Author/Editor		Vodušek, David B
Title		Racionalna obravnava epilepsij
Translated title		Rational management of epilepsies
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 10
Publication year		2000
Volume		str. 3-9
Language		slo
Abstract		After the first seizure, its cause (which may be a serious disease) needs to be determined. The actual diagnostic procedure depends on the clinical context and should as a rule be performed by a neurologist. In patienis suspected to have epilepsy, the primary concern is often to distinguish epileptiform phenomena from syncope, intoxication, involuntary movements, dissomnias, parasomnias and psychogenic disorders. Knowledge of the clinical characieristics of the disease is of primary importance and electroencephalography is the most useful test. At least 50% of these patients will require more than one recording session and some diagnostic dilemmas can only be resolved by prolonged EEG-video monitoring. Early on in the diagnostic procedure neuroimaging should be performed, MRI if possible. Further differential diagnostics will be narrowed down if identification of the particular epileptic syndrome in the individual patient has been made previously (on account of the clinical picture, EEG and neuroimaging). The diagnostics should be performed by a neurologist, and in complex cases by a neurologist-epileptologist. For some patients additional specialists, in particular a psychiatrist, will need to be consulted. After the diagnosis of epilepsy the possibility of causal therapy should be considered. In the absence of this possibility the patient needs to be counselled (regarding driving, etc.), and in most cases antiepileptic treatment will be necessary. Valproate and carbamazepine are the first choice drugs. The former has a wide applicability in primary generalized epilepsies, but is also effective for partial epilepsies. Carbamazepine is usually the first choice drug for partial epilepsies. Carbamazepine should not be used for absences (picnolepsy) and myoclonic epilepsies). (Abstract truncated at 2000 characters)
Summary		Po prvem epileptičnem napadu je treba pri preiskovancu opredeliti vzrok, zaradi katerega je prišlo do napada, saj gre lahko tudi za začetek resne bolezni. Postopki bodo odvisni od kliničnega konteksta, praviloma pa naj jih izpelje nevrolog. Pri preiskovancu s sumom na epilepsijo bomo najprej v diagnostičnem postopku opredelili, ali gre res za epileptično motnjo, in pa, kakšna ta je. Ključno je poznavanje kliničnih slik epileptičnih fenomenov, sinkope, intoksikacij; nehotenih zgibkov, disomnij, parasomnij in psihagenih motenj, pri razlikovanju je pomembna elektroencefalografija. Vsaj 50 % preiskovancev bo potrebovalo več kot en sam posnetek. Nekateri preiskovanci bodo potrebovali tudi dolgotrajno snemanje fizioloških parametrov in videa. Zgodaj v diagnostičnem postopku preiskovanca z epilepsijo se bomo odločili za nevroradiološko preiskavo (po možnosti magnetno resonanco). Nadaljnja diferencialna diagnostika pa bo že usmerjena glede na predhodno opredelitev epileptičnega sindroma (na podlagi klinične slike, elektroencefalografije in nevroradiološkega izvida). To diagnostiko naj izpelje nevrolog, v kompleksnih primerih pa nevrolog epileptolog. Pri nekaterih bolnikih bo treba k obravnavi pritegniti še druge specialiste; predvsem psihiatra. (Izvleček skrajšan pri 2000 znakih)
Descriptors		EPILEPSY ELECTROENCEPHALOGRAPHY MAGNETIC RESONANCE IMAGING DISEASE MANAGEMENT