Clinical Presentation, Investigation and Management of Epilepsy Adult

Details

Title

Clinical Presentation, Investigation and Management of Epilepsy Adult

Type

Stage One

Module code

HPS214

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply knowledge with respect to epilepsy in adults and other disorders of consciousness in collaboration with more senior Clinical Scientists and the clinician(s) responsible for the overall care of the patient. They will be competent to identify the specialist assessments required to form a structured differential diagnosis and consistently demonstrate the attitudes and behaviours necessary to undertake the role of a Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their knowledge with respect to epilepsy in adults and other disorders of consciousness, including:

• epidemiology;
• causes of epilepsy, including adult/adolescent epileptic syndromes;
• classification of epileptic seizures and epilepsies, including NICE guidelines (www.nice.org.uk/guidance/CG137/chapter/Introduction);
• relevant national and local guidelines, pathways and protocols, recognising their benefits and limitations;
• mechanisms of excessive or hypersynchronous neural activity;
• mechanisms of the generalised corticoreticular epilepsies;
• approach to the first seizure;
• psychosocial aspects of epilepsy;
• empowering patients, including patient education;
• protecting paediatric patients and vulnerable adults from maltreatment, abuse, neglect, or exploitation (safeguarding).

Clinical scientific research topics:

• functional and structural neuroimaging;
• genetics of epilepsy;
• genomics.

Clinical presentation:

• approach to the patient with episodic neurological disturbance;
• history;
• signs and symptoms;
• sudden unexpected death in epilepsy;
• clinical examination;
• refractory epilepsy;
• special diagnostic approaches.

Diagnostic investigations and management, including investigations involving:

• laboratory blood tests (e.g. glucose, electrolytes, calcium, renal function, liver function) and urine biochemistry to identify potential causes and/or to identify any significant co-morbidity;
• neuroimaging;
• clinical scientific neurophysiology tests;
• other investigations:
  • 12-lead ECG
  • neuropsychological and psychiatric assessment
• differential diagnosis of epileptic and non-epileptic seizures.

Medical management of epilepsy:

• medical management;
• advice with respect to driving;
• device-based treatments;
• psychological interventions;
• common antiepileptic drugs, their uses, dosage and side effects;
• withdrawal of drug treatment;
• long-term review and follow-up;
• complications;
• prognosis;
• management of status epilepticus;
• management of the elderly patient with epilepsy;
• special considerations for women and girls of childbearing potential with epilepsy;
• transition and transfer of adolescents into adult services, including the:
  • process of transition
  • needs of young people and adolescents with epilepsy and their attitudes to their need for care
  • need to provide a seamless transfer of care from the paediatric to adult services for those with long-standing epilepsy
  • needs of learning disabled young people during transition and transfer into adult services
• long-term follow-up of patients with epilepsy;
• the management of epilepsy in primary care.

Surgical treatment for epilepsy:

• assessment for epilepsy surgery;
• role of EEG in presurgical assessment of epilepsy;
• role of scalp and monitoring EEG techniques in pre-surgical assessment of epilepsy.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST, with respect to epilepsy in adults, will be able to demonstrate a critical understanding of current research and its application to the performance of the following techniques and will:

• perform complex neurophysiological investigations in non-routine adult patients with epilepsy, including:
  • video EEG
  • ictal and interictal EEGs
  • telemetric and ambulatory recordings
• evaluate, interpret and produce a supervised clinical report on video recordings of seizures of epileptic and non-epileptic origin;
• evaluate, interpret and produce a supervised clinical report pertaining to ictal and inter-ictal EEGs in persons with epileptic and non-epileptic attacks;
• set up telemetric and ambulatory recordings, select montages, polygraphy, etc., and identify and rectify faults;
• analyse the results and present accurate, clear and concise documentation of patient data, including appropriate interpretation.

They will also be expected to contribute to the supervision, teaching and assessment of colleagues.

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice an appropriate range of clinical and communication skills and will:

Clinical examination:

• obtain informed consent;
• take a relevant focused history (see Stage 1(ii), Advanced History Taking and Clinical Examination);
• select the appropriate neurophysiological investigations, taking into account the clinical and other special circumstances, contraindications, confounding factors and risks.

Diagnostic investigations and management as part of the multiprofessional team, including:

• interpret and produce a supervised clinical report of clinical scientific neurophysiological investigations to include EEG, 24-hour ambulatory EEG monitoring and video EEG;
• present accurate, clear and concise documentation of patient data;
• advise and communicate effectively with patients, relevant clinicians and the public, and other healthcare professionals working within the multidisciplinary team;contribute to advice on the best course of treatment, including communication and liaison with other clinical teams.
• interpret the range of investigations and biochemical assessments, including but not limited to: anticonvulsant levels, glucose, electrolytes, calcium, renal function, liver function and urine biochemistry, to identify potential causes and/or to identify any significant co-morbidity;
• provide a supportive and informative clinical atmosphere in which the young person can raise sensitive issues about their epilepsy and associated issues in their own right, in particular being aware of safeguarding issues in this group of adolescents;
• ensure that the neurophysiological science service provision across the transition period is coordinated, including both process and practice;
• seek the views of service users and pursue opportunities to improve the transition into adult services;
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence;
• contribute to advice on the best course of treatment, including communication and liaison with other clinical teams.