A review of epilepsy in the elderly, the etiopathogenesis, clinical challenges, diagnosis, use of antiseizure drugs and outcomes. Also the various special considerations in managing elderly patients with epilepsy.
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
This is a brief review of autoimmune epilepsies, especially autoimmune encephalitis, SREAT, NORSE, FIRES and Rasmussen's encephalitis. A brief overview of investigations and treatment is included.
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
This is a brief review of autoimmune epilepsies, especially autoimmune encephalitis, SREAT, NORSE, FIRES and Rasmussen's encephalitis. A brief overview of investigations and treatment is included.
Vagal Nerve stimulation
Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy and treatment-resistant depression. Frequent side effects include coughing and shortness of breath. Serious side effects may include trouble talking and cardiac arrest.
This lecture is all about the recognition of an abnormal EEG, its characteristics, its appearance and all about how to differentiate the abnormal activity with normal EEG background.
This presentation looks at EEG signal generation, pyramidal cells, recording of EEG, source localisation, polarity, analysis of dipole, derivations, montages,
Vagal Nerve stimulation
Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy and treatment-resistant depression. Frequent side effects include coughing and shortness of breath. Serious side effects may include trouble talking and cardiac arrest.
This lecture is all about the recognition of an abnormal EEG, its characteristics, its appearance and all about how to differentiate the abnormal activity with normal EEG background.
This presentation looks at EEG signal generation, pyramidal cells, recording of EEG, source localisation, polarity, analysis of dipole, derivations, montages,
Epilepsy Management: Key issues and challengesPramod Krishnan
This brief presentation summarises the key issues and challenges in Epilepsy management, including diagnosis, treatment, compliance, special populations, adverse effects, psychiatric comorbidities and ASM withdrawal.
This presentation focusses on the importance of diagnostic biomarkers for Alzheimer's disease. MRI, amyloid PET and CSF biomarkers are discussed in detail.
This presentation looks at the benign or non-epileptiform variants in EEG, their characteristics and identification. Examples of the common benign variants are provided in the presentation.
This presentation reviews the common artifacts in EEG, their identification and rectification. Examples of various artifacts are provided in the presentation.
This presentation looks at the role of Pregabalin in refractory trigeminal neuralgia and chemotherapy induced peripheral neuropathy through illustrative case studies.
This review focusses on the role of role of gut microbiota in health and disease, specifically multiple sclerosis. It looks at the interaction of gut microbiota, enteric nervous system, central nervous system, neuroendocrine system in the pathogenesis of multiple sclerosis
This presentation summarises the importance of genetics in epilepsy, whom to test, and the various tests available. It looks at the role of genetics in various forms of epilepsy and recent advances in precision medicine.
EEG in convulsive and non convulsive seizures in the intensive care unitPramod Krishnan
Case based discussion regarding the utility of EEG in the management of convulsive and non convulsive seizures, including status epilepticus in the intensive care unit
A review of the common antiseizure drugs with broad spectrum action. We look at the major evidence in favour of valproate, topiramate, perampanel and brivaracetam.
Treatment of epilepsy polytherapy vs monotherapyPramod Krishnan
This presentation reviews the evidence regarding use of early polytherapy in patients with epilepsy with regards to seizure control and adverse effects. The advantages and disadvantages of polytherapy compared to monotherapy is addressed.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
Epilepsy in the Elderly.pptx
1. Epilepsy in the Elderly
Dr Pramod Krishnan
Consultant Neurologist and Epileptologist
Manipal Institute of Neurological Disorders
Manipal Hospital, Bangalore
2. Introduction
• Seizures and epilepsy are 3rd most common neurological disorder
affecting older adults, after stroke and dementia.
EPILEPSY IS NOT A DISEASE LIMITED TO YOUNG PEOPLE
3. Bacellar A et al. Open Neurology J 2018: 12; 1-11.
Elderly patients admitted with neurological disorders
4. Challenging aspects in the Elderly
• Age related physiological changes.
• Altered pharmacokinetics.
• Altered pharmacodynamics.
• Comorbidities and comedications.
• Safety issues, falls, cognitive aspects.
• Bone health.
• Seizures may be symptomatic of other systemic illness.
5. Epilepsy in the elderly population requires coordination with
primary care physicians as well as specialty care physicians.
6. The incidence of new-
onset epileptic seizures
as a function of age
Olafsson E, et al. Lancet Neurol 2005; 4: 627–34
7. Incidence
• Incidence of seizures (symptomatic, unprovoked) and epilepsy are
highest in people >65 years of age.
• Incidence is highest in those >75 years of age (5 times that of
young adults).
• Overall incidence in elderly is 2.4/1000 per year.
• Approximately 24% of new-onset epilepsy occurs after age 60.
Faught E, et al. Neurology. 2012;78:448-453.
8. Incidence of epilepsy
(per 100,000/years) in
various countries,
overall and in selected
age groups in the
elderly.
Giussani G, et al. Neuroepidemiology 2018;51:216–223
9. Prevalence
• Prevalence of unprovoked seizures is 1% in those >60 years of age.
• In those > 75 years of age it is 1.2-1.5% (twice that of young
people).
• In a study of 1 million US citizens aged >65 years, 1.8% had
epilepsy.
• Overall prevalence of epilepsy in the elderly is 10.8/ 1000.
Sander JW, et al. Lancet. 1990;336:1267-1271.
10. Prevalence of
epilepsy (per 1,000)
in various countries,
overall and in
selected age groups
in the elderly.
Giussani G, et al. Neuroepidemiology 2018;51:216–223
13. Etiology of Epilepsy is different
in elderly compared to young
patients, with a predominance
of acquired causes.
Fujimoto A, et al. Neuropsychiatric Disease and Treatment 2018:14 2879–2887
14. Etiological prevalence of epilepsy in hospitalised
patients aged 60 years or more in a tertiary care
centre in Brazil.
Nascimento M, et al. Arq Neuropsiquiatr 2015;73(2):83-89
15. Etiological prevalence of epilepsy in the subgroup
of hospitalised patients aged at least 75 years old
(median age) in a tertiary care centre in Brazil.
Nascimento M, et al. Arq Neuropsiquiatr 2015;73(2):83-89
16. Cerebrovascular disease
• It is the leading identified
cause of new-onset epilepsy in
the elderly.
• It accounts for up to half of
new cases of epilepsy.
• Patients have a 11.5%
probability of seizures within 5
years of stroke onset.
17. Bi-directional interface between cerebrovascular disease (CVD) and epilepsy
Gibson LM, et al. Journal of Cerebral Blood Flow & Metabolism (2014), 564 – 570
18. Possible interrelationships in the pathophysiology of epileptogenesis associated with
occult cerebrovascular disease (CVD).
Gibson LM, et al. Journal of Cerebral Blood Flow & Metabolism (2014), 564 – 570
19. Dementia and Epilepsy
• High seizure frequency increase risk of cognitive decline.
• Upregulation of APP, increase in senile plaques, premature
accumulation of corpora amylacea.
• Presence of apoE-e4 allele in TLE accelerates cognitive decline.
• Epilepsy patients aged 50-75 yrs have increased risk of dementia.
• Upto 10-20% of people with Alzhiemers disease have epilepsy. The
risk of epilepsy is 6 fold.
• In non-Alzheimers dementia: the risk is 8 fold.
20. Etiology
• Brain tumors (primary, metastatic): 10% to 30% of new cases.
• Traumatic brain injury and extraparenchymal hemorrhages (eg,
SDH, SAH), a frequent sequelae of falls, are also seen.
• Paraneoplastic and autoimmune causes of epilepsy.
• Psychiatric illness (BPAD, depression, schizophrenia, substance
abuse) have a higher risk of seizures.
21. DIAGNOSIS
“The most powerful diagnostic tool is an accurate history
of the onset, evolution of and recovery from the episode”.
22. Diagnosis
Veteran Affairs Cooperative Study of seizures in >60 year olds.
• Epilepsy was a diagnostic consideration in only 73% of patients,
all of whom had epilepsy.
• Only 37% were correctly diagnosed on initial evaluation.
• Mean time to correct diagnosis was 2.3 years.
Rowan AJ, et al. Neurology 2005; 64: 1868-1873
“The greatest challenge to a correct diagnosis is the
differentiation of seizures from syncope”.
23. Feature Syncope Seizure
Pre-ictal
Trigger (position, emotion, Valsalva) Common Rare
Sweating, nausea Common Rare
Aura Rare Common
Ictal
Unilateral symptoms Rare Common
Pallor Common Rare
Cyanosis Rare Common
Duration of LOC <30 sec >60 sec
Movements Few clonic, myoclonic jerks <15sec. GTCS, focal seizures, myoclonic.
Automatism Rare In CPS.
Tongue bite Rare, may be anterior tongue injury Lateral. Occasional.
Frothing Rare Common
Ictal EEG Non-specific slowing Ictal EEG pattern
Post-ictal
Confusion Rare. If present, it is brief (<30 sec). Common. Several minutes
Diffuse myalgia Rare, brief, upper body Hours to days.
CK elevation Rare. Common (after 12-24 hrs)
Inter-ictal EEG Normal Epileptiform discharges.
25. Clinical presentation
• 70% of seizures are partial onset.
• However, even apparently generalised seizures in elderly should be
considered as partial onset unless proven otherwise.
• In a small VEEG study, 75% of seizures were of temporal origin.
26. Feature Young patients Elderly
Onset Focal, generalised Usually focal.
Location Temporal is relatively
common
Extratemporal is more common
Aura More common Less common
Ictus Focal onset, generalised Can be subtle, like memory lapses, altered
mental state, confusion.
Post-ictal state Less prolonged Prolonged confusion, drowsiness likely,
especially in those with pre-existing
cerebral dysfunction.
Etiology Acquired, genetic Usually acquired
Subclinical seizures Less common More common, especially in dementia pts
GCSE, NCSE Less common More common, especially NCSE
How are seizures in the elderly different from those in the young?
27. 1. EEG, especially
longer recordings
2. VEEG
Cardiac evaluation:
1. ECG
2. Holter, ELR
3. Tilt table testing
4. 2D ECHO
PSG
Blood investigations:
1. CBC
2. Na, K, Cl, Ca, Mg.
3. Renal parameters
4. LFT, Ammonia
1. MRI brain
2. Intracranial and
neck vessel
angiography
3. PET CT/MRI brain
1. LP CSF
2. Autoimmune
encephalitis panel.
3. Paraneoplastic
antibody panel.
4. Vasculitic and
CTD work up
New onset seizures in Elderly
29. Risk of recurrence
• In all patients with new onset seizure, risk of recurrence over 2
years is 38%.
• Factors that increase recurrence risk:
1. IEDs on EEG
2. Epileptogenic lesion on MRI
3. Underlying identified cause
4. Seizures in sleep.
• If a cause is identified, risk of recurrence is double that of
cryptogenic first seizure.
30. Treatment of
Seizures/ Epilepsy
Acute
symptomatic
seizures
Unprovoked single
seizures
1. >1 Unprovoked seizure
2. Single Unprovoked
seizure with:
IEDs on EEG and /or
Epileptogenic lesion on
MRI
• Correct
underlying
cause.
• Short duration
of AEDs may be
required.
Normal EEG,
MRI
Start AED
AED therapy is
preferable
Status epilepticus
Yes
No
Levetiracetam
Sodium Valproate
Levetiracetam
Lamotrigine
Gabapentin
Sodium Valproate
Eslicarbazepine
Oxcarbazepine
37. Treatment
• Epilepsy may be more easily controlled in the elderly (?).
• Choice of AED is based of tolerability and safety than efficacy.
• Monotherapy is preferred.
• Start low and increase dose slowly.
• Monitor for adverse effects with drug levels and metabolic
parameters.
• Adherence must be ensured (cognitive issues, bedridden pts).
• Therapeutic window is narrower than in younger patients.
38. Peri-procedural advice
• All AEDs to be continued peri-procedurally.
• Change to IV formulation if oral intake is restricted or in case of
colonoscopy etc.
• Avoid medications that reduce seizure threshold: antipsychotics
(chlorpromazine, clozapine), diphenhydramine, atropine,
buproprion, imipenem, meperidine, or tramadol.
• Manage peri-procedural electrolyte disturbances, sleep issues.
• Dose adjustments may be necessary.
39. Refractory Epilepsy
• Video EEG
• MRI brain, PET, SPECT.
• Neuropsychological assessment.
• Seizure freedom after epilepsy surgery in TLE in patients > 60
years of age is similar to those of younger patients.
• However, post surgery benefit in attentional performance was
greater in younger patients, declined in older patients.
• Therefore older patients with intractable epilepsy should not be
denied surgery because of age.
40. Bone health.
• In patients >65 years of age, those taking AEDs are 75% more
likely to experience a fall than those not taking AEDs.
• Patients with epilepsy have double the fracture risk compared to
controls.
• Risk of falls and fractures is more with polytherapy.
• Potent inducers of cytochrome P450 have worst effect on BMD:
PHT, PB, CBZ.
• Even 1 year of PHT monotherapy reduced BMD significantly.
• VPA has mild negative effects on bone health.
41. Conclusion
• Elderly have highest incidence and prevalence of seizures/epilepsy.
• Acquired causes are most likely.
• All seizures are to be treated as focal onset seizures+/- generalisation.
• Epilepsy in elderly requires detailed evaluation.
• Cryptogenic or remote symptomatic seizures require therapy.
• Levetiracetam, Lamotrigine are the most suitable AEDs.
• Patients should be monitored, especially for bone health.
• Epilepsy surgery is an option in selected patients.