00 : 00 / 05: 00 (Preview)

This discussion has ended. Watch the recording on Medflix app,

Epilepsy: Recent Advancements

Sep 21 | 1:30 PM

Join Dr. Atma Ram Bansal, Associate Director of Epilepsy Programme at Medanta, as he discusses about epilepsy and its management. Let's understand all the treatment options apart from regular medication therapy in treating epilepsy.

[Music] good evening everyone i am dr naveda from netflix and on behalf of team netflix i would like to welcome you all this evening uh for a very interesting talk on advances in epilepsy management by dr atmaram bansal dr bansal is the associate director at uh epilepsy program at medanta the medici he is a certified fellow in epilepsy and is also a certified electroencephalographer he has been in charge of comprehensive epilepsy care for 10 years and he has special interests in uh complicated epilepsies and eegs a very good evening and thanks dr nevadita for this introduction and this platform uh to me looks very promising from discussion point of view it doesn't involve any kind of sponsorship or it's not biased and we can have something like a very pure academic kind of discussion here so my talk for today is advances in epilepsy management i'm sure each and one of us including physicians do deal with the epilepsy quite frequently whether it is a primary care physician whether pediatrician or any any practicing physician even surgeons they do face users quite often so for this we'll start the discussion today and we'll try to keep it as informative as possible and let's start the talk now so my purpose of today's discussion is to tell you what is the new in definition of epilepsy what all advancement we have received in investigations what all advances are there in medicines and last point i'll touch about epilepsy surgery so coming to the new definition of epilepsy which was revised about uh five seven years back it says that previously we used to say any two on probox user it is epilepsy now we say that even after one seizure we can label it as epilepsy if the risk of recurrence is by very very high so how will you know after first seizure that my patient is likely to have another seizure and the risk is very high and i should label this patient as epilepsy and i should start the treatment from first either itself so there are certain risk factors we should know and the most important risk factor is history if there is a clear-cut history that this patient had stroke in the past this is patient at brain tumor in the path this patient had brain infection in surpassed or head injury in the past or this patient first time is presenting with seizure but the seizure is very very bad something like status effectiveness then we should not wait for the second seizure we can straightaway start entering there are certain risk factors uh study has been done by me till my teacher dr chatur bhujrathol who is practicing currently in badoda and he has clearly defined certain risk factors that include some etiologies which we discussed right now any patient whose iq is on the lower side that itself indicate probably brain is not normal patient having neurological type like hemiparesis or anything any weakness mri showing some abnormality which is relevant to epilepsy age of onset if it is in the pediatric case the risks are very less if it is in the onset or 20 30 40 50 years then the sciences are very high e if each is abnormal again the risk is high focal epilepsy seizure of multiple type complex liberal seizures and when we are admitting as his first seizure but it occurs in clusters multiple episodes and a person who is having seizure despite an anti-epileptic those patients are very highly likely to have seizures so there is certain new finding or new discussion about epilepsy classification seizure classification so basically in 2017 internationally against epilepsy try to classify seizures into three main domains whether it is that focal onset whether it is sunlight onset or unknown focal onset with impaired awareness with awareness so previously we use a simple partial seizure that means focal onsets users with awareness then we used to say focal seas as complex partial seizure now it becomes focal parcel focal length seizure with impaired awareness so technically speaking those terms are a bit easy to use rather than from the patient point of view if you say that focal onset and impaired awareness patient can understand while complex partial seizure patient may not be able to understand generalized onset seizure can be tony cloney can be other motors user absence users and at times you may not able to classify similarly epilepsy has also been classified by ile and there are two three important points we should know first point we already discussed about focal length epilepsy uh unknown onset generalized onset then types of epilepsy again focal generalized mix then comes epilepsy syndromes so syndrome means why this particular epilepsy is happening there are certain syndromes which are very very clear like juvenile mycolonic appellation we know that this is a typical type of hapless certain syndromes like focal cortical dysplasias or tuberous sclerosis where we know that this particular patient is likely to behave in long term like this so if you mention that tuberous sclerosis with epilepsy then each and every physician or neurologist should understand that this is why this particular discussion is going on and what is likely prognosis in this patient then comes about the ideology so in terms of ideology whether it is structural pathology whether it is genetic problem infection problem metabolic problem immune problem so this immune problem has recently been added as we know that there are certain epilepsies which are autoimmune i'm not going to touch those autoimmune epilepsies but any young female or young patient presenting it's a bit of behavior problem then suddenly start having very frequent seizures and psychotic problems those patients knew onset refractory epilepsy patient who never had epilepsy come to you with refractory status of replicas is very likely to be immune so what is new in diagnosis even now the most important factor for the diagnosis of epilepsy is history this has not changed the detail history is still important we should know what has happened during the season for that eyewitness account is very very important if the eyewitness has not come with the patient always try to call that person over phone take the details and in such scenarios mri or eegs have very very limited role so purpose of diagnosis of epilepsy is purely by history mri and easy does not serve that purpose they may just help in knowing the type of epilepsy so recently as you know that everybody is having those smartphones very easy to record users and educate the attendants that if you get an another attack please make a video and seeing that video helps us in making a diagram so next point is what are the investigations required for a patient with epilepsy so two important points are like mri brain and eeg and the latest one is genetic study there are certain genetic markers or genes responsible for epilepsy which can easily be kind of evaluated by just doing simple blood tests and this genetic field is evolving and many patients who we are not able to diagnose by mri or eeg may show some positive diagnosis by genetic study coming to the mri mri is again evolving it started with something like 0.5 tesla 0.3 tesla 0.1 tesla then became 1.5 tesla now majority of the good places have three tesla mri and there are certain research centers where seven tesla mri is there so purpose of doing an mri is not only doing mri brain but to look for epilepsy so we should always do epilepsy protocol mri which have some special sequences like inwards high resolution imaging there are certain other types of mri like functional mri which can be done for locating the speech or the motor power of the patient in the brain then there is some diffusion tensor imaging which is also evolving technique where we can check the tracks of the brain and last is this arterial spin labeling which is also becoming very effective there are certain other images like pet scan spect scan so pet and spect are basically nuclear medicine scans which we do mainly for kind of a malignancies or spectators mainly for heart so these tests are also useful to know that which part of the brain is having high metabolism which are part of the brain is having low metabolism so we can compare one half to the brain with the other half and can detect that this area is abnormal there is another technique known as mag which is mri based eeg so with this is a again a new new kind of thing where you can do eeg based upon magnetic resonance uh in india there are two centers which are doing it and it's being found to be useful for patients with epilepsy surgery where mri is not showing anything but uh coming to the point about eeg as you know um most of the us most of you might have already been doing an eeg referring the patient for eeg and seeing the report unfortunately the quality of eeg being used is not very good in many centers it is often misused so if the quality is not good then it can give a biased report or a report which may not be relevant like something like cerebral dysrhythmia so those terms are very very common mild abnormality borderline abnormality which do not lead us to anywhere and it's not necessary that if eeg report is abnormal actually it is abnormal or the there are issues at the level of machine at the level of technician or at the level of reporting person so a well-trained technician with well-trained reporting person including good quality machine is important and nowadays we do have video recordings and digital easy machines where you can send data to anyone just email it the other person can use it so now come about the video easy so i'll show you this video after some time so video easy is basically the recording the video as well as gg simultaneously you can see in this patient that video camera is showing the patient lying on the bed his head is covered with the cap which is over the electrode so eeg is going on and video is going on you can do easy for few hours for 12 to 14 hours for three to five days depending upon what you want so if my patient is having very frequent seizure every day every week i may have to continue for a longer period and i want to record the sieges unfortunately in india there are not many setups which are doing long term video easies long term video easy means when we are doing it for more than 48 hour or 72 hour so video easy unfortunately is an issue because it's not available at many centers in india we don't have many qualified technicians in india and there is an issue of cost also in government setups there is a long waiting list in corporate setup there are issues with the economical factors because doing a video easy in a given patient for 24 hour cost a good amount of money to the patient which patient do need videog that is another important point so indications are when you are not sure whether this patient is having epilepsy or this patient is having pseudo seizures so we want to record it and we want to see whether eeg will show something or not if there are seizures then whether it is focal epilepsy or generalized epilepsy if it is focal epilepsy then which part of the brain is producing that epilepsy so these are the three main indications for doing video eeg we we discuss about mac which is mri based eeg which is done in patient we are not able to diagnose the type of epilepsy but yes there are availability issues next part comes about the recent advances in the treatment so as we know that epilepsy is in evolving field there are many newer medications recently the newer medications are definitely having lesser side effect almost equals efficacy and drug interaction is very very minimal so if i show this uh slide it may not be very well visible i'll try it what i want to show is before 1940 we used to say first line drag 75 up to 75 second generation and then it became third generation so here it may be visible in a better way so certain people decide it in different way so but what i'm showing you is the latest drug which was which was launched in india include bravo rashid parampanil ashley carbajapin so these drugs are available for last more than five years and there are other drugs like lacosamide which is there for more than 10 years zoonisamide for more than 20 years ox car japan again 20 years lava transit on 20 years lamont region 25 years so these are the drugs which are easily available and we are using it quite frequently in april which drug is a broad spectrum as this drug is a narrow spectrum so that means a drug which can be used in any type of epilepsy versus a drug which can be used only in certain types of epilepsies so broad spectrum drugs include sodium welfare which is a very old drug and still a very useful drug globalism can be used in any type of epilepsy lamotrigine topiramate laboratory acetone which is being used right and left nowadays and advanced version of levator system is breviorocity then jonasamide and rufinamide among the narrow spectrum drug most of the drugs are basically sodium channel drugs like austere japan carbamide japan likosamide slicaro japin phenetine so these sodium channel drugs are mainly used for focal epilepsy so which drug should be started and when it should be started whatever drug you start always start with this single dose drug and a smaller dose until as it is an emergency and it should be discussed about paretogenicity about the contraceptive issues so those factors should be discussed when we are starting specially in female and when you are starting a drug always tell that this drug is important we need to take the drug very regularly the compliance is important and get right rate very slowly start slow and start low and go slow the which drug should be given depend upon multiple factors then the most important factor is the which type of seizure patient is having support patient designing focal epilepsy then we'll have to start some other drug patients having generalized epilepsy then we'll have to start some other problem but at the same time it also depend upon which syndrome patient is having like if it is journal my chronic epilepsy will have to start sodium product or laboratory system then comes about efficacy coast is a big factor a patient who can't afford newer drugs then carbohydrate is the cheapest drug for that patient instead of oxalation we can just give carbohydrate carbamisupin phenytoin is very cheap and phenobarbiton is very cheap pharmacokinetic point of view the drugs are important if somebody is already on multiple drug a patient of transplant appreciate of cancer those patients we need to avoid a first older drug because they have enzyme induction property and they can kind of make chemotherapy ineffective or transplant medicines ineffective so those patients should always be put on newer drug with the practically zero pharmacokinetic profile then each drug has its own side effect and that we need to know about which drug should be used in which patient last but the most important part is comorbid condition so i'll discuss briefly about this comorbidities conditions also later on so what is the best drug a drug which is effective for all caesars drug which is very effective good tolerability safe can be given in pregnancy no drug interaction water soluble single dose per day available in oral iv syrup no need of monitoring no major side effect when we stop it and should be very cheap but unfortunately there is nothing like an ideal drug available so when we start always start with the single drug that helps in avoiding the side effects if you are taking 2 3 drug and patient is user-free then easily we can try single drug so how to tolera kind of start it it also depend upon please which disease patient is having like focal epilepsy then phantom carbohydrate in generalized seizures sodium vibrate absence then ethos oxymite but also depend upon which issues patient is having suppose the patient is having obesity then we will definitely avoid sodium sorry next point is about if first drug fail or monotherapy fail what can be done always rule out non-epileptic events or the patient who is having both pseudo seizure as well as true seizure at the same time pseudoreflector eplexi can also happen patient might not be taking the drug or the drug which is given in that epilepsy may not be the best always look for compliance factors alcohol sleep issues stress issues so key point in selection of the first line drug is what's the epilepsy we are having and there are two points we should always understand first is like if it is journal microclinic epilepsy we should not give carbohydrate means we should not give harm rather than benefiting absent seizures which can again worsen by karma jumping and if we are not able to classify then you can just straight away give broad spectrum anti anticipate so there are certain ways to kind of substitute like you start with the drug b and taper drug a or start with drug b reach a good level then taper drug a so maybe the low second part may be of a better choice and this is how we transit polytherapy suppose patient is taking drug b which was not working we can stop drug b and king can give drug c so what polytherapy is we can give this drug are good to give polytherapy we should know the mechanism of action of the various drug sodium channel drugs can be combined with gaba sodium channel also can be combined with broad spectrum drug but we should not combine two sodium or two gaba drugs uh so each of the anti-epileptic drug has its own mechanism of action and i'll go back just to tell you about these uh things so one i was telling that when we are giving monotherapy and we want to substitute because the drug is not working so one way is to start with drug b give half dose and then start kind of reducing the drug a at the same time other is you reach full dose of drug b and then only start tapering the drug a similarly when we are switching to polytherapy suppose we know that drug b was not working then you can stop rugby and start drug c so this was about the various combinations that two different mechanism actions should be combined rather than the same drug two drug of same mechanism action then comorbidity which i was discussing that somebody is having migraine that sodium while protopyramide may be a good choice because they also help in migraine if somebody is having anxiety depression and carbohydrate sodium oxaloace these are good mood stabilizers and we should avoid the better setting topiramate innovation even jonissamide this can cause a bit of depression if somebody is not able to sleep properly you can add kalobaja patient is having some cognitive impairment then we should avoid topiramate and phenobarbital if somebody is obese then we can give drug which has side effect of weight loss which include propylamide and jonathamite but we should not give sodium well through it if there are some attention issues again the drug which irritates brain should be avoided if there is an arrhythmia significant arrhythmia then phaneta and lycosamide may be avoided now come uh to the chart which was uh given in landsat if it is focal onset seizure first line drug is carbohydrate we can give oxaloapin lamotrigine penetrane to pyramid if it is analyzed seizure or unclassified seizure then for women we should not give sodium vapor any child wearing age group female please don't start your sodium well through it until unless we don't have option either you can give laboratory acetone or you can give lamotrigine these are good drugs if we are not able to control then yes you may have to give ultra but that should always be given in a very very very low dose if it is not a female of child bearing age group then sodium alcohol is that regard choice so this is the chart where if the drug fails then what should be done uh you may not be able to see it so clearly but what here it is mentioned is that if the patient compliance is very good always look what type of epilepsy patient is having or is the patient having non-epileptic event the compliance is good drug is not working then patient should be considered for epilepsy surgery so this is what we will talk about drug resistant epilepsy so there are about 10 percent of the patient to 20 30 percent of the patient where the patient will not respond whatever drug you give those patient comes under the category of drug resistant epilepsy so in that drug resistant epilepsy the definition wise if we have failed two drugs previously there was a rule of two that if there are more than two seizures per month for more than two years but now it is any epilepsy which is not controlled by two drugs despite the frequency despite that duration of epilepsy can be taken at drug register and why it is important to know that drug resistant epilepsy because that creates diagnostic issues we need to have medical optimization there are certain other options like ketogenic diet which is available what is ketogenic diet it's a special type of diet which is rich in fat with practically zero carbs and it's useful in pediatric population with refractory epilepsy now comes to the last part of my talk which is about the epilepsy surgery so it's uh not a new concept as such but for the physicians who are not very well worse with this concept it may be a new thing so in india it's available only in very limited limited centers i was fortunate to get trained in sri chitra in trivandrum which is the kind of best center for epilepsy surgery in this part of the world and most of the centers for epilepsy surgery are actually based in southern india in northern india we hardly have any so for epilepsy surgery we need to know the clinical details of the patient mri of the patient video age of the patient psychological assessment then other imagings and finally we need something like the invasive monitor so each patient with refractory epilepsy then is cons discussed in a meeting sorry that include neurologist epilepsy expert radiology surgeon psychology strike at least social worker i'll just show you one case a 22 year old boy who had seizures for last 10 years he was having weight type of seizure not able to concentrate stuck on road will stop for a few seconds will recover but not able to tell what happens so if he is crossing the road he will not be able to save himself so he was given a lot of anti anti-epileptic drugs antidepressants but still used to have one to two episodes per week and that the reason the family did not allow him to go out of house school was not allowed unfortunately at that time this online classes were not there so he was otherwise a very intelligent guy so nivedita can you just run this video so you can see this patient video the patient is lying on the bed and he had some aura so himself removed the blanket he knew that something is going to happen you can see his right hand is a bit postured a unique type of posture is there for the right hand this is known as dystonic posturing or abnormal posturing during seizure you can see his lip smacking if you see carefully he is moving his lips and some kind of chewing movements are there [Music] so this is what we say that so you can see that right hand is going posturing in a different position left hand he is just touching his trouser his uh smacking his lips making is there some kind of movement in the lips as if something is following the family is there with the patient and they are trying to talk to him he is not responding and again you can see that he is confused not talking to anyone right hand is going some in abnormal posture so the family is there is which is not visible in the video they are talking to him he is not responding so it's not hypocalcemia this is dystonic posturing happening spontaneously not related to breathing not related to low calcium but yes hypocalcemia can also produce this kind of posturing and the family you see that they are trying to talk to him he is not responding and it continues for about two minutes these kind of seizures may not look very aggressive seizures or big seizures but if he is at in the on the road he will not be able to save himself because he is not aware what is happening in his surrounding and these kind of seizure used to happen to him twice to thrice a week despite trying five to six anti-epileptic drugs so dystonia will will it's a different topic we'll discuss about dystonia these are the minor scissors which can easily be missed but the family does not miss because they know it's happening so frequently so that's what any patient who says my kid is having something abnormal he is not responding in between is like a statue for few minutes always tell them to make a video this kind of posturing deep kind of lip smacking is important so this video we have seen and now i'll show you this patient's mri you can see the yellow arrow the left side of the hippocampus was atrophied compared to right side this condition is known as medial temporal sclerosis so this type of epilepsy of temporal lobe epilepsy with the mts is a different syndrome and those patients chances of responding to medication is less than 10 percent and those patient will not respond to medication but will respond very well to surgery if you see the pet scan you can see that left side is not normal compared to right side so this is video easy so that is the advantage of video easy whether it is a seizure or not a seizure you can identify if the eeg is going on in this patient the red lines which are visible show clearly a seizure which is from the left temporal video so temporal lobe epilepsy or these minor seizures there are four component aura the patient will have some feeling that attack is going to come that include bit of epigastric sensation something coming in the tummy some fear then arrest patient will be like a statue automatism means patient will do flowing movement or hand movement hand rubbing movement rubbing the claws these kind of movement so this is automatic then amnesia means patient will not be remembering what has happened and last day is absence of gdcs those patients may not have gtcs so this is very very important so this patient was operated you can see in the mri this part was removed and this patient is doing very well there are no seizures he's not on any medicine now he has stopped medication started driving going to college enjoying his life so this is the beauty of epilepsy surgery there are certain advantage recent advances in surgery as well something like minimal relative surgery there was some point about vns wagon of stimulation is the kind of surgery where you put a machine or kind of a pacemaker over the vegas now it's effective in about 50 percent of the patient with 50 percent outcome we are doing it and many centers in the world are doing it it's a very safe surgery but not 100 effective other options are there like gamma knife and laser at my center we have done more than 100 surgeries we do full international standard with very good outcome and many of those patients had now free of medicine and this definitely lead to dramatic change in quality of life like in this patient vision so in conclusion for today there is definitely an advancement in technology management is better smartphones are helping in diagnosis newer anti-epileptic trucks are safe and effective we do have video easy pads packed spatial mri and surgery is successful thank you thank you so much uh for a wonderful uh presentation for the session uh we can start with the questions i'll just stop presenting uh so we have a question is gabapentin safe for patients on chemotherapy yeah gabapentine is not having much of drug interaction but gabapentine per se is hardly used in patient with epilepsy so we do have better choices than kava painting for epilepsy okay so and i'll just go through the comments for the questions uh so is there any other way or to uh diagnose a seizure unless like i mean other than the very obvious signs like unconsciousness frothing of mouth eyes rolling up so other than that can present yeah yeah i got your point so seizure can be of different different manifestations in a given patient so calmness one is gtc which everyone know but the seizure which i showed you or patient getting bit of myoclonic drugs or facial teaching so these can also be the symptom of epilepsy are there any safe anti-epileptics for elderly population okay so for elderly population the safer drugs are definitely available the drugs which have very minimal drug interaction that include levator acetaminophen lemon region glucosamide even sodium alpha in low dose can be given okay is there any safe anti-epileptic drug for pregnant women like so that's a very very important question so my suggestion to you is that first any patient who is getting married any pregnant like likely to be pregnant uh female we should avoid sodium microbiota that is first point if c is married and even if they are not saying anything a c zone sodium will provide better to change it before pregnancy the drug of choice will be levator time or lamborghini if somebody is on carbohydrate uh so we have a question here patients with controlled seizures but frequent aura what can be done for them see if the auras are not disabling then you don't need to do anything if the aura is disabling then yes we will have to start some medication or do the work of why this patient is not responding whether the patient is having something in the mri or whether those auras are really something or not by doing video aed should be given to febrile seizures so febrile caesar is actually done by pediatric neurologists but still a typical febrile caesar we you can give globalization for sos purpose during fever and is it possible that seizures can only last like for a few seconds so like uh you may miss it sometimes yes absent scissors can be easily missed they may last for 10 to 12 seconds the only complaint by the teacher is that kid is sitting in the room in the class but not responding quite often is there any current treatment regimen for a migraine that's a different topic but yes there are drugs like sodium vaporite propanol uh flunara gene hemitriptaline there is a new injection suviray which is okay and uh which is like the best combination of aed that can be used like commonly so for a focal epilepsy carbohydrate or oxalation with global jam is very good drug for generalized epilepsy sodium bulk rate well fruit with lemon region is very good even this phenome orbital and phenytoin combination in patients who are not able to afford is a good combination one question i could read was is there any need for monitoring electrolyte with epilepsy yes in patients who are taking carbohydrate or specially ox carbohydrate in elderly population sodium can be very low so avoids oxycodone in elderly and if somebody's on carbon is up in elderly you can monitor sodium so for myoclonic jerk or myoclonic application the drug growth choice is sodium right if the sodium vaporite is not working we can add lava transit so these are two drugs for my chronic effects uh what drugs to be avoided in case of uncontrolled uh hypoglycemic state so for hypoglycemia we don't need anti-epileptic drug and none of the drug is required from epilepsy none of the drug has a side effect of hypoglycemia so as such nothing particular but you can give you easily levitate them if it is required okay sir [Music] and what would be the criteria to stop uh aeds that's a very important question because when should we stop it's easy to start so uh a thing is worldwide there is no defined guidelines some people say two years from three years some five years so what we do is each and every patient minimum three to five years and see whether the patient is having high risk of recurrence or not if the patient is having high risk of recurrence better not to stop at three year better to continue for five years in pediatric population you can take a bit of liberty and after one to two years you can try treating the drugs in elderly population better not to stop with patient whom the risk is very high better not to stop how to manage epilepsy in pregnancy and avoid the teratogenic effects of the drugs so any patient who is taking anti-appellate should be given folic acid from the very beginning even before marriage you can start it and keep the dose as low as possible at 18 week always do level 2 ultrasound or level 3 ultrasound and you can do serum quadruple test for the retrogenicity testing and if the quadruple test is normal ultrasound is normal can continue pregnancy we have seen that many gynecologists of technicians physicians discouraging pregnancy and epilepsy the fact is more than 95 percent of the female can have normal pregnancy so it should not be discouraged but it should be planned properly good evening sir yes sir uh actually i'm studying uh neuro clinical neurophysiology in savida medical college uh house my first question is how's your experience in pediatric neurology [Music] is okay so uh is there any uh eg course the free egos in india sir so we are running an eeg course but unfortunately it's not free it is done through nissan national laboratory surgery support association and network group you can put an email to me next time when we are starting it i'll let you okay so thank you so much somebody is asking about clona g palm in epilepsy so colonoscopy is hardly of any use in epilepsy because we have a better drug which is clobazon the colonoscopy we rarely use only in patients who have a bit of refractory myoclonic jobs with anxiety in patient like a particular condition on the juon syndrome otherwise cloning palm is really not required except you want to give it for steep pointer yes doctor nika pavar you can go ahead my question is that i am a physiotherapist and mostly i deal with special kids and most of the cp and mr child are a case of epilepsy my sir problem is that during my evening practice most of the kids are most of the time drowsy and the complaint of the parents is that they feel so drowsy that they don't respond to the physiotherapy so how to go about with the dose and about my physiotherapy session i agree that this is a tough scenario to handle what you can do on that particular day when they are on for your session they can take the drug in the slightly one to two hour before the schedule time so what would be the diazepam usage in status epileptics so daisy pum is still very useful because you can store it at room temperature and can give ivim so it's still useful but the better drugs are like medazarama and lorazepam because they have less sedative effect and they are faster acting so digest suppositories are there digest injection is available so you can give if you don't have any other option it's a good drug all right so and is there like a drug of choice for seizures in children uh yes you can say partly because if it is something like uh focal epilepsy where some part of the brain is abnormal the drug of trash will be same like carbohydrate or carbohydrate but if it is absence epilepsy then we'll have to give sodium vibrate or now it is a human ethos optimized was available in between if you are not able to classify you can give sodium vapority and what how would we uh manage seizures in organophosphate poisoning that's a tricky scenario we can give lava transit and that's all it levator stem has practically no interaction with any of the thing it's safe to give kidney renal hepatic cardiac any patient okay so uh there was a question there was another question what drug can be given in renal failure yeah so for renal failure patient again you can give laboratories time you can give braver acid time you can give phenytoin you can give sodium alcohol these are safe drugs without any even phenobarbiton can be given you should avoid lava pantene and other drugs okay so i think that would be the end of uh the comments for now uh questions but thank you for an amazing talk on epilepsy and the recent advance in the management of epilepsy and i'd like to thank our audience to stay back and ask so many questions to sir uh thank you so much and we hope to see you again so yeah sure i'm ready whenever you need thank you sir so it's a very good platform actually i think it should work well

BEING ATTENDED BY

Dr. Darius Justus & 1677 others

SPEAKERS

dr. Atma Ram Bansal

Dr. Atma Ram Bansal

Neurologist & Epileptologist | Associate Director - Epilepsy Programme | Institute of Neurosciences, Medanta - The Medicity

+ Details
dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

+ Details
dr. Atma Ram Bansal

Dr. Atma Ram Bansal

Neurologist & Epileptologist | Associate Dire...

+ Details
dr. Rohan Desai

Dr. Rohan Desai

MBBS | MBA, IIM-A | Founder & CEO, PlexusMD

+ Details

About Medflix

Medflix is a new platform by PlexusMD, India's most active and trusted doctor community. On Medflix, you can discover live surgeries, discussions, conferences and courses from some of the top doctors and institutions across the world. Join clubs in your areas of interest and access hundreds of amazing live discussions everyday.