Clinical lunch chats
Seizure Emergencies
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This episode promises to delve into Dr James Butler’s knowledge and experience to provide evidence-based insights into the recognition and management of seizures and epilepsy in clinical practice. Amongst the highlights of this episode will be the diagnostic criteria, first-line management strategies, and long-term treatment considerations for patients with seizure disorders. The episode aims to strengthen confidence in decision-making when managing acute presentations and guiding patients on therapy continuation or discontinuation.
LEARNING OBJECTIVES
- Differentiate between seizures and epilepsy by applying the definition of epilepsy (two unprovoked seizures occurring more than 24 hours apart).
- Recognise when anti-epileptic treatment is not indicated following a first generalised tonic-clonic seizure without high-risk features.
- Identify the diagnostic threshold for status epilepticus and apply the 5-minute definition in acute care scenarios.
- Outline the immediate first-line management of status epilepticus, with emphasis on the timely administration of benzodiazepines.
- Evaluate when it is appropriate to consider discontinuing anti-epileptic therapy, balancing seizure-free duration, underlying risk factors, and patient counseling needs.
Dr James (JT) Butler
MBChB (UCT), FCP (SA) Neurology
Dr James Butler is a Neurologist based at Constantiaberg Mediclinic in Cape Town, where he runs a full-time private practice with a special interest in epilepsy and epilepsy surgery. He also serves as a part-time consultant at Tygerberg Hospital, Stellenbosch University, and the Department of Neurology at Groote Schuur Hospital and UCT. He completed his MBChB at the University of Cape Town in 1988, his FCP (SA) Neurology in 1995, and a Clinical Fellowship in Epilepsy at the University Hospital London, Ontario, Canada. Dr Butler has authored and co-authored numerous peer-reviewed publications on epilepsy, EEG, and related neurological topics, and has contributed to international guidelines and book chapters. He is a regular presenter at local and international conferences and plays an active role in teaching, including weekly EEG training and neuroscience meetings.
