CPD: New onset seizure and Epilepsy: Diagnosis and Management

CPD: New onset seizure and Epilepsy: Diagnosis and Management. Written by Dr Gerard Mullane and Dr Albi Chalissery

New onset seizure and Epilepsy: Diagnosis and Management.

Dr Gerard Mullane MB MCh BAO MRCPI is a Neurology Registrar in Beaumont Hospital in the RCSI hospital group.

Dr Albi Chalissery MBBS MRCPI MD is a Consultant Neurologist at Beaumont Hospital Dublin and Connolly Hospital. Blanchardstown in RCSI hospital group. Her specialty interest includes Epilepsy, and she recently established a “New seizure” clinic at Beaumont hospital.

60 Second Summary – New onset seizure and Epilepsy:

Epilepsy is “a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. Older terms such as “simple partial” and “complex partial” seizures have now largely been replaced. This is by terms “focal aware seizures” or “focal seizures with impaired awareness” in the most recent ILAE classification. The correct identification and classification of seizures and epilepsy syndromes is therefore important. This is because it can have major effects on treatment decisions.

The core investigations remain EEG and dedicated epilepsy protocol MRI brain. But more extensive investigations such as genomic analysis and autoantibody screening are being increasingly used. This is due to a greater understanding and becoming more cost effective. Despite the availability of investigations, it is important to recognise that epilepsy is primarily diagnosed on careful clinical history and often all investigations can be normal.

The treatment options available to clinicians in seizures has become broader. It’s important to recognise side effects of the more common anti-seizure drugs, as well as their mechanism of action. Many other medications can affect the metabolism of ASMs and it is important to check for drug interaction prior to the commencement of new medications.

The driving regulations regarding seizures is clearly laid out in the RSA guidelines. The general restriction is 1 year for patients with known seizure disorder and 6 months for first unprovoked seizure or seizures in the context
of alcohol. Therefore, the restrictions regarding group 2 vehicles (buses and trucks) are much more restrictive and requires 10 years of seizure freedom with no medications for patients with known seizures and 5 years of medicine free seizure freedom after a single unprovoked seizure.

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