1. EPILEPSY

2. Diagnosis Refer to specialist ? < 28 days 50% of referred pts don’t have epilepsy 20% of pts on epilepsy medication have been misdiagnosed Diagnosis may have profound psychological social and financial implications Inability to drive, unemployment, low self esteem, discrimination

3. History Eye witness account Dates and times of seizures What where they doing Any mood changes – extreme excitement, anxiety, anger. Any loss of consciousness or confusion Skin colour changes – pale, flushed, blue.

4. History Alteration of breathing – noisy or difficult Did body stiffen, jerk or twist Incontinence Bite tongue or cheek How long was seizure How where they afterwards – tired, confused. How long till normal

5. Examination Blood pressure Pulse, heart sounds, carotid bruits. Cranial nerves Fundi Tone power coordiantion

6. Investigations Fasting blood sugar Fbc U&E LFT’s TFT’s

7. Advice Bathing Swimming Driving most stop till sees specialist Other high risk activities Document discussion in notes Recurrence risk is 30% over next 6/12

8. Goals of therapy Complete freedom from seizures No side effects of medication No impact on quality of life Least medication necessary

9. Epilepsy Prevalence 4-10 per 1000 population 50% female Life long condition

10. New contract Compile a register of patients with epilepsy receiving drug treatment Review them annually Record seizure frequency and date of last seizure Aim to achieve seizure freedom in 705 of patients.

11. Special issues for Women Fertility Contraception Preconceptual counselling Management of pregnancy Risk to developing foetus Menopause

12. Adolescence Ensure handover from paediatric service to adult service occurs Effect of menstrual cycle on seizures – clustering round menstruation