Epilepsy AwarenessJuly 2015

Tutor: Patrick Doyle

© Training Innovations Ltd 2015 Last updated: 17.07.15

Learning Outcomes

• Demonstrate an awareness of what Epilepsy is and recognition of different seizure types

• Be able to support patients’ experiencing seizures, ensuring their safety and dignity

• Demonstrate awareness of the importance in observing and recording seizure activity

• Recognise possible trigger factors

Learning Outcomes

• Demonstrate an understanding of the epilepsy/emergency management plan

• Raise awareness of the impact of epilepsy on a patient's life

• Understand the need for balancing risk and achieving a quality of life

• Raise awareness of the possible educational implications of the condition

What is Epilepsy?

• Epilepsy has been defined as a tendency to have recurrent seizures– Also referred to as “fits”, “convulsions” etc.

• The chemical balance in the brain is upset and there is abnormal firing of nerve cells– One seizure does not constitute epilepsy

• Common condition – Affects 1:242 School Age Children (Epilepsy Action 2005)

– More common in patients with learning disability• Approximately 22% of people with learning disability have epilepsy

Important Points

• Common serious /chronic condition

• Approximately 40 different types of seizures

• Can develop at any age, however it is diagnosed most before the age of 20 and after the age of 60

• Very individual/specific to the person

SUDEP (sudden unexpected death in epilepsy)

• Sudden death with no obvious cause• Can occur with/without evidence of a

seizure• It is estimated that approx 1 per 1000

people with epilepsy in the UK die as a result

What causes Epilepsy

• 60 - 70% of cases the cause is unknown• Some known causes include

– Birth injury– Head injury– Stroke– Brain haemorrhage– Brain Tumour– Meningitis/encephalitis– Drugs– Alcohol

Potential Triggers

• Flickering lights/photosensitivity• Lack of sleep/tiredness• Stress• Excitement• Missed meals• High Temperature• Menstruation• Missed or late medication

Classification of Seizures

Seizures can be divided into two main groups

Groups:• Generalised Seizures• Focal/ Partial Seizures

Generalised Seizure Types

• Tonic-Clonic• Typical Absence• Atonic• Tonic• Myoclonic

Tonic -Clonic Seizures

• Most common of the generalised seizure• May have an aura leading into the

tonic/clonic seizure• Lose consciousness• Usual duration 1-2 minutes• May follow on from a focal seizure

Tonic Phase

• Muscles contract, body stiffens and patient falls to the ground

• The patient may become pale• Their breathing may be irregular and

around their lips may appear blue• Saliva may dribble from mouth and can be

blood stained if tongue has been bitten• Incontinence may occur

Clonic Phase

• Consists of short sharp rhythmic jerks caused by alternate contraction and relaxation of muscles in the trunk and limbs

• Periods of relaxation become more frequent and prolonged

• Muscles relax and the body goes limp. At this stage the patient will still be unconscious

• Slowly they will regain consciousness, but may be groggy and confused

Management of Tonic-Clonic Seizures

DO:• Stay calm• Assess danger to patient- move if in

danger• Protect their head• Loosen tight clothing, remove glasses

Management of Tonic-Clonic Seizures

DO• Time seizure/observe and record• Once seizure has finished aid breathing by

gently placing them in the recovery position

• Stay with the patient until recovery is complete

• Reassure and re-orientate the patient, tell them they have had a seizure

Management of Tonic-Clonic Seizures

DO• Allow the patient a period of rest /sleep

afterwards if required

Management of Tonic-Clonic Seizures

DON’T:• Try to restrain or restrict the patient's

movements• Put anything into their mouth*• Give the patient anything to eat or drink

until they are fully recovered

Typical Absence Seizures

• Generally a childhood disorder• May look blank and stare, lasting a few

seconds• Eye lid fluttering/blinking may occur• May have minor facial movements or head

drop• Able to continue normal activity almost

immediately

Management of Absence Seizures

DO• Record the time of day and frequency• Reassure if necessary• Repeat information that the patient may

have missed

Atonic Seizures(drop attack)

• Sudden loss of muscle tone• Fall heavily to the ground • Lasts only a few seconds• Able to continue normal activity almost

immediately

Tonic Seizures

• Muscles contract• Body stiffens- trunk, facial muscles and

limbs• Results in falls• Quick recovery

Management of Atonic and Tonic Seizures

• Check for injuries which may need medical attention

• Stay with the patient and reassure

Myoclonic Seizures

• Quick muscle jerks usually of limbs however head and shoulders may jerk forward

• May be one or both sided• Usually seen in specific patienthood epilepsy

syndromes• Frequent soon after waking• Short lived so difficult to tell if consciousness is

impaired

Management of Myoclonic Seizures

• May be unsteady and if they fall check for injuries

• Stay with the patient until they recover• Reassure

Focal/ Partial Seizures

• Abnormal discharge confined to part of one cerebral hemisphere

• Can spread to the rest of the brain resulting in a secondary generalised seizure

• Consciousness may or may not be impaired• Symptoms depend on the area of the brain

involved e.g. hearing, vision, smell or taste

Focal/Partial Seizures

Symptoms can last from seconds to 1 – 3 minutes can

present as:• mumbling or uncontrolled laughter• Sucking, chewing or swallowing movements• Plucking at or removing clothing• May wander around as if drunk

Management of Focal Seizures

DO• Stay calm• Guide the patient from danger• Stay with the patient until recovery is

complete• Reassure and explain anything they have

missed

Management of Focal Seizures

DON’T• Restrain the patient• Act in a way that could frighten them, such

as making abrupt movements or shouting at them

• Give the patient anything to eat or drink until they are fully recovered

Call an Ambulance if ……

• You think the patient needs urgent medical assistance

• The patient has any breathing difficulties following a seizure

• It is a first seizure• The seizure continues for longer than

normal• One seizure follows another without

regaining consciousness

Following a Seizure

After a seizure the patient may be…..– Confused– Have no memory of what has occurred– Subdued– Tired & sleepy– Have a headache– Concentration impaired– Hyperactivity

Care following a Seizure

• Clear understanding of what has occurred• Observe:

– Breathing & colour– Any injuries

• Be aware of post-ictal state• Offer support and counselling as

appropriate

Seizure Management Plan

• Seizure Management Plan should be in place & available agreed by:– Parent/carer – Doctor– patient’s Epilepsy Nurse Specialist

• Original Copy to travel with the patient (Epilepsy Passport)• Updated yearly or more often if required• Be aware of who is responsible for first aid• Parent/carer should be informed of seizure ASAP• Record seizure

Seizure Management Plan

WILL PROVIDE:• Description of seizure• Usual duration of seizure• Trigger factors • Management of seizure

Emergency Seizure Management Plan

WILL PROVIDE:• Description of seizure/duration• Indications for use of emergency

medication inc. Buccal Midazolam• Initial dose of emergency medication• Usual response to emergency medication

Emergency Seizure Management Plan

WILL PROVIDE• Who is trained to administer• Consent

Observable Implications

A change in behaviour can be observed:• Seizure activity• Side effects of medication

Memory:

Can experience some loss or difficulty retaining

information

Role of Staff/Carer

• Be aware of patients’ with epilepsy• Have as much information as possible

about specific seizures from parent/carer• Observe any unusual behaviour & liaise

with parent/carer• Staff may be first to pick up on the seizure

– Absences/day dreaming

Role of Staff/Carer

• Positive attitude to condition• Avoid treating condition as an illness• Recognise/record changes in

mood/behaviour/social interaction• Risk assess for particular activities

Role of Staff/Carer

• Observe and record details of seizures• Promote communication with parents• Minimise embarrassment

Care of other Patients

• Reassure other patients present• The type of seizure they witness will have

a direct impact on how they cope• Do not keep epilepsy a secret

Activity

• Most patients with epilepsy should be able to fully participate in most activities ensuring adequate supervision is provided

• Each activity & each patient should be considered individually

• Special considerations & precautions should be discussed with the parent

Social Life

The following increase the risk of seizures– Excess alcohol – Lack of sleep– Disturbed sleep patterns– Missing meals– Forgetting to take medication– Recreational drugs

Points to Remember

• Normally seizures run their course and the patient recovers without need for medical intervention.

• patients should be given the opportunity to participate in the same activities as their peers do promoting independence, confidence and self-esteem.

• Any questions?• Please take some time to complete the course evaluation - Thank

you…• PowerPoint slides available at: www.slideshare.net/TInnovations• patrickdoyle@traininginnovations.co.uk• www.traininginnovtions.co.uk

• Twitter: @Traininnovate• Facebook: https://facebook.com/pages/Training-Innovations-Ltd