Approach to Patient with Epilepsy

Approach to Patient with EpilepsyCreated OnJune 1, 2020Last Updated OnJune 1, 2020byadmin You are here: Main Clinical Examination Approach to Patient with Epilepsy < All Topics Table of Contents Examination: General: Assess level of consciousness of patient Observe for any abnormal movement/involuntary movement Build of patient Hand – Tremors, Pulse (rate, rhythm) Arm – Blood pressure look for hypertension. Skin – Look for any neurocutaneous stigmata, hair loss, Acne, Bruises/scars Head – Scars due to trauma, Head circumference in paediatric age group Face – Dysmorphic features Mouth – Gum hypertrophy, marks/ulceration on the side of the tongue/oral mucosa Ophthalmic examination Look for nystagmus – Not common, but can be caused by focal onset seizure. Visual acuity – Can have visual hallucinations caused by occipital lobe seizure Any visual field defect – Homonymous hemianopia Examine the retina Extraocular muscle movement Higher mental function assessment Assess the level of consciousness. Any memory impairment in case of medial temporal lobe affected. Motor system Look for asymmetries in the size of limbs. Look for Todd’s paresis usually present for less than 24 hours after seizure. Sensory system Look for any sensory deficit (Eg. Tingling/electric sensation at the contralateral face and limbs) Cerebellum Look for ataxia Assess Tandem gait – Unable to do in case of antiepileptic drug toxicity. Assess for Anti-epileptic drug side effects Tremor Slurred speech Nystagmus Unable to walk in a straight line (Tandem gait) Hair loss Weight gain Gum hypertrophy Acne Ataxia Absence of reflex Investigations for the 1st seizure: Electrocardiography (ECG) Check dextrose stick to look for hypoglycemia Blood tests and metabolic investigations Hyponatremia Hypoglycemia Hypomagnesemia Uremia Hepatic encephalopathy Serum and urine toxicology Neuroimaging CT scan/MRI To rule out subdural hematoma, haemorrhage, abscess, neoplasm Electroencephalogram (EEG) Help to confirm the diagnosis of epilepsy Identify certain epileptic syndromes Management: Indications to start anti-epileptic treatment Single seizure but with a high risk of seizure recurrence (abnormal MRI or EEG) More than 1 unprovoked seizure Types of seizure Medications Focal onset seizure Carbamazepine Lamotrigine Levetiracetam Valproate Generalized tonic-clonic seizure Valproate Lamotrigine Carbamazepine Absence seizure Ethosuximide Valproate Lamotrigine Antiepileptics Side effects Carbamazepine Sedation, headache, blurred vision, ataxia, hyponatremia, osteoporosis. Valproate Nausea, anorexia, tremor, weight gain, hair loss, thrombocytopenia, hyperammonaemic encephalopathy, osteoporosis. Lamotrigine Dizziness, Steven-Johnson syndrome, unsteadiness Phenytoin Ataxia, gingival hyperplasia, hirsutism, diplopia Phenobarbitone Sedation, behavior change, osteoporosis Surgical treatment Lobectomy Lesionectomy Commonly asked questions What is the emergency management of tonic-clonic status epilepticus? Secure airway,...

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