Summary
Clinicians who diagnose and manage epilepsy frequently encounter diagnoses of a nonneurological nature, particularly when assessing patients with transient loss of consciousness (T‐LOC). Among these, and perhaps the most important, is cardiac syncope. As a group, patients with cardiac syncope have the highest likelihood of subsequent sudden death, and yet, unlike sudden unexpected death in epilepsy (SUDEP) for example, it is the norm for these tragic occurrences to be both easily predictable and preventable. In the 12 months following initial presentation with cardiac syncope, sudden death has been found to be 6 times more common than in those with noncardiac syncope (N Engl J Med 309, 1983, 197). In short, for every patient seen with T‐LOC, two fundamental aims of the consultation are to assess the likelihood of cardiac syncope as the cause, and to estimate the risk of future sudden death for the individual. This article aims to outline for the noncardiologist how to recognize cardiac syncope, how to tell it apart from more benign cardiovascular forms of syncope as well as from seizures and epilepsy, and what can be done to predict and prevent sudden death in these patients. This is achieved through the assessment triad of a clinical history and examination, risk stratification, and 12‐lead electrocardiography (ECG).
-Epilepsy is the most common serious chronic neurological disorder affecting between 0.5% and 1% of Western populations. 1 Most patients take anti-epileptic drugs (AEDs) for years if not decades, and are commonly admitted to hospital with seizures. Many have symptomatic epilepsy, arising as a consequence of another disorder, for example a brain tumour. General practitioners, emergency physicians and most hospital teams (especially general medicine) commonly encounter difficulties surrounding AEDs yet often require assistance from neurology services. This can be difficult when neurology services are not on-site or easily available. This article gives a practical overview of difficulties relating to AEDs and their management, with the focus on problems commonly encountered by non-neurologists. These include the patient who is acutely unwell, pregnant or elderly; AED side effects and drug interactions; status epilepticus and AED blood levels.
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