLS Recs: Cerebrovascular risk factor control. Driving restriction Stop tramadol Treatment with AEDs in the short term (acute pathology).
16 Leah 44 y.o. female hx/o migraine w/aura and depression. New onset GTC out of sleep lasting 1 minute. + incontinence - tongue bite No personal history of seizure. FH: Brother with childhood seizures. SH: EtOH 1 glass of wine with dinner. Drives school bus. Remote concussion with indeterminate loss of consciousness. VS: T 37, BP 120/80, P 90 Meds: Nortriptyline, sumatriptan, tramadol (PRN) CT head: No acute abnormality. EEG: Sharply-contoured intermittent right frontal slowing. High probability for seizure recurrence Nocturnal seizure + Family history EEG suggestive of focality but nothing clearly epileptiform. + structural abnormality +/- head trauma w/loc Employment risk Recs: Driving restriction Treat with AED: TPM (postmenopausal) or LTG
17
18 Previously Simple Partial Previously Complex Partial, focal dyscognitive
19 Frontal: Primary motor area: Jacksonian march Supplementary motor area (SMA): Hypermotor, asymmetric tonic, brief, may lack postictal period. Lateral Temporal: Auditory/visual hallucinations, language impairment (dominant) Mesial Temporal: Epigastric/olfactory/gustatory aura, déjà vu, jamais vu, fear, orolingual automatisms, dysautonomia, impending doom. Interictal memory complaints, dysphoria Parietal: Somatosensory symptoms, visual illusions/hallucinations, distortions of body image. Occipital: Visual hallucinations
20 Diagnosis: Establishing a diagnosis (epileptic vs. nonepileptic events) Characterization of epilepsy (generalized vs. focal) Identification of epilepsy syndrome Identify triggers (photosensitivity, sleep deprivation) Management: Assessing risk of recurrence after single unprovoked seizure Guiding selection of appropriate anticonvulsant Localizing seizure focus Surgical planning Assessing mental status change Evaluating for nonconvulsive status epilepticus Monitoring/guiding treatment in status epilepticus Risk stratification for seizure recurrence prior to taper off anticonvulsants Prognostication in the ICU setting
21 Advantages Measure of brain function complements neuroimaging Relatively non-invasive May be the only test abnormal in epileptic patients Low cost Low morbidity Ambulatory/portable options Limitations Relatively low sensitivity for IEDs Influenced by state of alertness, medications, and other metabolic factors Subjectivity Potential for false localization Small/deep discharges may produce no changes on scalp EEG Artifact
22 Confirm a diagnosis of epilepsy (+/-) Determine seizure subtype (history, EEG, imaging) How quickly does medication needs to be introduced? Consider comorbid conditions, social circumstances, finances, etc. Cost Mechanism of action
23 BROAD SPECTRUM OLDER Valproic Acid/Divalproex * VPA) Clonazepam (CZP) NEWER Lamotrigine * (LTG) Levetiracetam * (LEV) Topiramate * (TPM) Zonisamide (ZNS) Perampanel (PER) NARROW SPECTRUM Carbamazepine (CBZ) (focal) Ethosuximide (ESX/ETX/ESM) (absence) Phenobarbital (PB) (focal>generalized) Phenytoin (PHT) (focal>generalized, status epilepticus) Primidone (PRM) (focal) Brivaracetam (BRV) (focal) Cannabidiol (CBD) (Lennox Gastaut, Dravet) Clobazam (CLB) (Lennox Gastaut) Eslicarbazepine (ESL) (focal) Felbamate (FBM) (focal; severe refractory) Gabapentin (GBP) (focal) Lacosamide (LCM) (focal) Oxcarbazepine* (OXC) (focal) Pregabalin (PRG) (focal) Rufinamide (RFM) (Lennox Gastaut) Tiagabine (TGB) (focal) Vigabatrin (VGB) (focal, infantile spasms) * Available in once-daily extended release formulation
24 Newer AEDs have fewer side-effects. Choose broad spectrum coverage if unsure of seizure subtype: 1. Levetiracetam 2. Lamotrigine 3. Valproic acid 4. Topiramate 5. Zonisamide (approved only as an adjunct in treatment of partial seizures, though it does have broad-spectrum efficacy). Focal epilepsy agents can exacerbate generalized epilepsies CBZ, OXC, ESL, GBP, PRG
25 Conditions/Circumstances Unsure what epilepsy type Mood disorder Migraines Chronic Pain Pregnancy Hepatic dysfunction Problems with medication adherence AED Selection LEV, LTG, VPA, ZNS, TPM LTG, VPA, OXC (if focal) TPM, ZNS, PRG, GBP, CBZ GBP, PRG, CBZ LEV, LTG, possibly ZNS LEV AED with XR formulation (LTG, LEV, TPM, OXC) or long half life (ESL, ZNS)
26 Drug(s) Cautions LEV, BRV, PER LTG, (CBZ, OXC, ESL-Asian) PHT, CBZ, OXC, PHB, PRM, and VPA VPA, FBM PHT, PHB, CBZ, PHB, PRM, VPA, FBM, CBD LEV, GBP, PRG TPM, ZNS CBZ, OXC, ESL VPA, FBM, LTG, CBZ, PHB VPA LTG, LEV Depression, irritability, psychosis, anxiety, homicidal ideation (PER). Stevens-Johnson syndrome (rapid initiation, concurrent use of VPA) and other skin reactions. Vitamin D deficiency, osteoporosis Weight gain Many drug-drug interactions (especially warfarin), hepatotoxic May require dose adjustment if renal impairment. Cognitive slowing, weight loss, renal calculi. Acute angle closure glaucoma (TPM), sulfa allergy (ZNS) Hyponatremia Blood dyscrasias Hyperammonemia Adjustment in dose during pregnancy; LTG dose change with OCPs
27 Women of childbearing age LTG and LEV safest Potential for teratogenicity of ALL AEDs Newer AEDs better than older AEDs Folic acid in ALL women of childbearing potential LTG and LEV levels drop in pregnancy Other AEDs: Possible reduction in contraceptive efficacy; secondary contraception should be used. Women of all ages LTG: Estrogen-containing OCPs increases LTG clearance and may decrease levels. VPA: Hirsutism, weight gain, alopecia
28 Not appropriate for most patients with seizure CBD antiepileptic properties THC may make seizures worse Recreational and medical dispensaries poorly regulated New FDA formulation Epidiolex for patients with Lennox-Gastaut and Dravet Synromes.
29 ~1/3 epileptic patients Several surgical and non-surgical options for patients living with medically refractory seizures. Epilepsy surgery (focal epilepsy): Resection, laser ablation RNS (focal epilepsy) VNS (focal and generalized epilepsy) Diet (focal and generalized epilepsy) Medically refractory cases should be managed at an epilepsy center.
30
31
32
33
34
35 Elective admission for diagnostic purposes, seizure classification, medication titration, and/or pre-surgical evaluation Continuous video EEG monitoring Candidates: Patients with or without diagnosis of epilepsy experiencing continued seizures despite therapeutic levels of AEDs Patients requiring expedient medication adjustment in a controlled atmosphere Patients undergoing pre-surgical evaluation Patients with deficits out of proportion to reported seizure frequency (e.g. persistent memory problems, weakness)
36 Introduce stressors to provoke events in question: Reduced/discontinuation of medications Sleep deprivation Hyperventilation Photic stimulation Exposure to agents known to provokes seizures in individual patients Important to capture ALL of the patient s events *Some patients may have epileptic and nonepileptic events.
37 Epilepsy is common. Treatment may be warranted after a single unprovoked seizure on the basis of EEG, MRI, and history. All that shakes is not seizure; All seizures do not shake. There is no one-size fits all approach to epilepsy management. When seizure subtype isn t clear, choose a broad-spectrum AED. Use of the EMU to differentiate between epileptic and nonepileptic events is imperative to providing patients with appropriate treatment when there is diagnostic uncertainty. Non-epileptic events do not preclude the coexistence of epileptic seizures.
38
I have no financial relationships to disclose.
Julia B. Toub, MD Providence Brain & Spine Institute April 14, 2016 I have no financial relationships to disclose. 1 1. Seizure: the clinical manifestation of an abnormal and excessive synchronization
More informationJulia B. Toub, MD Providence Brain & Spine Institute November 17-18, 2016
Julia B. Toub, MD Providence Brain & Spine Institute November 17-18, 2016 I have no financial relationships to disclose. 1. To provide an overview of the diagnosis and management of patients with epilepsy,
More informationEpilepsy T.I.A. Cataplexy. Nonepileptic seizure. syncope. Dystonia. Epilepsy & other attack disorders Overview
: Clinical presentation and management Markus Reuber Professor of Clinical Neurology Academic Neurology Unit University of Sheffield, Royal Hallamshire Hospital. Is it epilepsy? Overview Common attack
More informationObjectives. Amanda Diamond, MD
Amanda Diamond, MD Objectives Recognize symptoms suggestive of seizure and what those clinical symptoms represent Understand classification of epilepsy and why this is important Identify the appropriate
More informationAED Treatment Approaches. David Spencer, MD Director, OHSU Epilepsy Center Professor, Department of Neurology
AED Treatment Approaches David Spencer, MD Director, OHSU Epilepsy Center Professor, Department of Neurology Audience Response Keypads Please utilize the keypad at your table to answer questions throughout
More informationPrescribing and Monitoring Anti-Epileptic Drugs
Prescribing and Monitoring Anti-Epileptic Drugs Mark Granner, MD Clinical Professor and Vice Chair for Clinical Programs Director, Iowa Comprehensive Epilepsy Program Department of Neurology University
More informationEpilepsy 7/28/09! Definitions. Classification of epilepsy. Epidemiology of Seizures and Epilepsy. International classification of epilepsies
Definitions Epilepsy Dr.Yotin Chinvarun M.D., Ph.D. Seizure: the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons Epilepsy: a tendency toward recurrent
More informationPharmacological Treatment of Non-Lesional Epilepsy December 8, 2013
Pharmacological Treatment of Non-Lesional Epilepsy December 8, 2013 Michael Privitera, MD Professor of Neurology University of Cincinnati, Neuroscience Institute American Epilepsy Society Annual Meeting
More informationAMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY, INC. SUBSPECIALTY CERTIFICATION EXAMINATION IN EPILEPSY MEDICINE
SUBSPECIALTY CERTIFICATION EXAMINATION IN EPILEPSY MEDICINE 2014 Content Blueprint (November 26, 2012) Number of questions: 200 I. Classification 7 9% II. Routine EEG 16 20% III. Evaluation 22 26% IV.
More informationEpilepsy. Annual Incidence. Adult Epilepsy Update
Adult Epilepsy Update Annual Incidence J. Layne Moore, MD, MPH Associate Professor Department of Neurology and Pharmacy Director, Division of Epilepsy The Ohio State University Used by permission Health
More informationErnie Somerville Prince of Wales Hospital EPILEPSY
Ernie Somerville Prince of Wales Hospital EPILEPSY Overview Classification New and old anti-epileptic drugs (AEDs) Neuropsychiatric side-effects Limbic encephalitis Non-drug therapies Therapeutic wishlist
More informationIs it epilepsy? Does the patient need long-term therapy?
Is it a seizure? Definition Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain Is it provoked or unprovoked? Is it epilepsy? Does the
More informationNeuromuscular Disease(2) Epilepsy. Department of Pediatrics Soochow University Affiliated Children s Hospital
Neuromuscular Disease(2) Epilepsy Department of Pediatrics Soochow University Affiliated Children s Hospital Seizures (p130) Main contents: 1) Emphasize the clinical features of epileptic seizure and epilepsy.
More informationSUBSPECIALTY CERTIFICATION EXAMINATION IN EPILEPSY MEDICINE Content Blueprint (December 21, 2015)
SUBSPECIALTY CERTIFICATION EXAMINATION IN EPILEPSY MEDICINE 2016 Content Blueprint (December 21, 2015) Number of questions: 200 1. Classification 8-12% 2. Routine EEG 16-20% 3. Evaluation 23-27% 4. Management
More informationJulia B. Toub, MD Providence Brain & Spine Institute November 12-13, 2015
Julia B. Toub, MD Providence Brain & Spine Institute November 12-13, 2015 I HAVE NO FINANCIAL RELATIONSHIPS TO DISCLOSE. 1. Seizure: the clinical manifestation of an abnormal and excessive synchronization
More informationManagement of Epilepsy in Primary Care and the Community. Carrie Burke, Epilepsy Specialist Nurse
Management of Epilepsy in Primary Care and the Community Carrie Burke, Epilepsy Specialist Nurse Epilepsy & Seizures Epilepsy is a common neurological disorder characterised by recurring seizures (NICE,
More informationCase 1: Issues in this case. Generalized Seizures. Seizure Rounds with S.Khoshbin M.D. Disclosures: NONE
Disclosures: NONE Seizure Rounds with S.Khoshbin M.D. Case 1: 45 yo male while jogging with his wife stopped,acted strangely for a while then fell to the ground and had a convulsion.emt s were called by
More informationJeffrey W Boyle, MD, PhD Avera Medical Group Neurology Sioux Falls, SD
Jeffrey W Boyle, MD, PhD Avera Medical Group Neurology Sioux Falls, SD Disclosures: None Objectives Recognize the incidence of seizure and epilepsy in the US population Appreciate the differences in seizure
More information7/31/09. New AEDs. AEDs. Dr. Yotin Chinvarun M.D. Ph.D. Comprehensive Epilepsy and Sleep disorder Program PMK hospital. 1 st genera*on AEDs
Dr. Yotin Chinvarun M.D. Ph.D. Comprehensive Epilepsy and Sleep disorder Program PMK hospital New AEDs AEDs NEW OLD Pregabalin Pregabalin 1 st genera*on AEDs Phenytoin Carbamazepine Valproate Phenobarbital
More information11/7/2018 EPILEPSY UPDATE. Dr.Ram Sankaraneni. Disclosures. Speaker bureau LivaNova
EPILEPSY UPDATE Dr.Ram Sankaraneni Disclosures Speaker bureau LivaNova 1 Outline New onset Seizure Investigations in patients with epilepsy Medical management of epilepsy Non Pharmacological options in
More informationEpilepsy 101. Russell P. Saneto, DO, PhD. Seattle Children s Hospital/University of Washington November 2011
Epilepsy 101 Russell P. Saneto, DO, PhD Seattle Children s Hospital/University of Washington November 2011 Specific Aims How do we define epilepsy? Do seizures equal epilepsy? What are seizures? Seizure
More informationEpilepsy the Essentials
INSTITUTE OF NEUROLOGY DCEE / NSE Epilepsy the Essentials Fergus Rugg-Gunn Consultant Neurologist Dept of Clinical and Experimental Epilepsy Institute of Neurology, University College London Epilepsy Society
More informationReview of Anticonvulsant Medications: Traditional and Alternative Uses. Andrea Michel, PharmD, CACP
Review of Anticonvulsant Medications: Traditional and Alternative Uses Andrea Michel, PharmD, CACP Objectives Review epidemiology of epilepsy Classify types of seizures Discuss non-pharmacologic and pharmacologic
More informationUpdated advice for nurses who care for patients with epilepsy
NICE BULLETIN Updated advice for nurses who care for patients with epilepsy NICE provided the content for this booklet which is independent of any company or product advertised NICE BULLETIN Updated advice
More informationHormones & Epilepsy 18/07/61. Hormones & Women With Epilepsy (WWE) How different are women? Estradiol = Proconvulsant. Progesterone = Anticonvulsant
How different are women? AED choice in special population Women With Epilepsy (WWE) Updated 2018 Habitus Metabolism Co-morbidities Pasiri Sithinamsuwan Psychosocial stigma Phramongkutklao Hospital Hormonal
More informationChildhood Epilepsy - Overview & Update
Childhood Epilepsy - Overview & Update Nicholas Allen Dept. Paediatrics Mar 2016 NO DISCLOSURES Videos 1 Outline: Childhood Epilepsy What is it? How do we classify it? How do we diagnose it? How do we
More informationUpdate in Pediatric Epilepsy
Update in Pediatric Epilepsy Cherie Herren, MD Assistant Professor OUHSC, Department of Neurology September 20, 2018 Disclosures None Objectives 1. Identify common pediatric epilepsy syndromes 2. Describe
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Absence seizures, 6 in childhood, 95 Adults, seizures and status epilepticus in, management of, 34 35 with first-time seizures. See Seizure(s),
More informationNewer AEDs compared to LVT as adjunctive treatments for uncontrolled focal epilepsy. Dr. Yotin Chinvarun. M.D. Ph.D.
Newer AEDs compared to LVT as adjunctive treatments for uncontrolled focal epilepsy Dr. Yotin Chinvarun. M.D. Ph.D. Chronology of antiepileptic drug introduction over the past 150 years 20 15 10 Perampanel
More informationAnticonvulsants Antiseizure
Anticonvulsants Antiseizure Seizure disorders Head trauma Stroke Drugs (overdose, withdrawal) Brain tumor Encephalitis/ Meningitis High fever Hypoglycemia Hypocalcemia Hypoxia genetic factors Epileptic
More informationDisclosure. Learning Objectives
Linda D. Leary, M.D. Associate Clinical Professor of Pediatrics & Neurology South Texas Comprehensive Epilepsy Center UT Health Science Center San Antonio Disclosure Linda D. Leary, M.D. discloses the
More informationEpilepsy and EEG in Clinical Practice
Mayo School of Professional Development Epilepsy and EEG in Clinical Practice November 10-12, 2016 Hard Rock Hotel at Universal Orlando Orlando, FL Course Directors Jeffrey Britton, MD and William Tatum,
More informationSeizures in Children: Laboratory
Article neurology Seizures in Children: Laboratory Diagnosis and Management Philippe Major, MD,* Elizabeth A. Thiele, MD, PhD* Objectives After completing this article, readers should be able to: 1. Formulate
More informationThe epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care Issued: January 2012 guidance.nice.org.uk/cg137 NHS Evidence has accredited the process
More informationEpilepsy and Epileptic Seizures
Epilepsy and Epileptic Seizures Petr Marusič Dpt. of Neurology Charles University, Second Faculty of Medicine Motol University Hospital Diagnosis Steps Differentiation of nonepileptic events Seizure classification
More informationContemporary Developments in Childhood Epilepsy Management. Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital
Contemporary Developments in Childhood Epilepsy Management Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital Developments in Epilepsy Care Standardised epilepsy care using
More informationUpdate in Clinical Guidelines in Epilepsy
Why We Need Clinical Guidelines? Clinician needs advice! Update in Clinical Guidelines in Epilepsy Charcrin Nabangchang, M.D. Phramongkutklao College of Medicine Tiamkao S, Neurology Asia2013 Why We Need
More informationNew AEDs in Uncontrolled seizures
New AEDs in Uncontrolled seizures Uncontrolled seizures/epilepsy Intractable epilepsy, Refractory epilepsy, Pharmacoresistant epilepsy Dr. Suthida Yenjun Traditionally, referred to therapeutic failure
More informationDavid Dredge, MD MGH Child Neurology CME Course September 9, 2017
David Dredge, MD MGH Child Neurology CME Course September 9, 2017 } 25-40,000 children experience their first nonfebrile seizure each year } AAN/CNS guidelines developed in early 2000s and subsequently
More informationPaediatric Epilepsy Update N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y
Paediatric Epilepsy Update 2018 N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y Epilepsy Service CUH ~550 children New diagnosis-education, support, clinic follow up Epilepsy
More informationInitial Treatment of Seizures in Childhood
Initial Treatment of Seizures in Childhood Roderic L. Smith, MD, Ph.D. Pediatric Neurology Clinic of Alaska,PC Incidence of Seizures Overall 5% by age 20 yrs. Lifetime risk= 5-10% CNS Infections= 5% TBI=10%
More informationIntroduction to seizures and epilepsy
Introduction to seizures and epilepsy Selim R. Benbadis, M.D. Professor Departments of Neurology & Neurosurgery Director, Comprehensive Epilepsy Program Symptomatic seizures Head injury (trauma) Stroke
More informationThe epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care
The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care Issued: January 2012 last modified: January 2015 guidance.nice.org.uk/cg137 NICE has
More informationHow to choose/use anti-epileptic drugs wisely? Dr. Chusak Limotai, MD., M.Sc., CSCN(C)
How to choose/use anti-epileptic drugs wisely? Dr. Chusak Limotai, MD., M.Sc., CSCN(C) Talk overview When to start treatment? Which drug? Monotherapy Combining AEDs (Rational polytherapy) Old AEDs versus
More informationEpilepsy Martin J Brodie, Steven C Schachter, Patrick Kwan Fourth edition
Fast Facts Fast Facts: Epilepsy Martin J Brodie, Steven C Schachter, Patrick Kwan Fourth edition Fast Facts Fast Facts: Epilepsy Fourth edition Martin J Brodie MB ChB MRCP MD FRCP Director, Epilepsy Unit
More informationSeizures- an Update. Epileptic Seizure: Definition. When is a Seizure Epilepsy?
Seizures- an Update Jaishree T. Narayanan Department of Neurology, NorthShore University Health System Epileptic Seizure: Definition An Epileptic Seizure is a transient occurrence of signs and symptoms
More informationClassification of Seizures. Generalized Epilepsies. Classification of Seizures. Classification of Seizures. Bassel F. Shneker
Classification of Seizures Generalized Epilepsies Bassel F. Shneker Traditionally divided into grand mal and petit mal seizures ILAE classification of epileptic seizures in 1981 based on clinical observation
More informationChild-Youth Epilepsy Overview, epidemiology, terminology. Glen Fenton, MD Professor, Child Neurology and Epilepsy University of New Mexico
Child-Youth Epilepsy Overview, epidemiology, terminology Glen Fenton, MD Professor, Child Neurology and Epilepsy University of New Mexico New onset seizure case An 8-year-old girl has a witnessed seizure
More informationThe Fitting Child. A/Prof Alex Tang
The Fitting Child A/Prof Alex Tang Objective Define relevant history taking and physical examination Classify the types of epilepsy in children Demonstrate the usefulness of investigations Define treatment
More informationEPILEPSY. Martyn Bracewell Consultant Neurologist The Walton Centre, Liverpool Betsi Cadwaladr University Health Board Noble s Hospital, IOM
EPILEPSY Martyn Bracewell Consultant Neurologist The Walton Centre, Liverpool Betsi Cadwaladr University Health Board Noble s Hospital, IOM Senior Lecturer Bangor University Epilepsy An Overview Definitions,
More informationChildren Are Not Just Small Adults Choosing AEDs in Children
Children Are Not Just Small Adults Choosing AEDs in Children Natrujee Wiwattanadittakun, MD Neurology division, Department of Pediatrics, Chiang Mai University Hospital, Chiang Mai University 20 th July,
More informationSeizures and you. Michael B. Lloyd, MD
Seizures and you Michael B. Lloyd, MD Objectives Definition Epidemiology Classification Epileptic syndromes Differential and recognition Work-up Treatment Frequently asked questions Definition Sudden
More informationSleep in Epilepsy. Kurupath Radhakrishnan,
Sleep in Epilepsy Kurupath Radhakrishnan, Retired Senior Professor (Emeritus), R. Madavan Nayar Center for Comprehensive Epilepsy Care, Retired Director, Sree Chitra Tirunal Institute for Medical Sciences
More informationEpilepsy Currents and Pearls. Eniko Nagy-Wilde, MD Medical Director of Epilepsy and Clinical Neurophysiology Sutter Medical Center, Sacramento
Epilepsy Currents and Pearls Eniko Nagy-Wilde, MD Medical Director of Epilepsy and Clinical Neurophysiology Sutter Medical Center, Sacramento No disclosures Presenter Disclosure Information Learning Objectives
More informationAPPENDIX K Pharmacological Management
1 2 3 4 APPENDIX K Pharmacological Management Table 1 AED options by seizure type Table 1 AED options by seizure type Seizure type First-line AEDs Adjunctive AEDs Generalised tonic clonic Lamotrigine Oxcarbazepine
More informationOn completion of this chapter you should be able to: list the most common types of childhood epilepsies and their symptoms
9 Epilepsy The incidence of epilepsy is highest in the first two decades of life. It falls after that only to rise again in late life. Epilepsy is one of the most common chronic neurological condition
More informationDravet syndrome : Clinical presentation, genetic investigation and anti-seizure medication. Bradley Osterman MD, FRCPC, CSCN
Dravet syndrome : Clinical presentation, genetic investigation and anti-seizure medication Bradley Osterman MD, FRCPC, CSCN Objectives Learn about the typical early clinical presentation of Dravet syndrome
More informationEpilepsies of Childhood: An Over-view of Treatment 2 nd October 2018
Epilepsies of Childhood: An Over-view of Treatment 2 nd October 2018 Dr Sophia Varadkar MRCPI, PhD Consultant Paediatric Neurologist and Honorary Senior Lecturer Great Ormond Street Hospital for Children
More informationClinical guideline Published: 11 January 2012 nice.org.uk/guidance/cg137
Epilepsies: diagnosis and management Clinical guideline Published: 11 January 2012 nice.org.uk/guidance/cg137 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationTherapeutic strategies in the choice of antiepileptic drugs
Acta neurol. belg., 2002, 102, 6-10 Original articles Therapeutic strategies in the choice of antiepileptic drugs V. DE BORCHGRAVE, V. DELVAUX, M. DE TOURCHANINOFF, J.M. DUBRU, S. GHARIANI, Th. GRISAR,
More information8/30/10. How to use Antiepileptic drugs properly. 3nd generation AEDs. Introduction. Introduction. Introduction. AEDs. Dr.Yotin Chinvarun M.D., Ph.D.
Introduction How to use Antiepileptic drugs properly Modern treatment of seizures started in 1850 with the introduction of bromides, based on the theory that epilepsy was caused by an excessive sex drive
More informationAntiepileptics. Medications Comment Quantity Limit Carbamazepine. May be subject Preferred to quantity limit Epitol
Market DC Antiepileptics Override(s) Approval Duration Prior Authorization 1 year Step Therapy Quantity Limit *Indiana Medicaid See State Specific Mandate below *Maryland Medicaid See State Specific Mandate
More informationEPILEPSY: SPECTRUM OF CHANGE WITH AGE. Gail D. Anderson, Ph.D.
EPILEPSY: SPECTRUM OF CHANGE WITH AGE Gail D. Anderson, Ph.D. Incidence: 0.5% - 1.0% of U.S. population Peak incidence of onset: first 2 years of life, ages 5-7 years, early puberty and elderly. 125,000
More informationMeasures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity
Measures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity Seizures in the School Setting Meghan Candee, MD MS Assistant
More informationDifficult to treat childhood epilepsy: Lessons from clinical case scenario
Difficult to treat childhood epilepsy: Lessons from clinical case scenario Surachai Likasitwattanakul, M.D. Department of Pediatrics Faculty of Medicine, Siriraj Hospital Natural history of Epilepsy Untreated
More informationEpilepsy 2005 ILAE Report
1 Seizure & Epilepsy Care Gregory Krauss, MD Johns Hopkins University October 31, 2016 1 Epilepsy 2005 ILAE Report Seizure = a symptom Defined as paroxysmal change in behavior due to abnormal electrical
More information1/31/2009. Paroxysmal, uncontrolled electrical discharge of neurons in brain interrupting normal function
Paroxysmal, uncontrolled electrical discharge of neurons in brain interrupting normal function In epilepsy abnormal neurons undergo spontaneous firing Cause of abnormal firing is unclear Firing spreads
More informationDiagnosing Epilepsy in Children and Adolescents
2019 Annual Epilepsy Pediatric Patient Care Conference Diagnosing Epilepsy in Children and Adolescents Korwyn Williams, MD, PhD Staff Epileptologist, BNI at PCH Clinical Assistant Professor, Department
More informationEpilepsy DOJ Lecture Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis
Epilepsy DOJ Lecture - 2005 Masud Seyal, M.D., Ph.D. Department of Neurology University of California, Davis Epilepsy SEIZURE: A temporary dysfunction of the brain resulting from a self-limited abnormal
More informationManagement of Epilepsy In Primary Care Practice. Video Examples. Talk Like a Neurologist: Seizure Types
Management of Epilepsy In Primary Care Practice S. Andrew Josephson MD Carmen Castro Franceschi and Gladyne K. Mitchell Neurohospitalist Distinguished Professor Vice Chairman, Department of Neurology Director,
More informationEpilepsy: diagnosis and treatment. Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM
Epilepsy: diagnosis and treatment Sergiusz Jóźwiak Klinika Neurologii Dziecięcej WUM Definition: the clinical manifestation of an excessive excitation of a population of cortical neurons Neurotransmitters:
More informationIntroduction. 1 person in 20 will have an epileptic seizure at some time in their life
Introduction 1 person in 20 will have an epileptic seizure at some time in their life Epilepsy is diagnosed on the basis of two or more epileptic seizures. Around 450,000 people in the UK have epilepsy
More informationEEG in Epileptic Syndrome
EEG in Epileptic Syndrome Surachai Likasitwattanakul, M.D. Division of Neurology, Department of Pediatrics Faculty of Medicine, Siriraj Hospital Mahidol University Epileptic syndrome Electroclinical syndrome
More information*Pathophysiology of. Epilepsy
*Pathophysiology of Epilepsy *Objectives * At the end of this lecture the students should be able to:- 1.Define Epilepsy 2.Etio-pathology of Epilepsy 3.Types of Epilepsy 4.Role of Genetic in Epilepsy 5.Clinical
More informationPediatric Epilepsy Care in Milwaukee
Pediatric Epilepsy Care in Milwaukee Priya Monrad, MD Assistant Professor, Pediatric Neurology and Epilepsy Children s Hospital of Wisconsin Disclosures I have no relevant financial relationships to disclose.
More informationManagement of Epilepsy in Pregnancy
Management of Epilepsy in Pregnancy September 7, 2018 Stephanie Paolini, MD Clinical Instructor/Women s Neurology Fellow UPMC Neurology We ve come a long way Sterilization of people with epilepsy was legal
More informationDiagnosis, Assessment and Evaluation for Seizures
Lehigh Valley Health Network LVHN Scholarly Works Neurology Update for the Non-Neurologist 2013 Neurology Update for the Non-Neurologist Feb 20th, 7:40 PM - 8:10 PM Diagnosis, Assessment and Evaluation
More informationEpilepsy management What, when and how?
Epilepsy management What, when and how? J Helen Cross UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London, & National Centre for Young People with Epilepsy, Lingfield, UK What
More informationAEDs in 2011: A Critical Comparative Review December 3, 2011
AEDs in 2011: A Critical Comparative Review December 3, 2011 Selim R. Benbadis, M.D. University of South Florida Tampa, FL American Epilepsy Society Annual Meeting Disclosure Speakers bureau Consultant
More informationDoes a diagnosis of epilepsy commit patients to lifelong therapy? Not always. Here s how to taper AEDs safely and avoid relapse.
Does a diagnosis of epilepsy commit patients to lifelong therapy? Not always. Here s how to taper AEDs safely and avoid relapse. T he epilepsy specialist always has two equally important endpoints in mind
More informationTreatment Options for Seizures: Practical Points in Epilepsy Management
Lehigh Valley Health Network LVHN Scholarly Works Neurology Update for the Non-Neurologist 2013 Neurology Update for the Non-Neurologist Feb 20th, 8:10 PM - 8:40 PM Treatment Options for Seizures: Practical
More informationManagement of Seizures and Status Epilepticus. Emergent ICP Management
Management of Seizures and Status Epilepticus S. Andrew Josephson MD Carmen Castro Franceschi and Gladyne K. Mitchell Neurohospitalist Distinguished Professor Senior Executive Vice Chair, Department of
More informationTreatment of Epilepsy - Overview. AED Therapy in Children with Epilepsy. Antiepileptic Drugs (AEDs) Lifestyle Issues with Epilepsy
AED Therapy in Children with Epilepsy non-drug treatment issues factors influencing choice of AEDs general principles of AED therapy in children specific AEDs Treatment of Epilepsy - Overview counselling
More informationEpilepsy 101. Overview of Treatment Kathryn A. O Hara RN. American Epilepsy Society
Epilepsy 101 Overview of Treatment Kathryn A. O Hara RN American Epilepsy Society Objectives Describe the main treatment options for epilepsy Identify factors essential in the selection of appropriate
More informationNew antiepileptic drugs
Chapter 29 New antiepileptic drugs J.W. SANDER UCL Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, Queen Square, London, and Epilepsy Society, Chalfont
More informationAPPENDIX S. Removed sections from original guideline. 1.1 Pharmacological treatment Introduction
00 0 APPENDIX S Removed sections from original guideline. Pharmacological treatment.. Introduction The evidence base for the newer AEDs (gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine,
More informationAdvances in the diagnosis and management of epilepsy in adults
n DRUG REVIEW Advances in the diagnosis and management of epilepsy in adults Diego Kaski MRCP, PhD and Charles Cockerell MD, FRCP SPL This drug review looks at the key issues in diagnosing epilepsy, initiating
More informationEpilepsy. Hyunmi Choi, M.D., M.S. Columbia Comprehensive Epilepsy Center The Neurological Institute. Seizure
Epilepsy Hyunmi Choi, M.D., M.S. Columbia Comprehensive Epilepsy Center The Neurological Institute Seizure Symptom Transient event Paroxysmal Temporary physiologic dysfunction Caused by self-limited, abnormal,
More informationUNDERSTANDING THE PHARMACOLOGY OF ANTIEPILEPTIC DRUGS
UNDERSTANDING THE PHARMACOLOGY OF ANTIEPILEPTIC DRUGS THANARAT SUANSANAE, BPharm, MPharm, BCPP, BCGP Clinical Pharmacy Division, Faculty of Pharmacy, Mahidol University Epileptogenesis 1 Neuronal Network
More informationClinical Epilepsy. American Epilepsy Society. C-Slide. American Epilepsy Society 2010
Clinical Epilepsy American Epilepsy Society 1 1 Clinical Epilepsy: Index Hyperlinks can be used in slide-show mode: Click on topics to navigate to section. Click on Return to index to return to this page.
More informationSpecial Lecture Update in Epilepsy Prof. Sirichai Chayasirisobhon January 7, Update in Epilepsy
Special Lecture Update in Epilepsy Prof. Sirichai Chayasirisobhon January 7, 2014 Update in Epilepsy Sirichai Chayasirisobhon, M.D., FAAN Director Emeritus, Adult Epilepsy Program, Kaiser Permanente Medical
More informationChronic Management of Idiopathic Generalized epilepsies (IGE) Hassan S.Hosny M.D. Prof of Neurology, Cairo University
Chronic Management of Idiopathic Generalized epilepsies (IGE) Hassan S.Hosny M.D. Prof of Neurology, Cairo University Sanaa 2009 Points of Discussion Prevalence compared to focal epilepsy Adult form Status
More informationAnd They All Fall Down
And They All Fall Down Amy Vierhile, DNP, RN, PPCNP BC Division of Child Neurology University of Rochester Medical Center Disclosures Research funding: Greenwich Pharmaceuticals, Biohaven, Teva, NINDS
More informationEpilepsy for the General Internist
Epilepsy for the General Internist William O. Tatum DO, FAAN, FACNS Professor of Neurology Mayo College of Medicine Senior Consultant, Mayo Clinic Florida Director, Epilepsy Center and Monitoring Unit
More information2018 American Academy of Neurology
Practice Guideline Update Efficacy and Tolerability of the New Antiepileptic Drugs II: Treatment-Resistant Epilepsy Report by: Guideline Development, Dissemination, and Implementation Subcommittee of the
More information2018 American Academy of Neurology
Practice Guideline Update Efficacy and Tolerability of the New Antiepileptic Drugs I: Treatment of New-Onset Epilepsy Report by: Guideline Development, Dissemination, and Implementation Subcommittee of
More informationAET Symposium 2013: One size does not fit all: Personalized Medical Care December 7 th, 2013
AET Symposium 2013: One size does not fit all: Personalized Medical Care December 7 th, 2013 Co-chairs: Aristea S. Galanopoulou, MD PhD Albert Einstein College of Medicine, Bronx NY USA Angus A. Wilfong,
More information21 st Century Fits. Alexandre J. Lockfeld, M.D. Clinical Neuroscience Practice May, 2010 Eugene, Oregon
21 st Century Fits Alexandre J. Lockfeld, M.D. Clinical Neuroscience Practice 2010 18 May, 2010 Eugene, Oregon Current Disclosures: Alexandre J. Lockfeld, M.D. Adult Neurology and Epilepsy Speaker s Bureau/Consultant:
More informationMultiple-Choice Questions Preferred Responses
CME Multiple-Choice Questions Preferred Responses Following are the preferred responses for the Multiple-Choice Questions in this issue. The questions and answer options are repeated, and the preferred
More informationElectroclinical Syndromes Epilepsy Syndromes. Angel W. Hernandez, MD Division Chief, Neurosciences Helen DeVos Children s Hospital Grand Rapids, MI
Electroclinical Syndromes Epilepsy Syndromes Angel W. Hernandez, MD Division Chief, Neurosciences Helen DeVos Children s Hospital Grand Rapids, MI Disclosures Research Grants: NIH (NINDS) Lundbeck GW Pharma
More information