Mistakes in Epilepsy Care - Orrin Devinsky, MD

Download Mistakes in Epilepsy Care - Orrin Devinsky, MD

Post on 28-Nov-2014

4.473 views

Category:

Health & Medicine

1 download

DESCRIPTION

Mistakes in Epilepsy Care2011 faces Epilepsy Conference at NYU Langone Medical Center

TRANSCRIPT

  • 1. Mistakes in Epilepsy Care Orrin Devinsky, M.D. NYU Epilepsy Center

2. What do NBA coaches, mothers and doctors have in common?

  • The Diagnostic Bias
    • 1 stround v. 2 ndround choice
    • Diagnosis to doctor = child to mother
  • Reliance on prior diagnosis
  • Failure to consider other disorders
  • Convulsive syncope
  • Nonepileptic psychogenic seizures
  • Failure to consider diagnostic changes

3. Missing The Big Picture

  • Focus on person, not diagnosis
    • Listen, beyond the words to feelings
    • See their world: situations influence health
    • Look patient in the eyes
    • Speak with family and friends
  • Therapies are limited by medical box
    • Therapists - cognitive, psychological, etc
    • Pragmatic approaches (sometimes key!)
      • Compliance
      • Sleep hygiene
      • Memory lists

4. Missing Mood Disorders

  • All epilepsy patients at increased risk
  • Patients must tell; doctors must ask both often fail
  • Refractory epilepsy
      • Greater contributor to impaired Quality of Life than seizures
      • Depression in up to 50%
      • Suicidal ideation - 20% in past 6 mos
      • Majority are untreated

5. Not So Benign Epilepsy

  • Benign Epilepsies
    • Yes or No?
  • Absence Epilepsy
    • Childhood (5-9 yo) vs. Adolescent (10-14 yo)
  • Benign Occipital Epilepsy
  • Benign Rolandic Epilepsy

6. Absence Epilespy: A Wolf in Sheeps Clothing

    • 56 Absence Epilepsy v. 61 Juvenile Rheumatoid Arthritis patientsWirrell et al,Arch Pediatr Adolesc Med 1997;151:152-158
    • Remission
      • 57% of absence epilepsy and 28% of JRA patients.
    • Absence epilepsy - increased academic, personal, and behavioral disorders (p

Recommended

View more >