Epilepsy Basics AND Working Effectively with Your Doctor
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Transcript of Epilepsy Basics AND Working Effectively with Your Doctor
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Epilepsy Basics Definition Epilepsy vs. Seizures Statistics Causes
Seizure Classification Treatments Medications Surgical Interventions Dietary Non-Epileptic Events Emergencies
Status EpilepticusClusters
Seizure First Aid Personal Care and Safety Mobility
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Seizure: An episode of pathological, hyperactive, hypersynchronous brain activity, expressed as abnormal motor, sensory, or psychologic behavior.
Seizure Disorder: A chronic brain disorder characterized by recurrent unprovoked seizures.
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Nothing, they are the same thing.
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Single Seizure: 9%Recurrent Seizures: 0.5%
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0%
5%
10%
15%
20%
25%
30%
5 10 15 20 25 30 35 40 45 50+
years
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0%
20%
40%
60%
80%
100%
0 to 4 5 to
14
15 to
24
25 to
44
45 to
64
65+
other
Degen.
CVD
brain tumor
trauma
infection
Devel.
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Clinical observation+
EEG findings
Partial seizure Generalized seizure
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More common in adults than childrenInvolves a focal area of the brain at onsetA warning (aura) often precedes the seizureMay or may not be associated with an alteration of
consciousnessUsually symptomatic
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Visual hallucinationAuditory hallucinationTactile sensationMotor sensationAutonomic sensation
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Pause in activity with a blank stareMay have an inability to talkMay have hand or arm posturingEye deviationMay appear apprehensiveMay turn in a circleMay run away - random
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Partial seizures
Simple partial Complex partial
Consciousness preserved Impaired consciousness
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Patient may pause, or slow down.Aware of seizureAble to comprehend and speakDuration: variablePost ictal phase: may feel tired
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Usually begin with an aura.Alteration of consciousness.May exhibit automatisms:
Lip smackingHand posturingPick at clothing or reach out without purposeMove about in a purposeless manner
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Duration: usually 2 – 3 minutesPost ictal phase is variable in length.
ConfusedFrightenedCombative or angrySleepy or may become hyperactiveAmnestic for the event
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Partial Seizure
Simple partial seizure
Complex partial seizures
Secondary Generalization
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Occur in 20 – 40%More common in childrenGenetic cause suspected with mostThey begin without warningAlways associated with an alteration of consciousness
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Generalized tonic clonic or clonicAbsence or Atypical Absence MyoclonicTonicAtonic
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Abrupt onsetLoss of consciousnessStiffening of the extremitiesDecreased ability to breathRhythmic jerkingDuration: 1 – 3 minutes (usually)
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Often associated with tongue biting, and loss of bowel or bladder control
Post ictal phaseConfusionSleepy may sleep 30 minutes to 4 hours
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Brief loss of consciousness (10 – 20 seconds)Blank stareNo post ictal period associatedMay have subtle twitching (myoclonic movements)May have simple automatisms
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Generally look like a fast tonic seizure or startlePatient will often fall to the groundBrief – lasting only a few secondsUsually occur in clustersNo post ictal phase
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Patient often yell at the onsetArms are up, and extended to the front or side.Head drops, and legs may become stiffPatient may drop abruptly.Duration usually 1 minute or lessOften poor respiratory effortPost ictal phase is variable
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Sudden loss of muscle toneFall to the groundNo warningDuration: a few seconds
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InsomniaConstipationFebrile illnessesExcessive ExcitementExcessive StressMedication changes
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MedicationsSurgeryDietary
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Valproate SodiumLamotriginePhenytoinCarbamazepinePhenobarbital
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LamotriginePhenytoinCarbamazepinePhenobarbital
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PhenobarbitalDilantinTopamaxLevetiracetam
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Vagal Nerve StimulatorTemporal lobectomyCorpus CallosotomySubpial transection
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Ketogenic DietAtkins Diet(Low carbohydrate)?
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SyncopeCardiac arrhythmiaBreath holding spellPanic attacksMovement disorderHypoglycemic episodes
Esophageal refluxSleep disorderBenign nocturnal jerksPsychogenic episodesMensestrauma
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DOStay CalmProtect from injuryMove surrounding
objects awayPosition on floor or soft
surface
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DOProtect airwayPlace head on pillowLoosen clothingPlace on left side
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Do not panic!Do not try to stop the seizureDo not place objects in mouthDo not try to restraint them
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Any first time seizure
When it compromises respiration
When it has lasted
>5 minutes
>2 seizures in 10 minutes
Associated with trauma
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In a Wheelchair, Stroller or BusDo not try to remove them from this Position
The seat provides support.Moving the person puts you and the client at risk of injury.You may provide extra padding, move footrests or take steps
to protect limbs from injury.Always continue to monitor airway
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-Loosen but do not unfasten seat belts-They may need to be taken out of the chair after the seizure
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At workAt home
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Around the HousePad corners, rounded cornersCarpet with extra padding underneathNo top bunks Low bed or mattress on the floorPlace guards around fireplace or woo stovesMonitor in the bedroom
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Bathroom:Supervise showerDo not lock doorsKeep water levels low in tubSet lower temperature on water
heaterDoors opening outwards
instead of inwards
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KitchenUse Plastic containers/dishesUse microwave instead of stove as much as possibleSupervision with knives or sharp objects
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In the workplace:have a place to restkeep extra set of clothestake regular breaks to
avoid fatigueavoid flashing lightsspecial safety around
machinery
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