AnticonvulsantTherapy-BCEpilepsySociety：抗惊厥疗法-公元前癫痫协会.pptVIP

Anticonvulsant Therapy Dr. Sia Michoulas Pediatric Epilepsy Fellow BC Children’s Hospital Seizure Occurrence Up to 10% of the population will experience a single seizure during their lifetime majority due to an acute reversible cause: fever, metabolic changes, drug intoxication/withdrawal. Since seizures don’t recur in these patients after the provoking factor has been corrected, they don’t have a diagnosis of epilepsy. A diagnosis of epilepsy is made after a patient has had 2 or more unprovoked seizures What was the cause of the seizure? Epileptic seizures are symptoms due to a variety of causes Determining the underlying cause has implications for both treatment and prognosis Causes epileptic seizures Idiopathic (Genetic) - 50% of cases Childhood and Juvenile absence epilepsy Benign rolandic epilepsy of childhood Juvenile myoclonic epilepsy (JME) Symptomatic - 50% of cases Malformations of brain developmental Tuberous Sclerosis Brain Infection Stroke Traumatic brain injury Tumor Clinical Factors Associated With Genetic Versus Symptomatic Epilepsy When do you consider starting treatment? After first unprovoked seizure 50% of patients will have a 2nd seizure. This needs to be balanced against the potential side-effects and cost of medication. In general treatment is started after the 2nd seizure. Case #1 Mark is an 7 year boy seen in the neurology clinic accompanied by his mom. Teachers have noticed “staring spells” at school. VIDEOPanayiotopoulos CP. Typical Absence. Neurology Medlink. June 2007 Adverse Effects Case #1 continued Mark’s mom calls your office 2 weeks later. Patient has been increasing the medication every 5 days but noticing that she is more “sleepy” during the day. Adverse Effects Initiation Dose related adverse effects Important to recognize Seldom are serious – reversible Decreasing medication Discontinuing medication Case # 2 Sarah 14 year old girl. She has experience 2 brief generalized tonic-clonic seizures. Decisi