AN OVERVIEW OF EPILEPSY
Andrea Zonneveld Community Education & Events Coordinator
Reviewing the Basics, First Aid, and Treatment Options for Dif ferent Kinds of Seizures
SOME FUNDAMENTAL BASICS What is epilepsy? A neurological disorder characterized by recurring seizures May also be referred to as a “seizure disorder”
What is a seizure? To answer this question, let’s talk a little about how the brain works…
Introduction
Seizure Types & First Aid
Treatment
Social Impact
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SEIZURES AND THE BRAIN A seizure is a temporary disruption of the electrical system of the brain Specifically, they are caused by the release of excessive energy in a synchronized form Source: http://www.post-gazette.com/pg/images/200709/20070916pd2testfans_500.jpg
Introduction
Seizure Types & First Aid
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SEIZURES AND THE BRAIN
(CONT’D)
Can af fect the entire brain and impair consciousness and memory Can af fect only part of the brain, which may or may not disrupt awareness Produces changes in consciousness, behavior, and/or movement
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EPILEPSY IS NOT… Contagious/disease Mental illness Intellectual disability The result of a single seizure
A condition you can tell someone has based on their appearance
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WHO DOES EPILEPSY AFFECT? Approximately 3 million Americans That’s more people than Americans with Parkinson’s disease, cerebral palsy, multiple sclerosis, and muscular dystrophy combined
326,000 children (through age 15)
Cumulative Incidence: By 75 years of age, 3% of the population can be expected to develop epilepsy, and 10% will have experienced some type of seizure .
Introduction
Seizure Types & First Aid
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WHAT CAUSES SEIZURES? 70% of cases are idiopathic (of unknown cause) Symptomatic epilepsy (the other 30%) can be caused by: • • • • • •
Birth trauma Head injury Brain tumors Strokes Lead poisoning Infection of the brain
Introduction
Seizure Types & First Aid
• Heredity • Lack of oxygen to the brain • Chronic usage of drugs/alcohol • Metabolic abnormalities
Treatment
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SEIZURE T YPES
Epileptic Seizures
Generalized Seizures
Partial Seizures
Tonic-Clonic
Absence
Atonic
(grand mal)
(petit mal)
(drop seizures)
Introduction
Seizure Types & First Aid
Myoclonic
Treatment
Simple Partial
Social Impact
Complex Partial
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GENERALIZED SEIZURES Also referred to as non-focal seizures Seizure af fects the entire brain Alter consciousness and af fect memory Types include:
Tonic-clonic (grand mal) Absence (petit mal) Atonic (drop seizures) Myoclonic
Introduction
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TONIC-CLONIC SEIZURES Also known as grand mal seizure – most common and best known of generalized seizures During the seizure: May let out a sudden cry or gasp for air Consciousness is lost Breathing may become shallow/irregular Begins with stiffening of muscles (tonic phase), followed by jerking of limbs and face (clonic phase) Drooling or vomiting, bluing of skin, and loss of bladder or bowel control may occur
After the seizure: Will often be confused and fatigued Introduction
Seizure Types & First Aid
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TONIC-CLONIC SEIZURES: FIRST AID
Lay the person on the ground Turn them onto their side Support the head Loosen tight clothing that could restrict breathing Keep track of time – call EMS if seizure >5 minutes Check for medical alert ID Stay with person until the seizure has ended
NEVER place anything in person’s mouth NEVER forcefully restrain person NEVER try to administer food, drink, or oral medication until full awareness has returned and seizure has ended Introduction
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ABSENCE SEIZURES Also known as petit mal Cause brief lapses in awareness, often mistaken for daydreaming During the seizure: Vacant stare that lasts a few seconds Eyes may blink or roll Twitching of face or mouth may occur
After the seizure: No memory of what was said during the seizure
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ABSENCE SEIZURES
(CONT’D)
Because of their subtlety, absence seizures may go undetected for an extended period of time May occur 50-100 times a day and still be unnoticed
Symptoms of person experiencing absence seizures:
Frequent periods of confusion Difficulty following along in class/meetings Decline in academic work/performance Perceived difficulty with remembering assignments/tasks
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ATONIC SEIZURES Also referred to as drop seizures Characterized by a sudden loss of muscle tone May cause brief, sudden drops in posture and/or unexpected falls Greatest risk is injury to head and/or face Seizures usually only last a few seconds and during the seizure consciousness is impaired First Aid: Not required, unless injury occurs as a result of sudden fall
Introduction
Seizure Types & First Aid
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MYOCLONIC SEIZURES Characterized by sudden brief, massive muscle jerks Jerks may af fect the whole body or only part of the body Usually jerks occur on both sides of the body simultaneously (i.e. both legs or both arms) Seizures may cause person to suddenly fall out of chair or drop an object they were holding First Aid: Not required, unless injury occurs
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Seizure Types & First Aid
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PARTIAL SEIZURES Also referred to as focal seizures, these are the most common type of seizure experienced by people with epilepsy Virtually any movement, sensory or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations May spread to cause a generalized seizure classified as a partial seizure secondarily generalized Types include: Simple partial Complex partial Introduction
Seizure Types & First Aid
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SIMPLE PARTIAL SEIZURES May experience an aura before the seizure, in the form of a sudden unexplained emotion, tingling sensation, etc. Typically last 1-2 minutes
During the seizure May experience uncontrolled jerking in one or more parts of the body Changes in behavior, perception, or sensation may occur Consciousness is maintained during seizure , but person may be limited in how they can interact during the seizure
First Aid: Not required, unless it secondarily generalizes Introduction
Seizure Types & First Aid
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COMPLEX PARTIAL SEIZURES May begin as simple partial seizure (i.e. a funny feeling or muscle jerking) During seizure: Consciousness is altered/and or impaired May experience unexplainable changes in emotion (i.e. anxiety or fear) May display a variety of unusual and unconscious behaviors known as automatisms
After seizure: No memory of their actions Typically lethargic and confused Introduction
Seizure Types & First Aid
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COMPLEX PARTIAL SEIZURES: FIRST AID Remove hazards from person’s path Speak in a gentle voice Do not forcefully restrain Stay with person until the seizure ends and consciousness has fully returned If the person appears angry or agitated, observe from a distance, but stay near them Keep track of time Help reorient the person after the seizure has ended and explain what has occurred to bystanders
Introduction
Seizure Types & First Aid
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WHEN TO CALL EMS If the person has no known history of epilepsy/seizures If the seizure lasted longer than 5 minutes (convulsive seizures) If the person is injured If the person is pregnant or has diabetes If the seizure occurs within water (i.e. swimming pool) If seizures occur in back -to-back clusters without the person regaining consciousness Seizures often have typical patterns that dif fer from person to person, so if possible develop a seizure action plan if you work with someone who has been diagnosed with epilepsy Introduction
Seizure Types & First Aid
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Seizure Action Plan
SEIZURE TRIGGERS
Missed medication or a change in medication Lack of sleep or fatigue Dehydration Flashing lights (photosensitivity ) Hormonal changes (esp. in women) Alcohol or drug abuse Fever (febrile seizures – usually happen in young children)
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TREATMENT OPTIONS Anti-epileptic drugs (AEDs) Vagus Nerve Stimulation (VNS) Ketogenic diet Surgery
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ANTI-EPILEPTIC DRUGS Anti-epileptic drugs (AEDs) are the most common form of treatment for children and adults with epilepsy In approximately 70% of epilepsy patients, AEDs control or substantially reduce the frequency and intensity of seizures
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COMMON ANTI-EPILEPTIC DRUGS
CARBATROL DEPAKENE DEPAKOTE DILANTIN DIASTAT FELBATOL GABITRIL
Introduction
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MYSOLINE NEURONTIN PHENOBARBITOL TEGRETOL TOPAMAX TRILEPTAL ZONEGRAN
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DIASTAT A unique gel formulation of diazepam that is given rectally An as-needed medication for management of prolonged and/or cluster seizures in patients with epilepsy
Designed so it can be administered by non -medical individuals such as a parent, teacher or caregiver Before using Diastat: Read the instruction sheet carefully Review administration steps with doctor Understand the directions! Introduction
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VAGUS NERVE STIMULATOR Received approval from the FDA in July 1997 Add-on therapy for adults and children over 12 with partial onset seizures
Used in conjunction with anti-epileptic drugs Source: http://health.ucsd.edu/news/images/Vagusmansm.jpg
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VAGUS NERVE STIMULATOR: HOW IT WORKS VNS implant is programmed by the neurologist to deliver electrical impulses automatically at specific intervals E.g. sending a signal for a 30 second period of time, every 5 minutes
VNS can also be activated manually with the use of a special magnet Common side ef fects:
Shortness of breath Hoarseness of throat Changes in voice quality during stimulation Tingling feeling in stimulation area Introduction
Seizure Types & First Aid
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KETOGENIC DIET Developed in the 1920’s as an alternative method of controlling seizures Diet works by altering metabolism so that the body becomes ketotic – forcing it to use fat as an energy source instead of glucose Diet is composed of 90% fat in -take and 10% proteins and carbohydrates Success rate: 1/3 report it substantially helped 1/3 report a reduction in seizures 1/3 report no change Introduction
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SURGERY Usually involves removal of location of seizure in the brain All surgeries have risks of death or complications, based on the complexity of the procedure
Seizures may be greatly reduced or totally controlled following a surgery, but it is important to note that many patients report periods of depression during the adjustment period
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Seizure Types & First Aid
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SOCIAL ISSUES AND EPILEPSY Both children and adults with epilepsy can experience social isolation as a result of ignorance and stigmas that surround their medical condition Children with epilepsy are at an increased risk of developing: Learning disabilities Social isolation Depression
Introduction
Seizure Types & First Aid
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MANAGING SEIZURES IN THE SCHOOL Establish ef fective communications between parents, teachers, students and other school personnel involved with the child Develop a seizure action plan and talk about it in the student’s IEP Keep a log documenting date, time and symptoms of seizure activity observed Note changes in behavior, both academic and social Keep updated records of any changes to the child’s medication (dosage and type) Avoid overprotection of the child Address teasing behaviors and educate other students about epilepsy Introduction
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SOME CLOSING WORDS Epilepsy is a disorder that has been around for centuries and people with epilepsy have been leading normal lives for just as long Did you know it is thought that Socrates, Julius Caesar and Joan of Arc all had epilepsy?
Although seizures can af fect a person’s perception, movement, behavior and memory, in most cases they are not medical emergencies Since a seizure can happen to anyone at any time, it is important for us, as a society, to be educated Introduction
Seizure Types & First Aid
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QUESTIONS? Andrea Zonneveld Community Education & Events Coordinator Epilepsy Foundation Western/Central PA 1501 Reedsdale Street Suite 3002 Pittsburgh, PA 15233 www.efwp.org ● 412-322-5880
