Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy...
-
Upload
kelly-dixon -
Category
Documents
-
view
217 -
download
1
Transcript of Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy...
![Page 1: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/1.jpg)
Advances in the Diagnosis and Advances in the Diagnosis and Treatment of Epilepsy Treatment of Epilepsy
Marcelo E. Lancman, M.D.Marcelo E. Lancman, M.D.Director, Epilepsy ProgramDirector, Epilepsy Program
Northeast Regional Epilepsy GroupNortheast Regional Epilepsy Group
![Page 2: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/2.jpg)
Advances in the Diagnosis Advances in the Diagnosis and Treatment of Epilepsy and Treatment of Epilepsy Epilepsy conceptsEpilepsy concepts Diagnosing EpilepsyDiagnosing Epilepsy What causes EpilepsyWhat causes Epilepsy Treating EpilepsyTreating Epilepsy New developmentsNew developments
![Page 3: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/3.jpg)
Epilepsy ConceptsEpilepsy Concepts
What is epilepsy?What is epilepsy?
What is a seizure?What is a seizure?
![Page 4: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/4.jpg)
IncidenceIncidence
EpilepsyEpilepsy
0.5-1% 0.5-1%
SeizuresSeizures
5-10%5-10%
![Page 5: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/5.jpg)
Classification of SeizuresClassification of Seizures
PartialPartialSimpleSimple
ComplexComplex
Secondary GeneralizedSecondary Generalized
GeneralizedGeneralizedAbsenceAbsence
AtonicAtonic
ClonicClonic
TonicTonic
Tonic-clonicTonic-clonic
MyoclonicMyoclonic
![Page 6: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/6.jpg)
Classification of EpilepsyClassification of Epilepsy
By LocalizationBy Localization– PartialPartial– GeneralizedGeneralized
By CauseBy Cause– Idiopathic (unknown)Idiopathic (unknown)– SymptomaticSymptomatic
![Page 7: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/7.jpg)
Classification of EpilepsyClassification of Epilepsy
Idiopathic Partial EpilepsyIdiopathic Partial Epilepsy Symptomatic Partial EpilepsySymptomatic Partial Epilepsy Idiopathic Generalized EpilepsyIdiopathic Generalized Epilepsy Symptomatic Generalized EpilepsySymptomatic Generalized Epilepsy
![Page 8: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/8.jpg)
Idiopathic Generalized Idiopathic Generalized EpilepsyEpilepsy Benign Neonatal Familial EpilepsyBenign Neonatal Familial Epilepsy Benign Myoclonic Epilepsy of InfancyBenign Myoclonic Epilepsy of Infancy Generalized epilepsy with febrile seizures plusGeneralized epilepsy with febrile seizures plus Epilepsy with myoclonic absenceEpilepsy with myoclonic absence Epilepsy with myoclonic-astatic seizuresEpilepsy with myoclonic-astatic seizures Childhood absence epilepsyChildhood absence epilepsy Juvenile absence epilepsyJuvenile absence epilepsy Epilepsy with GTCS onlyEpilepsy with GTCS only
![Page 9: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/9.jpg)
Idiopathic Partial EpilepsyIdiopathic Partial Epilepsy
Benign Rolandic EpilepsyBenign Rolandic Epilepsy Benign Occipital EpilepsyBenign Occipital Epilepsy
![Page 10: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/10.jpg)
Symptomatic Generalized Symptomatic Generalized EpilepsyEpilepsy Infantile spasms (West syndrome)Infantile spasms (West syndrome) Dravet syndromeDravet syndrome Lennox-Gastaut syndromeLennox-Gastaut syndrome
![Page 11: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/11.jpg)
Symptomatic Partial EpilepsySymptomatic Partial Epilepsy
Temporal Lobe EpilepsyTemporal Lobe Epilepsy Frontal Lobe EpilepsyFrontal Lobe Epilepsy Parietal Lobe EpilepsyParietal Lobe Epilepsy Occipital Lobe EpilepsyOccipital Lobe Epilepsy
![Page 12: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/12.jpg)
Type of EpilepsyType of Epilepsy
The importance of knowingThe importance of knowing
![Page 13: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/13.jpg)
Diagnosis of EpilepsyDiagnosis of Epilepsy
Medical HistoryMedical History Physical examPhysical exam
![Page 14: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/14.jpg)
TestingTesting
Testing Testing – EEG, AEEG, VEEGEEG, AEEG, VEEG
– LabsLabs
– GeneticsGenetics ImagingImaging
– CT, MRI (high CT, MRI (high definition)definition)
![Page 15: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/15.jpg)
Diagnosis Diagnosis
Diagnosis is clear: treatment is initiatedDiagnosis is clear: treatment is initiated
Diagnosis unclear: Video-EEGDiagnosis unclear: Video-EEG
![Page 16: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/16.jpg)
Video-EEG MonitoringVideo-EEG Monitoring
Continuous EEG monitoring along with Continuous EEG monitoring along with continuous audio-video recordingcontinuous audio-video recording
Mostly requires inpatient admissionMostly requires inpatient admission
![Page 17: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/17.jpg)
Goals of Video-EEG Goals of Video-EEG MonitoringMonitoring Epilepsy vs. non-Epilepsy vs. non-
epileptic eventsepileptic events
Characterize epilepsy Characterize epilepsy typetype
Pre-surgical Pre-surgical evaluation evaluation
![Page 18: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/18.jpg)
Non-Epileptic Events Non-Epileptic Events
20 to 30% of patients referred with 20 to 30% of patients referred with diagnosis of intractable epilepsydiagnosis of intractable epilepsy
Events that do not have electrical source in Events that do not have electrical source in brainbrain
May have physical or psychological May have physical or psychological causes that are not epilepsycauses that are not epilepsy
But CAN also occur in patients who have But CAN also occur in patients who have epilepsyepilepsy
![Page 19: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/19.jpg)
Non-epileptic eventsNon-epileptic events
Physiologic (other medical conditions)Physiologic (other medical conditions)– Fainting, low sugar, changes in electrolytes, Fainting, low sugar, changes in electrolytes,
toxins, fever.toxins, fever. Psychological Psychological
– Referred to psychiatry and neuropsychologist Referred to psychiatry and neuropsychologist who work with this type of stress-seizurewho work with this type of stress-seizure
– Psychiatric medication, psychotherapy, Psychiatric medication, psychotherapy, educationeducation
![Page 20: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/20.jpg)
Non-epileptic eventsNon-epileptic events
Conditions that may look like seizures:Conditions that may look like seizures:– TIAs, complicated migraines, movement TIAs, complicated migraines, movement
disorders, sleep disorders, anxiety/panic disorders, sleep disorders, anxiety/panic disorder, vertigo, cardiac disorders, rage disorder, vertigo, cardiac disorders, rage attacks, breath-holding spells, attacks, breath-holding spells,
![Page 21: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/21.jpg)
What causes of Epilepsy?What causes of Epilepsy?
The seizure thresholdThe seizure threshold Causes:Causes:
– Genetics, head injury, stroke, tumors, Genetics, head injury, stroke, tumors, infections, malformations, metabolic infections, malformations, metabolic disorders (diabetes, thyroid, parathyroid, disorders (diabetes, thyroid, parathyroid, adrenal), degenerative disorders, perinatal adrenal), degenerative disorders, perinatal factors and other less common (cardiac, GI, factors and other less common (cardiac, GI, blood, inflammatory, poisons, etc)blood, inflammatory, poisons, etc)
![Page 22: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/22.jpg)
Seizure TriggersSeizure Triggers
Alcohol, stress, environmental Alcohol, stress, environmental temperature, lights, fever/illness, temperature, lights, fever/illness, hormonal changes, hyperventilation, sleep hormonal changes, hyperventilation, sleep deprivation, medications and supplements, deprivation, medications and supplements, missing medication doses and travel missing medication doses and travel across time zonesacross time zones
![Page 23: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/23.jpg)
Treating EpilepsyTreating Epilepsy
What is intractable epilepsy?What is intractable epilepsy?
Despite medical management, patient Despite medical management, patient continues to have frequent, debilitating continues to have frequent, debilitating seizuresseizures
![Page 24: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/24.jpg)
Seizure ControlSeizure Control
![Page 25: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/25.jpg)
Options for the Intractable Options for the Intractable Seizure PatientSeizure Patient
Medications (combinations)Medications (combinations) DietsDiets Surgical proceduresSurgical procedures
– StimulatorsStimulators– ResectionsResections
![Page 26: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/26.jpg)
MedicationsMedications
Choices based on epilepsy type, patient profile, side Choices based on epilepsy type, patient profile, side effect profile, costeffect profile, cost
Best to have patient on single antiepileptic drug (AED)Best to have patient on single antiepileptic drug (AED)
May need polytherapy (combination of medications)May need polytherapy (combination of medications)
Adding meds requires going up slowly with the new Adding meds requires going up slowly with the new agent before discontinuing previous drugagent before discontinuing previous drug
Polytherapy requires deep knowledge of interactionsPolytherapy requires deep knowledge of interactions
![Page 27: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/27.jpg)
How to use polytherapy How to use polytherapy rationallyrationally Pharmacodynamics Pharmacodynamics
(what the medication does to the body)(what the medication does to the body)
Pharmacokinetics Pharmacokinetics (what the body does to the (what the body does to the
medications)medications)
– AbsorptionAbsorption
– Distribution Distribution
– EliminationElimination Half lifeHalf life LiverLiver KidneysKidneys
![Page 28: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/28.jpg)
How to use polytherapy How to use polytherapy rationallyrationally Side effectsSide effects
– Dose-related Dose-related
– Idiosyncratic (each Idiosyncratic (each person is different)person is different)
![Page 29: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/29.jpg)
Older MedicationsOlder Medications
Carbamazepine Carbamazepine (Tegretol)(Tegretol)
PhenobarbitalPhenobarbital
Ethosuximide (Zarontin)Ethosuximide (Zarontin)
Phenytoin Phenytoin (Dilantin/Cerebyx)(Dilantin/Cerebyx)
Valproic acid (Depakote)Valproic acid (Depakote)
Primidone (Mysoline)Primidone (Mysoline)
![Page 30: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/30.jpg)
Newer AED’sNewer AED’s
Gabapentin (Neurontin)Gabapentin (Neurontin)
Lamotrigine (Lamictal)Lamotrigine (Lamictal)
Topiramate (Topamax)Topiramate (Topamax)
Felbamate (Felbatol)Felbamate (Felbatol)
Diastat (Diazepam)Diastat (Diazepam)
Vigabatrin (Sabril)Vigabatrin (Sabril)
Ezogabine (Potiga)Ezogabine (Potiga)
Oxcarbazepine (Trileptal)Oxcarbazepine (Trileptal)
Pregabalin (Lyrica)Pregabalin (Lyrica)
Zonisamide (Zonegran)Zonisamide (Zonegran)
Levetiracetam (Keppra)Levetiracetam (Keppra)
Lacosamide (Vimpat)Lacosamide (Vimpat)
Rufinamide (Banzel)Rufinamide (Banzel)
Clobazam (Onfi)Clobazam (Onfi)
![Page 31: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/31.jpg)
Medication choices based on Medication choices based on epilepsy type…epilepsy type…
![Page 32: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/32.jpg)
AED’s for Partial EpilepsyAED’s for Partial Epilepsy
All but Zarontin and BanzelAll but Zarontin and Banzel
![Page 33: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/33.jpg)
Best AED’s for Generalized Best AED’s for Generalized EpilepsyEpilepsy DepakoteDepakote KeppraKeppra LamictalLamictal Topamax Topamax ZonegranZonegran BanzelBanzel
![Page 34: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/34.jpg)
Future MedicationsFuture Medications
– BrivaracetamBrivaracetam
– CarisbamateCarisbamate
– EslicarbazepineEslicarbazepine
– GanaxaloneGanaxalone
– LosigamoneLosigamone
– Nitrfazepam Nitrfazepam
– PerampanelPerampanel
– PiracetamPiracetam
– ProgabideProgabide
– RemacemideRemacemide
– RetigabineRetigabine
– SeletracetamSeletracetam
– StiripentolStiripentol
![Page 35: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/35.jpg)
What Are Some What Are Some Promising New Medical Promising New Medical Treatments?Treatments? Maintenance Maintenance
TreatmentTreatment
– Ezogabine Ezogabine (Potiga)(Potiga)
– PerampanelPerampanel
– VertexVertex
Emergency Emergency TreatmentTreatment
– Intranasal Intranasal MidazolamMidazolam
![Page 36: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/36.jpg)
PotigaPotiga
Potassium Potassium Channel OpenerChannel Opener
Partial SeizuresPartial Seizures
Rare but serious Rare but serious side effectsside effects
![Page 37: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/37.jpg)
PeramapanelPeramapanel
Glutamate BlockerGlutamate Blocker
Effective in trials Effective in trials for partial seizuresfor partial seizures
Side effects: Side effects: Dizziness, Dizziness, SleepinessSleepiness
Approved in Approved in EuropeEurope
Under study in US Under study in US for Generalized for Generalized Seizure typesSeizure types
Under FDA review Under FDA review for Partial Seizuresfor Partial Seizures
![Page 38: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/38.jpg)
Vx-765 for Partial Vx-765 for Partial EpilepsyEpilepsy New approach to New approach to
Epilepsy RxEpilepsy Rx
– Anti-InflammatoryAnti-Inflammatory
– Short Duration of Short Duration of therapy (weeks therapy (weeks instead of years)instead of years)
– Oral MedicineOral Medicine
Early Clinical Trials Early Clinical Trials CompletedCompleted
– Early results Early results encouraging but encouraging but longer treatment longer treatment duration to be duration to be studiedstudied
– Headache, dizziness, Headache, dizziness, GI most common side GI most common side effectseffects
![Page 39: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/39.jpg)
Emergency TreatmentEmergency Treatment
Rectal DiastatRectal Diastat
– Clinically provenClinically proven
– Hard to giveHard to give
– Adults don’t likeAdults don’t like
– Can’t self Can’t self administeradminister
![Page 40: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/40.jpg)
Intranasal MidazolamIntranasal Midazolam
Easy to giveEasy to give
Preferred routePreferred route
Can be self-Can be self-administered or administered or given by caretakergiven by caretaker
Under studyUnder study
![Page 41: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/41.jpg)
Advances in TreatmentAdvances in Treatment
NewermedicationsNewermedications– BrivaracetamBrivaracetam
– CarisbamateCarisbamate
– ClobazamClobazam
– EslicarbazepineEslicarbazepine
– GanaxaloneGanaxalone
– LosigamoneLosigamone
– Nitrfazepam Nitrfazepam
– PerampanelPerampanel
– PiracetamPiracetam
– ProgabideProgabide
– RemacemideRemacemide
– RetigabineRetigabine
– SeletracetamSeletracetam
– StiripentolStiripentol
![Page 42: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/42.jpg)
For patients that do not For patients that do not respond to medicationrespond to medication Ketogenic dietKetogenic diet SurgeriesSurgeries
![Page 43: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/43.jpg)
Ketogenic Diet (@1920)Ketogenic Diet (@1920)
High fat, low carbohydrate/protein dietHigh fat, low carbohydrate/protein diet Requires hospitalization to start itRequires hospitalization to start it
– NPO until patient in ketosisNPO until patient in ketosis– Parent educationParent education– Meds to be taken into accountMeds to be taken into account
Recommended mainly for young children Recommended mainly for young children due to compliance and efficacy due to compliance and efficacy
![Page 44: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/44.jpg)
Epilepsy SurgeryEpilepsy Surgery
The goals are:The goals are:
– To determine where the seizures are coming To determine where the seizures are coming fromfrom
– To make sure is safeTo make sure is safe
![Page 45: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/45.jpg)
Epilepsy SurgeryEpilepsy Surgery
To determine where the seizures are To determine where the seizures are coming fromcoming fromVideo-EEG monitoringVideo-EEG monitoring
MRIMRI
MRSMRS: :
PETPET: :
SPECTSPECT::
MEG: MEG:
![Page 46: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/46.jpg)
Epilepsy SurgeryEpilepsy Surgery
To make sure that it is safeTo make sure that it is safeWada testWada test: to study speech and memory: to study speech and memory
Neuropsychological testingNeuropsychological testing: mental functions : mental functions (IQ, memory, attention) and personality (IQ, memory, attention) and personality assessment assessment
Psychological evaluationPsychological evaluation
Ophthalmologic evaluationOphthalmologic evaluation
![Page 47: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/47.jpg)
Epilepsy SurgeryEpilepsy Surgery
Some cases in which the localization is not Some cases in which the localization is not clear or where function could be affected clear or where function could be affected will require INVASIVE ELECTRODESwill require INVASIVE ELECTRODES
– Depth electrodesDepth electrodes– Subdural electrodesSubdural electrodes
![Page 48: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/48.jpg)
Types of Epilepsy SurgeryTypes of Epilepsy Surgery
Temporal LobectomyTemporal Lobectomy Extratemporal Extratemporal
ResectionsResections HemispherectomyHemispherectomy Corpus CallosotomyCorpus Callosotomy
![Page 49: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/49.jpg)
Outcome after epilepsy Outcome after epilepsy surgerysurgery Anterior temporal lobectomyAnterior temporal lobectomy
– 70-80% seizure free70-80% seizure free Neocortical resectionNeocortical resection
– With lesion: 50-80% seizure freeWith lesion: 50-80% seizure free– Without lesion: 30-50% seizure freeWithout lesion: 30-50% seizure free
HemispherectomyHemispherectomy– Significant improvementSignificant improvement
Corpus CallosotomyCorpus Callosotomy– Significant improvement for drop attacksSignificant improvement for drop attacks
![Page 50: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/50.jpg)
Complications of surgeryComplications of surgery
Low rate of Low rate of complicationscomplications– InfectionsInfections
– BleedingBleeding
– AnesthesiaAnesthesia
– Function Function
![Page 51: Advances in the Diagnosis and Treatment of Epilepsy Marcelo E. Lancman, M.D. Director, Epilepsy Program Northeast Regional Epilepsy Group.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649ccb5503460f949950db/html5/thumbnails/51.jpg)
Vagus Nerve Stimulator Vagus Nerve Stimulator (1997)(1997) Intractable epilepsy patient without focus or Intractable epilepsy patient without focus or
desires interim step before epilepsy surgerydesires interim step before epilepsy surgery Goal is to reduce amount/severity of seizures vs. Goal is to reduce amount/severity of seizures vs.
curecure Device surgically implanted in left chest/axilla Device surgically implanted in left chest/axilla
areaarea Coils around left vagus nerveCoils around left vagus nerve Stimulation is automatic; patient can additionally Stimulation is automatic; patient can additionally
stimulate device if aura stimulate device if aura