1. Management

2. First and most important question….. treat or don’t treat? →confirmed epilepsy? →trigger or provoking factors ? →bothersome? →Patients view on treatment?

3. Treatment Anti-Epilepsy Drug Therapy Surgery Alternative Therapies Up to 70 - 80% chance of seizure freedom Available for refractory patients only: resective or stimulation Most commonly used (esp paeds) ketogenic diet

4. Commonly used AED’s Carbamazepine Sodium Valproate Leveitracetam Lamotrigine Phenytoin Topiramate Zonisamide

5. Common Rescue Medications Midazolam / Diazepam / Clobazam

6. Major drug related issues Type of epilepsy Age Sex Co-morbid problems Compliance Understanding of treatment Guidance (NICE, SIGN) Drug interactions

7. Aims of treatment →Long term →Single drug →Lowest effective dose →Established treatments first →Minimise adverse effects

8. Vigabatrin and visual field loss

9. Foetal Valproate Syndrome Women of childbearing age should not be started on sodium valproate without specialist neurological advice

10. Epilepsy surgery ResectiveStimulation

11. Resective Young age Partial onset / 2nd generalised seizures Resistance to AED Identifiable site of origin Minimal risk to memory and speech Concordance of all factors

12. Stimulation

13. Ketogenic diet →high-fat, low-carbohydrate “long-chain triglyceride diet” →3 / 4 g of fat for every 1 g of carbohydrate and protein →mechanisms unknown but Ketones are thought to be the more likely mechanism with higher ketone levels often leading to improved seizure control →Research in adults limited →In paeds 50% have up to 50% seizure reduction

14. Ultimate Treatment Aim For patients to be seizure free on appropriate medication, with little or no side-effects form their AED →70% of patients will become seizure free optimal therapy →80% controlled on single drug →10 – 15% controlled on polytherapy