Expert discuss diagnosis and management of Epilepsy


Expert discuss diagnosis and
management of Epilepsy

Nothing can be taught better about epilepsy
than through Video clips-Prof. Hassan Aziz

LAHORE: One of the sessions during the 10th National Neuropsycon held here last month was devoted to diagnosis and management of epilepsy which was addressed by many speakers. Prof. Muhammad Wasay along with Prof. Riaz Bhatti chaired this session while Dr. Ali Burhan acted as moderator.

Prof. Hasan Aziz replying to questions during a session on diagnosis and
management of epilepsy during the 10th National Neuropsycon held at
Lahore recently. Sitting on the dais also shows Prof. Riaz Bhatti, 
Dr. Amerjeet Singh Bedi and Dr. Ahsan Noman.

Prof. Hasan Aziz an eminent neurophysician of the country was the first speaker who with the help of video presentation discussed the clinical presentations of epileptic disorders besides partial seizures, generalized seizures and complex partial seizures. He was of the view that nothing can be taught better about epilepsy than through video clips. When epileptic discharges arise from one part of the cortex & remain limited here without spreading to any other area, clinically it results in focal signs and symptoms, it is known as partial seizures which last for three to four minutes. When epileptic discharges arise from the midline/deeper structures, they spread to all parts of the cortex at the same time & produce synchronous, symmetrical signs symptoms which is known as generalized seizure which last less than a minute. In some, epileptic discharges arise from one part & then spread to rest of the cortex. Clinically this results in a progression of signs & symptoms from one part of the body to another; initially limited to one side & then involving the other are the secondarily generalized seizures. Decrease in treatment gap has improved during the last decade while 700% increase has been reported in the use of antiepileptics during 1999-2011, he added.
Dr. Muhammad Babar Khan talking about diagnosis of Epilepsy said that it needs multi mode approach. History and EEG is the most important factor for the diagnosis of Epilepsy which provides useful information about other CNS disease but EEG is not a definitive diagnostic test for epilepsy. Different causes of new-onset and chronic epilepsy requires different structural imaging protocols. MRI, Dr. Babar stated is a superior structural imaging modality for patients with partial seizures and all patients having epilepsy must have MRI done. He also discussed the role of video EEG and PET scanning in the diagnosis of epilepsy. Diagnosis of epilepsy is not always straight forward, he added.
Dr. Wasim Ghani talking about management of Epileptic disorders said that making the correct diagnosis is very important. Simply diagnosing epilepsy and seizures are insufficient. How to diagnose is most important than how to treat. Basic medicines are still the drug of choice because 2nd line drugs are expensive and patient can’t afford it. Talking about management of epilepsy during pregnancy he said that only one drug should be used. Katamine is safe and effective besides being easy to use.
Replying to question Prof. Hasan Aziz said that MRI is three to four time more expensive and should not be used straight away. It should be done only when you suspect surgery of any part. It is waste of money and, we should prefer CT scan which is less costly as compared to MRI. Prof. Hasan Aziz further said that Phenobarbitone is still mostly used drug in the World but our Pharma companies have no interest in promoting it. Dr. Amargeet Sing said that role of medication is very important and carbamazepine is still the drug of choice in the management of epilepsy. Prof. Wasay said that there are 20 million people suffering from epilepsy in Pakistan and majority of them have not visited doctor and have no treatment. We have to train GP’s and family physicians, he added. Prof. Riaz Bhatti said that management of epilepsy requires joint efforts of Psychiatrists and neurologists and we have to work on it. It was also pointed out that if a patient has no lesions, no seizures, EEG is normal the patient can be advised to stop medication after two years.