clinical presentation about epilepsy and its pharmacological management.pptx

the above presentation is for neurological condition ,specifically epilepsy and it has it clinical management

1. EPILEPSY PRESENTATION BY:TIONDI FRANCIS PSYCHIATRIC CLINICAL OFFICER

2. Definition of epilepsy according to WHO Is a chronic noncommunicable neurological condition characterized by recurrent unprovoked seizure occurring at the same pattern. According to ILAE 2014 Epilepsy is a disease of the brain defined by any of the following conditions 1 . At least two unprovoked (or reflex) seizures occurring >24 h apart 2.One 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

3. Prevalence of epilepsy Epilepsy accounts for a significant proportion of the world's disease burden, affecting around 50 million people worldwide. Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages. Nearly 80% of people with epilepsy live in low- and middle-income countries. It is estimated that up to 70% of people living with epilepsy could live seizure-free if properly diagnosed and treated. The risk of premature death in people with epilepsy is up to three times higher than for the general population. Three quarters of people with epilepsy living in low-income countries do not get the treatment they need.

4. Prevalence continue…………. In Uganda; 2% ~770,000 of Ugandan population has epilepsy .according to MUK publication of 2019.

5. RISK FACTORS FOR EPILEPSY The causes of epilepsy are divided into the following categories: structural, genetic, infectious, metabolic, immune and unknown. Examples include: VITAMIN DE Vascular Cause,sah Infection Eg Menigitis Trauma Eht,sht Autoimuity Metabolic Eg Hyponatremia, Idiopathic Drugs Eclampsia

6. brain damage from prenatal or perinatal causes (e.g. a loss of oxygen or trauma during birth, low birth weight); congenital abnormalities or genetic conditions with associated brain malformations; a severe head injury; a stroke that restricts the amount of oxygen to the brain; an infection of the brain such as meningitis, encephalitis or neurocysticercosis, certain genetic syndromes; and a brain tumour.crimination

7. CLASSIFICATION OF EPILEPSY EPILEPSY FOCAL GENERALISED EPILEPSY EPILEPTIC SPASMS SIMPLE FOCAL SEIZURE GTCS COMPLEX FOCAL SEIZURE GENERAISED ANSENCE SEIZURE MAYOCLONIC CLONIC SECONDARY GENERALISED ATONIC

8. Classification of seizure 1.Generalised seizure. Abnormal electrical activities originates from both cerebral hemisphere. Generalize Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space. Tonic- clonic seizures, also called grand mal seizures, can make a person Cry out. Lose consciousness. Fall to the ground. Have muscle jerks or spasms. The person may feel tired after a tonic- clonic seizured seizures affect both sides of the brain

9. Continuation of epilepsy classification….. Tonic: Muscles in the body become stiff. Atonic: Muscles in the body relax. Myoclonic: Short jerking in parts of the body. Clonic : Periods of shaking or jerking parts on the body.

10. Classification continue…………. 2.Focal seizures are located in just one area of the brain. These seizures are also called partial seizures. Simple focal seizures affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell. Complex focal seizures can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes. Secondary generalized seizures begin in one part of the brain, but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure. Seizures may last as long as a few minutes.

11. Anti-Epileptic Drugs Before you start AEDs, please consider who, and what am I treating? DESSCRIBE Description Epileptic or non-epileptic or uncertain episodes (s) Seizure types (s) Syndrome? Cause? (Genetic, Structural, metabolic, Infectious, Immune, unknown) Relevant Impairment Behavioral & Emotional Problems

12. Selecting AED Broadly speaking antiepileptic drugs have either a broad spectrum of activity against both generalized and focal seizure types or a narrow spectrum of activity. CBZ and VPA, are the commonest for initiation in most children however, Carbamazepine has a narrow spectrum of action, mainly being active against focal seizures (including those evolving to bilateral convulsive seizures). Sodium valproate has a broad spectrum of action against focal and generalized seizures.

13. Choice of drug in various forms of seizure NOTE! The choice of AEDs for use depend on the type of seizure one has, various forms of seizure requires different medication in order to achieve good seizure outcome .

14. Focal seizures with or without secondary generalized tonic– clonic seizures FRISTLINE Valproate Start 400 mg daily in 2 divided doses. Increase by 500 mg daily each week (maximum 3000 mg daily). Children: Start 15-20 mg/kg daily in 2-3 divided doses. Increase each week by 15 mg/kg daily (max 15-40 mg/kg daily). Carbamazepine Start 100-200 mg daily in 2-3 divided doses. Increase by 200 mg each week (max 1400mg daily). Children: Start 5 mg/kg daily in 2-3 divided doses. Increase by 5 mg/kg daily each week (max 40mg/kg daily OR 1400mg daily Lamotrigine SECONDLINE Phenytoin Topiramate Tiagabine

15. Absence seizures FIRST LINE Ethosuximide Adult 500mg start and increase gradually max 1.5g Children 20mg/kg Valproate SECONDLINE Lamotrigine Clobazam/ clonazepam

16. Myoclonic jerks FIRSTLINE Valproate SECONDLINE Lamotrigine Clonazepam

17. Generalized seizures Primary (tonic– clonic ) FRISTLINE Valproate Lamotrigine SECONDLINE Clonazepam/clobazam Topiramate Phenytoin Start 150-200 mg daily in two divided doses. Increase by 50 mg daily every 3-4 weeks (max 400 mg daily). Children: Start 3-4 mg/kg daily in 2 divided doses. Increase by 5 mg/kg daily every 3-4 weeks (maximum 300 mg per day

18. phenorbab Start 60 mg daily in 1-2 divided doses. Increase weekly by 2.5-5 mg (maximum 180 mg daily). Children: Start 2-3 mg/kg daily in 2 divided doses. Increase weekly by 1-2 mg/kg daily depending on tolerance (maximum 6mg daily).

19. Drug Resistant epilepsy Children and young people whose seizures are resistant to treatment with standard antiepileptic drugs should be referred to a tertiary epilepsy center. Treatment modalities that are likely to be considered include: • The use of the newer antiepileptic drugs • The use of experimental antiepileptic drugs • Surgical treatment • The ketogenic diet

20. Drug Interactions Erythromycin (a commonly prescribed antibiotic in children and young people) interacts with carbamazepine, often leading to carbamazepine toxicity Melatonin may interact with AEDs, or even induce seizures in children (take caution) The efficacy of the contraceptive pill is reduced by a number (but not all) antiepileptic drugs. Higher doses may be needed. Always check the drug interaction apps

21. Special circumstances Measure levels of Phenytoin regularly for young people since small changes can have large effect in the levels of the drug (swollen gums). VPA should be used with caution in pregnant and girls in puberty due to its teratogenic effects but also ovarian issues (e.g. cysts). Although, risks must weigh the benefits during this decision. Phenobarbitone can increase hyperactivity and predispose the child to hyperactivity.

22. When to stop medication In children epilepsy is may not be a lifelong condition, many children ‘grow out of it’. Most children started on antiepileptic drugs However, this is no means certain and when it occurs is generally unpredictable will become seizure free and in nearly all there should be an attempt to withdraw antiepileptic medication. Attempted withdrawal once the child has been free of seizures for 2 years. However, this is not a ‘hard and fast rule’. The single most useful factor in helping to decide when to withdraw antiepileptic drugs is the type of epilepsy or epilepsy syndrome diagnosis

23. Prevention of epilepsy An estimated 25% of epilepsy cases are potentially preventable. Preventing head injury Adequate perinatal care. The use of drugs and other methods to lower the body temperature The prevention of epilepsy associated with stroke is focused on cardiovascular risk factor reduction. Central nervous system infections e.g parasites.