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Undeleted > Non Pharmacological Treatment Of Epilepsy > Flashcards

Non Pharmacological Treatment Of Epilepsy Flashcards

0
Q

Name four non-p treatments for epilepsy

A

Vagal nerve stimulation (VNS)
Deep brain stimulation DBS
resective surgery/ gamma knife surgery
Kerogenic diet

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1
Q

Give a simple definition for epilepsy

A

The tendency to have recurrent seizures

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2
Q

When is VNS a suitable treatment for epilepsy?

A

In those whose seizures are not fully controlled with AEDs
In those with focal or generalised onset seizures
As an adjunctive to AEDs

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3
Q

What is the aim of VNS treatment in those with refractory eplilepsy

A

Reduce the seizure frequency or intensity or negative symptoms of seizures

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4
Q

Where is the VNS stimulator implanted ? And where is it connected to ?

A

Underneath a pocket of skin Under the collarbone or close to the armpit

Connected with wires to the left Vagus nerve in the neck

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5
Q

How does the VNS work?

A

Sends regular , mild electric pulses to the nerve in order to interrupt electrical irregularities in brain to prevent seizures

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6
Q

What are the drawbacks of VNS?

A

Not beneficial to whole spectrum of patients
Not possible to know who will have reduction in seizures
Can take a months to 2 years to achieve optimum control
Mild side effects

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7
Q

Should DBS be used as mono-therapy or adjunctively to AEDs

A

Adjunctively

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8
Q

For which patients is DBS suitable ?

A

Those unable to control seizures with AEDs
Those with focal onset
May be suitable for those unsuitable for resective surgery

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9
Q

How does DBS work?

A

Implant electrodes in to specific area of brain affected

Control excess electrical activity by using regular impulses to reduce frequency and severity of seizures

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10
Q

Where is the DBS device implanted

A

Under skin below collar bone

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11
Q

What effect has clinical trials for DBS shown?

A

Some much less frequent
For others may reduce their seizure a little
For others it has no effect

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12
Q

What is the downside of DBS.?

A

Not beneficial to all patients
Not possible to know who will show benefit
Not widely available in the uk
Efficacy evidence is lacking

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13
Q

Under what restrictions should DBS be used?

A

Special arrangements for clinical governance, consent, and audit or research (nice guidelines 2012)

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14
Q

For who is epilepsy surgery suitable ?

A

Those with focal onset seizures
If several AEDs trialled and non have significant reduced seizure frequency (50%)
Post traumatic epilepsy and those with a physical cause

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15
Q

What does epilepsy surgery aim to do?

A

Stop or reduce the occurrence of seizures

16
Q

What is a warder test?

A

A neurosurgeon freezes part of the brain that is going to be removed to see if the individual can function without it

17
Q

What percentage of those who have surgery become seizure free?

A

70%

18
Q

What types of surgical procedures can be performed?

A

Resective

Disconnective

19
Q

What are the types of resective surgery

A

Lobectomies: temporal , frontal, etc
Topectomy( excision of area tailored to the seizure focus)
Hemispherectomy: removal of one half of the brain

20
Q

Are resective or dis connective procedures more likely to result in a cure?

A

Resective as it excises the seizure focus itself

21
Q

What types of dis connective procedures are available?

A

Corpus callostomy

Multiple pail transections

22
Q

What are the drawbacks of epilepsy surgery?

A

High risk of damage : ie stroke, death, paralysis, worsening of epilepsy

Ethical implications ie loss of carers

Approx 50% of patients recommended are unsuitable (fail the warder test)

23
Q

What is gamma knife surgery?

A

Radio surgical procedure
Narrow beams of radiation target precise volume of tissue in the brain
Highly focused to prevent damage to surrounding areas

24
Q

What are the benefits of gamma knife surgery

A

Precision results in minimal damage to health tissue
Lower risk of side effects compared to other radiation therapies
Often safer than traditional brain surgery

25
Q

What are the potential side effects of gamma knife

A

Common: Local scalp pain (responds to simple oral analgesia)
Potential : brain swelling, usually treatable with oral steroids
Rare: permanent cranial nerve dysfunction: double vision, numbness, hearing loss, voice loss

26
Q

What is the Kerogenic diet?

A

A special high fat, low carb diet that helps control seizures in some people with epilepsy

27
Q

In which type of epilepsy patients is the ketogenic diet often helpful?

A

Children who do not respond to AEDs (refractory)

Particularly helpful in those with Lennox gas taut syndrome

28
Q

How does the ketogenic diet work?

A

Ketones are formed when body uses fat for fuel

High level of ketones leads to improved seizure control

29
Q

What is the major drawback of ketogenic diet?

A

Very restrictive for adults and therefore is mostly used in children

30
Q

How are patients withdrawn from the ketogenic diet?

A

If well controlled for some time (>2yrs) the doctor may suggest coming off it

Withdrawn gradually

31
Q

What are the potential side effects of the ketogenic diet?

A 
Kidney stones 
High cholesterol 
Dehydration 
Constipation 
Slowed growth or weight gain
Bone fractures
32
Q

What sorts of lights may trigger photo-epileptic seizures?
Flickering fluorescent
High frequency light flashes
Contrasting patterns/colours

A

Flickering fluorescent
High frequency light flashes
Contrasting patterns/colours

33
Q

How can photosensitive epilepsy be managed?

A

Refrain from exposure to light types that can cause seizure
Cover one eye to reduce the number of brain cells being stimulated
Any blurred vision,loss of awareness or muscle twitching look away
Frequent breaks for rest and food

34
Q

What psychological factors present a risk to epilepsy patients

A 
Co morbid psychiatric illness 
Low self esteem 
Psychosocial problems 
Psychosis 
Self harm
Suicide ideation 
Sleep disturbances
35
Q

What are the cognitive and behavioal effects of epilepsy

A

Learning and education problems
Changed affect
Personality and behaviour difficulties
Psychiatric disorders

36
Q

What psychological therapies can be used in conjunction with AEDs

A

Relaxation, CBT, biofeedback (Nice 2004)

37
Q

What is the drawback of psychological therapies?

A

Not been proven to effect seizure frequency
Not an alternative to AEDs
NICE 2004

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