Clinical Case Database / Category: Patient Management
Diagnosis of epilepsy
Dr. Paul Gallagher
Foundation Years Journal, volume 8, issue 3, p.22 (123Doc Education, London, March 2014)
Epilepsy affects 50 million people worldwide (1), with a prevalence of 4-10 per 1000 in the UK (2). Ten percent of people will have a seizure during their lifetime, without necessarily developing epilepsy (1). The risk of an individual developing epilepsy in their lifetime is 3-5% (2). Essentially, regardless of your chosen specialty, it is likely you will encounter patients with epilepsy, either during an acute seizure event or as a co-morbid condition. Like any chronic medical condition, the aim of management is to allow patients to live life as normally as possible: indeed, this is the case for the majority of patients, with up to 70% becoming seizure-free on monotherapy (3,4).
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Dr. Paul Gallagher
MBChB, BSc (MedSc) Hons, MRCP (Neuro SCE)
Institute of Neurological Sciences
Southern General Hospital
1. World Health Organisation Fact Sheet No. 999: Epilepsy. http://www.who.int/mediacentre/factsheets/fs999/en/index.html.
2. Shorvon S, Duncan J, Koepp M, Sander J, Smith S, Walker M. Epilepsy and Related Disorders. In: Clarke C. Howard R, Rossor M, Shorvon S eds. Neurology: A Queen Square Textbook, 1st edition, London: Blackwell Publishing 2009, 189-244.
2. Cockerell OC, Eckle I, Goodridge DM et al. Epiliepsy in a population of 6000 re-examined: secular trends in first attendance rates, prevalence and prognosis. JNNP 1995; 58: 570-576
3. Kwan P, Brodie MJ. Early identification of refractory epilepsy. NEJM 2000; 342: 314-319
4. Paul S, Blaikley S, Chinthapalli, R. Clinical update: febrile convulsion in childhood. Community Practitioner 2012; 85: 36-38
5. Berg et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classiï¬cation and Terminology, 2005â€“2009. Epilepsia 2010; 51(4):676â€“685
6. Foldvary-Schaefer N, Unnwongse K. Localising and lateralizing features of auras and seizures. Epilepsy & Behaviour 2011; 20:160-166
7. Salmenpera TM, Duncan JS. Imaging in Epilepsy. JNNP 2005; 76(Suppl III): iii2-iii10
8. Annegers JF, Hauser WA, Coan SP, Rocca WA. A population-based study of seizures after traumatic brain injuries. N Engl J Med 1998; 338: 20â€“24
9. TrenitÃ© D. Provoked and reflex seizures: Surprising or common? Epilepsia 2012; 53(Suppl. 4):105â€“113. 10. Scottish Intercollegiate Gudeline Network (SIGN). Diagnosis and
management of epilepsy in Adults. 2003 (revised 2005). http://www.sign. ac.uk/guidelines/fulltext/70/index.html
11. Smith S. EEG in the diagnosis, classification and management of patients with epilepsy. JNNP 2005; 76(Suppl II):ii2-ii7
12. Berg et al. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 1991; 41:965-72
13. National Institute for Health andClinical Excellence (NICE). The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care 2012. http://publications.nice.org.uk/theepilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-andchildren-in-primary-and-cg137
14. Tomson et al. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurology 2008; 7:1021-31
15. Vincent M. The Long QT syndrome. Indian Pacing Electrophysoliogy Journal 2002; 2(4):127-142. http://www.health-pic.com/arrhythmogenic-rightventricular-cardiomyopathy. http://www.osuemed.wordpress.com.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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