Epilepsy: Challenges & Therapies Orrin Devinsky, M.D. NYU Epilepsy Center.
Post on 26-Dec-2015
- Slide 1
- Epilepsy: Challenges & Therapies Orrin Devinsky, M.D. NYU Epilepsy Center
- Slide 2
- Diagnostic Challenges Define epilepsy syndrome Video-EEG monitoring Understand the cause of epilepsy High resolution MRI Genetic studies (GEFS+, Chromosomal microarrays) Define factors that provoke seizures FAILURE Identify long-term effects of epilepsy &s its treatment
- Slide 3
- Therapeutic Challenges No seizures, no side effects If patients had their choice: No doctors, No Medicines In general, would rather see doctor than take medication
- Slide 4
- Therapeutic Challenges Ongoing assessment: consequences of seizures and therapy How aggressive to pursue seizure control? Do we treat interictal EEG? ? Benign rolandic epilepsy How to assess effects of long-term therapies?
- Slide 5
- Alternative Therapies for Epilepsy Diverse group Osteopathy, chiropractic, homeopathy, herbs, EEG feedback (neurotherapy), stress reduction, magnetic stimulation, carbon dioxide therapy, fatty acids We need data!
- Slide 6
- Common Errors that Doctors Make Misdiagnosis Is it epilepsy? Which epilepsy syndrome? Not noticing change Incorrect medication choice AEDs can exacerbate seizures Failure to reassess or consider VNS or surgery
- Slide 7
- Mistakes Ive Made Mistakes Ive Made Relying on prior diagnosis Becoming invested in a course of action Not listening to the information Not challenging ones own conclusion Finding information that supports Explaining information that doesnt fit
- Slide 8
- Physician Issues in Selecting AED AED relative efficacy:toxicity Knowledge Published studies Randomized v. open-label Dose range, methodology Statistical v. clinical significance Information from colleagues Personal experience Belief, Bias, & Comfort Zone
- Slide 9
- Quality of Life: The Traditional View Medical Education - MD perspective Medical literature, clinical experience Disorders - signs & symptoms Evaluation - history, PE, Lab Therapy - studies of medical outcome
- Slide 10
- QOL: A Different View QOL - Defined by patient not MD Should patients perspective be filtered through objective medical lens? - NO QOL is about listening, changing perspective, and using the patients view as the ultimate measure of outcome
- Slide 11
- QOL: Relevance to Epilepsy? QOL issues most relevant to chronic disorders, problems beyond disease symptoms Epilepsy is the paradigm of such a disorder Seizures are infrequent,AED effects & psychosocial problems are chronic
- Slide 12
- A Case Study 29 y.o. woman monthly CPS, rare GTCs Routine 6 mo. Checkup: complains of some tiredness, blurred vision, nausea Exam - mild nystagmus, tremor Labs - slightly elevated LFTs MDs perspective - doing great Womans perspective - doing poorly; not driving, underemployed, fearful of seizures, troubled by AEs
- Slide 13
- Cognitive & Behavioral Changes in Epilepsy Cognitive & Behavioral Changes in Epilepsy Must diagnose to treat Cognitive-behavioral disorders are often overlooked - under appreciated Not spontaneously reported Not asked about by MD/RN Noted, but considered minor Noted, but considered untreatable
- Slide 14
- Seizure Burden: The Great Lie Seizure Burden: The Great Lie Are complex partial seizures bad? Memory - long-term consequences Personality changes Affective changes Psychosis Are tonic-clonic seizures bad? You bet!
- Slide 15
- PGE and Behavior: Absence Epilepsy (Wirrell et al, 1997) 56 absence epilepsy v. 61 JRA patient Pts with absence epilepsy had more academic, personal, and behavioral disorders (p
View more >
Epilepsy Across the Reproductive Years Blanca Vazquez, MD Director of Clinical Trials Director of International Program NYU Epilepsy Center NYU Medical.
ALTERNATIVE THERAPIES FOR EPILEPSY - New York, therapies for epilepsy orrin devinsky, m.d. ... • reflexology • counseling / psychotherapy • nutritional • herbal remedies ...Published in: Neurology 2013Authors: Brian D MoseleyAffiliation: University of California Los Angeles
AED Treatment and the Adverse Effects of AEDs in the I/DD Patient Michael C. Smith M.D. Michael C. Smith M.D. Rush Epilepsy Center Rush Epilepsy Center.
Ruben Kuzniecky, M.D. NYU Comprehensive Epilepsy Center New York University New York Ruben.email@example.com Neuroimaging of Epilepsy.
Epilepsy in Children and Adolescents (Wheless/Epilepsy in Children and Adolescents) || Dietary Therapies to Treat Epilepsy
epilepsy stress complementary therapies - Epilepsy if you do plan ... Starflower and Borage Oil are similar to Evening Primrose Oil, and ... epilepsy stress complementary therapies ...
Getting a Good Night’s Sleep with Epilepsy Eilis Boudreau M.D., Ph.D. Portland VA Medical Center Epilepsy Center of Excellence & Sleep Medicine Program.
Women and Epilepsy FACES 2014 Annual Epilepsy Conference April 27, 2014 Patricia Dugan, MD Assistant Professor of Neurology NYU Langone Medical Center.
Dell hildrens Comprehensive Epilepsy Center - ?· Dell hildrens Comprehensive Epilepsy Center Mark R.…
Responsive Neurostimulation (RNS) for the treatment of epilepsy Daniel Friedman, MD Assistant Professor NYU Comprehensive Epilepsy Center April 27, 2014.
Norman geschwind: Selected publications on language, behavior, and epilepsy. Orrin devinsky, Steven C. Schacter, Newton, MA, Butterworth-Heinemann, 1997 601 pp