Chapter 2.7 explores anticonvulsant drugs. This includes a segment on benzodiazepines commonly used for sedation and anaesthesia, their mechanism of action, uses, side effects and actions in overdose. We then discuss specific antiepileptic agents in detail and the management of status epilepticus.

It may be difficult or impossible to obtain a valid history in the emergency. Additional time in the observation unit (OU) may be needed to determine the etiology of the event, whether a seizure or not.

In the OU, there is time for obtain such information, do a diagnostic workup to determine the etiology of the event, whether a seizure or not and if a seizure, determine the precipitating factors and treat them, repeat vital signs and neurologic checks, observe for any recurrent seizures or monitoring if syncope and dysrhythmias are a consideration. If this was a seizure, evaluation can be done, which may involve testing. In a patient with a known seizure disorder, anticonvulsants may be administered, if needed. Precipitating factors, such as infections or electrolyte abnormalities, known to trigger seizures can be treated in the OU. Dizziness has an extensive differntial

This chapter introduces the transformative power of music through the inspiring story of Michael, a young man with epilepsy and mutism who experienced remarkable progress through music therapy. It highlights the growing body of research on music’s therapeutic effects, while acknowledging the challenges of studying music’s impact in a rigorous scientific manner. The author emphasizes the importance of integrating music therapy into healthcare, advocating for policy changes to increase access for those in need. This chapter sets the stage for exploring the multifaceted ways music can enhance our health and well-being, drawing on insights from neuroscience, psychology, medicine, and musicology. It invites readers on a journey to discover the extraordinary potential of music to heal, inspire, and transform lives.

Anaesthetic preoperative assessment is an essential part of the child’s admission. Standards of care dictate that this needs to be done in advance of the day of admission to ensure the patient is medically optimised and prepared for their anaesthetic. A detailed discussion about the side effects and risk of anaesthesia is essential, and families should be given written or electronic information as part of this process. All anaesthetists who are involved in the care of children should have a sound knowledge of common medical conditions in childhood. They should understand how these conditions can be affected by anaesthesia and surgery and what preoperative investigations and planning are required to deliver a safe anaesthetic. Those medical specialties that are regularly involved in the care of the child should be contacted to help guide the perioperative management and ensure a collaborative approach to the care of the child.

Movement disorders arise from dysfunctional physiology within the motor and movement systems of the nervous system, and can involve multiple anatomic locations. A myriad of electrophysiologic manifestations can be detected in electromyography (EMG), electroencephalography (EEG), and other methods. Technical factors must be carefully considered and technical quality should be monitored throughout. Surface EMG provides the basis for the electrophysiologic examination of movement disorders. EEG is important for establishing cortical genesis as well as consciousness state determination during the movement disorder. Tremors of different etiologies may have different frequencies and activation characteristics that are best discovered on analysis of surface EMG characteristics. Also, classification of myoclonus physiology needs electrophysiologic testing. Proper myoclonus classification forms the best approach to symptomatic treatment strategy. Results from this testing provide important supplemental information, which can be used for a more exact diagnosis that leads to treatment.

Most women with epilepsy (WWE) will experience stable seizure control during pregnancy. Adverse fetal outcomes with epilepsy include spontaneous abortion, preterm birth, fetal growth restriction, major congenital malformation (MCM), hypertensive disorders of pregnancy, postpartum hemorrhage, peripartum depression, and—rarely—maternal death. Studies reporting these increased risks may be biased by differences in preexisting medical conditions, other patient characteristics, and anti-seizure medication (ASM) use and type. Poor seizure control preceding pregnancy, unplanned pregnancy, and polytherapy are associated with higher risks. Antenatal care should be coordinated by an experienced multidisciplinary team. Monotherapy with an appropriate ASM at the lowest effective dose is the goal, and drug levels should be monitored. Second trimester fetal anatomical sonography is the best screening modality for neural tube defects and other MCMs. Serial third trimester fetal growth ultrasounds are recommended. WWE are likely to have an uncomplicated labour and delivery. Epilepsy is not an indication for induction of labour or caesarean delivery. The risk of intrapartum seizures is 2−3%, and intractable seizures necessitating urgent delivery are rare. Attention is needed to avoid dehydration, missed ASM doses, sleep deprivation, and pain during labour and postpartum. WWE should be screened and counselled regarding their heightened risk of peripartum depression.

Sleep and epilepsy have bidirectional relationships, and various endocrine interactions. Besides the commonly observed increase in seizure frequency in association with sleep loss or with sleep disorders, such as sleep apnea, seizures themselves may lead to sleep fragmentation. Furthermore, nocturnal seizures may be associated with more severe and longer lasting respiratory consequences, as well as higher risk of sudden death. It is common for sleep to change during pregnancy in relation to endocrine changes and these changes may in turn affect seizure frequency. Overall, estrogens may have excitatory effects and may increase the consolidation of wakefulness and decrease REM sleep duration. Progesterone tends to have a sedative effect and the decrease in level may lead to more complaints of insomnia pre-menstrual and after menopause. Common sleep disorders are discussed. Obstructive sleep apnea becomes much more common after menopause, and sometimes may be seen in the third trimester of pregnancy as a result of weight gain. Restless legs syndrome is more common in pregnancy. Overall, insomnia is more common in women. Consideration should be given to comorbid primary sleep disorders whenever symptoms of insomnia or hypersomnolence are reported by patients with epilepsy.

Enzyme-inducing antiepileptic drugs (EI-ASMs) such as phenytoin, carbamazepine, oxcarbazepine, and phenobarbital may decrease contraceptive efficacy. When considering contraception for women with epilepsy (WWE), the intrauterine device (IUD) is a first line choice. It is important to keep in mind that hormonal contraception with estrogenic components induces the metabolism of lamotriginePreconception counseling should be started early and revisited frequently for WWE of childbearing age. Pre-partum optimization of ASMs ideally should be done 9−12 months before a planned pregnancy. The majority of WWE are likely to have a safe pregnancy and a healthy newborn.