Australian Family Physician December 2005 - Epilepsy
Vol 34, (12): 994 - 1061.
The theme for the December issue of AFP is Epilepsy.
Articles include management of epilepsy, epilepsy syndromes in children,
fits, faints and funny turns in children, febrile seizures and treatment
with anti-epileptic drugs.
The year ahead
Jenni Parsons
Every year when December suddenly arrives, I feel as though I have spent the year in the middle of an 'absence', and I can't quite work out what has happened to the year. When I was a child it seemed an eternity from one Christmas to the next. The world turns much faster now, and even my 12 year old daughter thinks the years pass very quickly.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners
Management of epilepsy in general practice patients
Janice Charles, Anthea Ng, Helena Britt
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of consultations in general practice involving the management of epilepsy. Participating general practitioners recorded the problem as 'epilepsy' in 90% of cases, while 'grand mal' was specified at about 4% of encounters and 'temporal lobe' and 'petit mal' were each specified at about 1% of encounters. This provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.
Fits, faints and funny turns in children
Mark Mackay
Seizures and epilepsy are a common problem in childhood. There are many other paroxysmal disorders that can mimic seizures and it is important to exclude these conditions before diagnosing epilepsy and making the decision to commence anticonvulsant treatment.
Epilepsy syndromes in children
Patrick W Carney, Michael A Prowse, Ingrid E Scheffer
Understanding the common childhood epilepsy syndromes is valuable when approaching the diagnosis and management of a child presenting with seizures.
Treatment with anti-epileptic drugs
Samuel F Berkovic
The principles of epilepsy management are accurate diagnosis coupled with education, lifestyle advice, and drug therapy. There are a large number of anti-epileptic drugs now available.
Febrile seizures
Jayasri Srinivasan, Katherine A Wallace, Ingrid E Scheffer
Febrile convulsions, or febrile seizures, are frequently encountered in paediatrics, and despite often being self limiting, these seizures strike fear in the hearts of patients' carers.
Locally advanced and inflammatory breast cancer
Verity Ahern, Meagan Brennan, Owen Ung
This tenth article in our series on breast disease focusses on locally advanced breast cancer and inflammatory breast cancer - both associated with a high risk of subsequent distant metastases.
Managing respiratory effects of air pollution
Bianca K Watson, Vicky Sheppeard
Exposure to air pollution (both indoor and outdoor) has many potential adverse effects on human health.
Diabetes and the skin (Part 3 - diabetic cheiroarthropathy) Case history - Janis
Pat Phillips, Warren Weightman
Janis runs the family service station and service centre. He is aged in his early 30s and has had type 1 diabetes for 15 years. Over the years his glycaemic control has been moderate (A1c value 7.5-9.5%; ideal <7). He has nonproliferative diabetic retinopathy but no microalbuminuria or neuropathy.
Elective procedures - Preparing patients with diabetic, renal and hypertensive disease
David James, Karda Cavanagh
Providing high quality pre- and peri-operative care to patients with diabetes, renal disease and hypertension requires forethought and planning. General practitioners can play a vital role in this process. A preoperative assessment provides an opportunity to support the patient, communicate accurate and relevant clinical information to the procedural team, and make therapeutic adjustments that aid a successful recovery.
Herpes simplex virus serology in an asymptomatic patient
Belinda Sheary, Linda Dayan
Genital herpes is one of the most common sexually transmitted infections. While genital herpes can present with self limiting genital lesions, most people with genital herpes simplex virus (HSV) infection are asymptomatic or have unrecognised infection. Use of type specific serology for HSV antibodies can identify these individuals.
Brain teaser: Itchy rash on the abdomen
Jerzy K Pawlak, TJ Kroczak
Case history
A boy, 17 years of age, presented with an itchy area near the umbilicus with mild erythema, scaling, fissuring, lichenification and excoriations.
Clinical challenge
Jenni Parsons
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam..
Active listening - More than just paying attention
Kathryn Robertson
Communication skills courses are an essential component of undergraduate and postgraduate training and effective communication skills are actively promoted by medical defence organisations as a means of decreasing litigation. This article discusses active listening, a difficult discipline for anyone to practise, and examines why this is particularly so for doctors. It draws together themes from key literature in the field of communication skills, and examines how these theories apply in general practice.
Getting started: confessions of a novice researcher
Susan Selby
My journey into research started at a weekend seminar on dealing with loss and grief. In my clinical work, I assess a group of cross cultural workers who are missionaries in various countries and on return from their placement, they present with re-entry adjustment often involving multiple issues of loss and grief. As I read about the topic, I realised there was little to guide the general practitioner to assess and manage these issues.
Epilepsy, driving and confidentiality
Sara Bird
Case histories are based on actual medical defence organisation cases, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. This article examines the duties of patients and general practitioners with respect to assessing fitness to drive. In some situations, GPs may need to consider breaching their patient's confidentiality and notifying the Driver Licensing Authority that a patient is unfit to drive.
Assessing general practice clinical decision making skills - The key features approach
Elizabeth A Farmer, John Hinchy
The key feature problem (KFP) is an innovative assessment format that tests clinical decision making skills by focussing on only the critical steps - or 'key features' - of each decision, thereby increasing the number of problems that can be answered in a 3 hour examination.
