Common Pitfalls in Epilepsy Case Based Learning 1st Edition by Dieter Schmidt, William O Tatum, Steven Schachter ISBN 9780521279710 0521279712

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ISBN 10: 0521279712
ISBN 13: 9780521279710
Author: Dieter Schmidt, William O Tatum, Steven Schachter

Common Pitfalls in Epilepsy Case Based Learning 1st Edition Table of contents:

1 Mistaking Nonepileptic Events for Epilepsy

What are the Pitfalls Involved in This Case for the Clinician?

Differential Diagnosis

Psychogenic Nonepileptic Attacks

Historical Features

Clinical Features of PNEAs

Bizarre Seizures

EEG

Video-EEG Monitoring

Rule of Two: 2 Normal EEGs + 2 Seizures/Week + 2 AED Failures = 85% Positive Predictive Value for PN

Treatment

References

2 Mistaking EEG Changes for Epilepsy

Misinterpreted Spells

Does She Have Epilepsy?

Misinterpreted EEG

Does She Have Epilepsy?

What about Her Abnormal EEG?

Diagnosis: Neurocardiogenic Syncope

Specific EEG Changes Mistaken for Epilepsy

Variations of Normal Waveforms

Benign Variants of Uncertain Significance

Artifact

Traps and Pitfalls in Epilepsy

Why the Clinical-EEG Disconnect?

References

3 Radiographic Errors in Epilepsy

MRI

Recommendation

References

4 The First Seizure: Is It Epilepsy?

Seizure Misdiagnosis

What are the Pitfalls Involved in this Case?

Final Diagnosis: Convulsive Syncope

Accurate Seizure Diagnosis

Types of First Seizures

Question: Does He Have Epilepsy?

Classifying First Seizures

Diagnosis: Focal Epilepsy

Evaluating a First Seizure

Neuroimaging

EEG

Treatment of a First Unprovoked Seizure

References

5 Errors in the Diagnosis of Seizure Types and Epilepsy Syndromes

Diagnostic Assessment of the First Seizure

Classification of Epileptic Seizures

The 2010 Classification of Epileptic Seizures

The 2017 ILAE Classification of Epileptic Seizures

Pitfalls in the Diagnostic Assessment of Unequivocally Epileptic Seizures

Pitfall: Underestimating the Difficulty to Accurately Count Seizures in Clinical Practice

Pitfall: Estimating the Duration of Seizures

Pitfall: Mistaking an Absence or a Myoclonic Seizure for a Focal Seizure

Pitfall: Ictal (Seizure) or Postictal Symptoms?

Pitfall: Elementary Ictal Hallucinatory States: Ictal or Postictal or Both?

Pitfall: Prolonged “Postictal” Confusion

Pitfall: Recognize “Postictal” Psychosis

Pitfall: Ictal versus Postictal Behavior in Childhood Epileptic Encephalopathies and Other Encephalo

Pitfall: Coma with or without NCSE. Ictal or Postictal?

Take Home Message

Pitfalls: Misdiagnosis of Nonepileptic Seizures as Epilepsy

Mistaking Psychogenic Seizures for Epilepsy

Psychogenic Nonepileptic Seizures

Pitfall: How to Avoid Missing Red Flags for PNES

Pitfall: How to Confirm the Diagnosis of PNES

Management of PNES

Take Home Message

Mistaking Psychiatric Disorders (Other Than PNES) for Epilepsy

Mistaking Non-psychogenic Attacks for Epilepsy

Syncope Mistaken for Epilepsy

Pitfalls in the Diagnosis of Syncope

Non-Psychogenic Attacks Other than Syncope Mistaken for Epilepsy

Take Home Message

Misdiagnosis of Epilepsy in Children

Pitfalls: Misdiagnosis of Epilepsy in the Elderly

How to Prevent Misdiagnosis of Nonepileptic Events as Epilepsy: No Fast and Hard Rules

Classification of Epilepsies

The ILAE Classification Update of 2010

Pragmatic Classification to Avoid Major Pitfalls

Clinically Relevant Pitfalls in the Diagnosis of Epilepsies

Pitfall: Missing the Diagnosis of Autoimmune Epilepsy

References

6 When to Start Treatment?

What a Physician Should Know before Deciding to Start Treatment

Scenario 1: The Decision Not to Start AEDs

Pitfall: Failure to Mention the Limitations of Current Treatment

Pitfall: Failure to Recognize that Not All Patients Need AEDs

Scenario 2: The Decision to Start AEDs in Patients Presenting with a Single Seizure

Are You Aware How Often Seizures Recur after a Single Seizure?

Is Failure to Start Early Treatment Associated with Poorer Long-Term Epilepsy Outcome?

Recommendation

Scenario 3: The Decision to Start AEDs in Patients Presenting after Two or More Seizures

Recommendation When to Start Treatment

References

7 Which Drug is Best?

Integrative Choice of Antiepileptic Drug

The Pitfalls in Finding the Best AED

The Most Common Sources of Pitfalls

Pitfall 2: Are Modern Drugs Generally Preferable over Older Drugs?

What is the Evidence Base for Preferring New over Older Drugs for New-Onset Focal Epilepsy?

Should Old or New Drugs Be Preferred for New-Onset Idiopathic Generalized Epilepsy?

Are Old or New AEDs Preferred for New-Onset West Syndrome?

The Choice of AEDs When Prior Drugs have Failed

Pitfall 1: Failure to Recognize the Risk-Benefit Profile of the Drug for Refractory Epilepsy

Pitfall 2: No Adequate Guidance of Head-to-Head Comparison from Controlled Trials

Pitfall 3: Avoid Less-Often-Used Drugs Unless You are Seeing Many Patients with Uncontrolled Seizure

Pitfall 4: Delayed Referral to a Comprehensive Epilepsy Center if Two Appropriately Selected and Dos

Pitfall 5: Refractory Generalized Epilepsy does Exist!

Pitfall 6: Failure to be Aware of the Best Drug for Lennox–Gastaut and Related Syndromes

Pitfalls in the Choice of Drugs for Children

Pitfall: Is Gene Testing Ready for Prime Time in the Choice of Drugs?

Pitfall: Relying on the Molecular Action of AEDs as a Guide for the Choice of Drugs

Pitfall: Failure to Adapt the Drug Choice to the Individual Patient Profile

Pitfall: Is the Pharmacokinetic Profile Ready for Prime Time in the Choice of an AED?

Take Home Messages

Pitfall: Base Your Choice on the Belief that New AEDs are Better Tolerated or Safer than Older Drugs

Pitfall: Are You Aware of the Limitations of Current Treatment?

Pitfalls in the Development of New AEDs

Summary of Pitfalls in the Choice of Drugs

References

8 How to Optimize Treatment and What can Go Wrong?

Finding the Optimal Dose of AEDs for New-Onset Epilepsy

Pitfall: What to Do If the Lowest Dose Does not Achieve Seizure-Freedom

Pitfall: What to Do If Seizures Persist despite Average Doses of AEDs?

Pitfall: What to Do in a Patient Who is not Seizure-Free and Reports Intolerable Side Effects

Pitfall: How to Avoid Overtreatment

Pitfall: Undertreatment

Pitfall: Is Add-On Therapy Advisable after Failure to Control Seizures with the First AED?

Pitfall: Do I Need to Monitor Treatment with AEDs?

Take Home Messages

Pitfall: Failure to Inform the Referring Physician about Diagnostic or Therapeutic Changes

Pitfall: Failure to Address Special Patient Needs

Pitfalls in the Management of Epilepsy in the Elderly

Pitfall: Diagnostic Errors in Geriatric Epilepsy

Pitfall: Management of Epilepsy in the Elderly

Pitfall: Failure to Recognize Treatment Options for Epilepsy in the Elderly

Pitfall: Failure to Address Issues in Treatment for Epilepsy in Adolescents

Pitfall: Failure to Address Issues in Treatment for Male Epilepsy Patients

Pitfall: Failure to Recognize the Usefulness of Complementary Medicine

References

9 What to Do If Drugs Don’t Work?

Pitfalls: Drug-Resistant Epilepsy: Elusive Definitions and Unclear Mechanisms

Elusive Mechanism(s) of Drug-Resistant Epilepsy

How Many Newly Diagnosed Patients have Drug-Resistant Epilepsy?

Pitfall: Are You Aware of the Most Common Reasons for Drug-Resistance?

Pitfalls in Assessing Drug Response

Pitfall: Recognize Seizure Aggravation as Cause for Drug Failure

Recommendation

Pitfall: Recognize Non-Pharmacological Seizure Precipitation as Cause for Why Drugs Fail

Pitfall: Failure to Recognize the Clinical Importance of Epilepsy Surgery

Resective Surgery

The Evidence

Pitfall: Failure to Recognize the Clinical Potential of Epilepsy Surgery for the Elderly

Recommendation

Pitfall: Failure to Recognize the Clinical Importance of Neurostimulation

Pitfall: Failure to Recognize the Clinical Importance of the Ketogenic Diet

Pitfalls in the Management of Ketogenic Diets for Epilepsy

Pitfall: Know Who Will Likely Benefit from the KD and Who Will Not

Pitfall: Be Aware of Acute Issues during Initiation of the Ketogenic Diet

Pitfall: Be Aware of Chronic Issues with the Ketogenic Diet

References

10 How to Avoid Management Errors

Inadequate Patient Communication

Common Treatment Errors

How to Avoid Medical-Legal Issues

Reference

11 When to Stop Treatment?

Pitfall: The Patient Wants to Continue Treatment Despite the Physician’s Urge to Stop AEDs

Pitfall: Under-Communicating the Risks of Stopping AEDs

Pitfall: Failure to Appreciate that the Individual Outcome of Stopping AEDs cannot be Predicted with

Pitfall: Failure to Relate the Seizure-Free Period Prior to Stopping with the Seizure Frequency of t

Pitfall: Overstating the Benefits of Remaining on AEDs

Pitfall: Overstating the Benefits of Stopping AEDs

Pitfall: Rapid versus Slow Withdrawal of AEDs of Patients in Seizure Remission

Pitfall: Early versus Late Antiepileptic Drug Withdrawal for Epilepsy in Remission

Pitfall: Stopping AEDs is not Necessarily the End of Treatment

Pitfall: Should Physicians Encourage Seizure-Free Patients to Discontinue AEDs?

Individualize AED Withdrawal in Remission

Pitfall: Failure to Appreciate the Risk of Poor Seizure Control after Relapse

Pitfall: Underestimate the Risk of Relapse after AED Discontinuation in Patients Seizure-Free after

Background: Why is Stopping AEDs after Entering Remission Fraught with So Many Pitfalls?

Common Scenarios of Stopping AEDs and Their Pitfalls

Pitfall: Stopping One of Two AEDs in Uncontrolled Epilepsy

Pitfall: Stopping AEDs Completely in Uncontrolled Epilepsy

Pitfalls: Stopping AEDs after Misdiagnosis of Epilepsy

References

12 Women with Epilepsy

AEDs and Fertility

Hormonal Influence on Epilepsy

Pitfall: Assuming WWE are 100% Reliable at Planning Pregnancy

Post-Partum Care

References

13 Management of Psychiatric Issues in Epilepsy

Failure to Diagnose

Failure to Treat Depression and Anxiety

Further Reading

14 Management of Emergencies in Epilepsy

Single Seizure

Pitfalls in the Management of a Single Seizure

Medial or Lateral Tongue Bite?

Lower Back Pain Following a Seizure: Vertebral Fracture?

Status Epilepticus

The Evidence

Pitfalls in the Definition

European Federation of Neurological Societies Guideline on the Management of Status Epilepticus

Treatment of Status Epilepticus in Adults: Guidelines of the Italian League against Epilepsy

Treatment of GCSE in Childhood

Observational Evidence for the Use of Drugs not Evaluated in the VA Study

Refractory Generalized Convulsive Status Epilepticus: A Guide to Treatment from Finland

Treatment of Refractory Status Epilepticus in Adults: Guidelines of the Italian League against Epile

Pitfalls in the Management of Status Epilepticus (Box 14.7)

Where Current Status Epilepticus Treatment Fails: Timing is Everything

References

15 Management of Social Issues

Failure to Discuss Driving

Clinical Scenario: Inappropriate Driving

Not Paying Attention to Quality of Life

Clinical Scenario: Impaired Quality of Life due to Poor Knowledge about Epilepsy

Overlooking the Importance of Employment to Patients

Clinical Scenario: Inappropriate Loss of Employment Resulting in Emotional Distress

Further Reading

Index

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Tags: Dieter Schmidt, William O Tatum, Steven Schachter, Common Pitfalls, Epilepsy