seizures & epilepsy beth blakeley, m.s. director of education epilepsy foundation of kentuckiana
TRANSCRIPT
Over 3 million Americans have epilepsy. Roughly 181,000 new cases of seizures and
epilepsy occur each year. 50% of people with epilepsy develop seizures by the
age of 25; however, anyone can get epilepsy at any time.
Now there are as many people with epilepsy who are 60 or older as children aged 10 or younger.
National Epilepsy Facts:
Kentucky Epilepsy Facts:
Over 90,000 of Kentucky’s residents have epilepsy. This was discovered using the Centers for Disease
Control & Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS).
BRFSS interviewed young – middle age adults via the telephone.
Because the very young nor very old were interviewed, experts at UK and UofL believe this number is actually closer to 180,000.
Studies suggest that traumatic brain injury (TBI) leads to post-traumatic epilepsy (PTE) in approximately 20 – 25% of civilians with closed head injuries.
Approximately 1.4 million soldiers were recently deployed to and are now returning from missions in Afghanistan and Iraq, and many have sustained TBI’s because of improvised explosive devices (IEDs).
Approximately 50% of military head injuries lead to PTE.
Kentucky is home to two military bases (Forts Knox and Campbell), therefore epilepsy experts are expecting a wave of epilepsy diagnoses in the very near future.
It is not getting better soon….
Workers with epilepsy have a job performance record that compares favorably with the job performance record of workers who do not have epilepsy.
Most people with epilepsy do not need accommodations to do their jobs.
For those that do need accommodations, most are less than $500.
Epilepsy & Employment Facts:
In about 70% of people with epilepsy, the cause is not known.
In the remaining 30%, the most common causes are:
Head trauma
Brain tumor and stroke
Lead poisoning
Infection of brain tissue
Heredity
Prenatal disturbance of brain development
What causes epilepsy?
Most seizures are NOT medical emergencies. Epilepsy is NOT contagious. Epilepsy is NOT a form of mental illness, it is a
medical condition. People rarely die or have brain damage from a
seizure. A person can NOT swallow his/her tongue during a
seizure
Dispelling Misconceptions about Epilepsy
Who is at a risk for developing epilepsy?
Approximately 1% of the general population will develop epilepsy.
The risk is higher in people with certain medical conditions:
Mental retardation
Cerebral palsy
Alzheimer’s disease
Stroke
Autism
What is a Seizure?
Your brain cells (neurons) constantly send tiny electrical impulses (signals) that direct the functions of your body.
All brain functions – including feeling, seeing, thinking and moving in the brain – depend on these electrical impulses passed between the neurons.
A seizure occurs when too many neurons in the brain “fire” too quickly, causing an “electrical storm”.
These uncontrolled electrical impulses can cause a change in awareness or movement.
Symptoms that may indicate a seizure disorder:
Periods of blackout or confused memory Occasional “fainting spells” Episodes of blank staring in children Sudden falls for no apparent reason Episodes of blinking or chewing at inappropriate
times A convulsion, with or without fever Clusters of swift jerking movements in babies
Seizure – a brief, temporary disturbance in the electrical activity of the brain
Epilepsy – a disorder characterized by recurring seizures
A seizure is a symptom of epilepsy
What is the difference between Epilepsy and Seizures?
There are over 20 different types of seizures. Some seizures cause people to shake, fall or have
convulsions. Other seizures involve staring, confusion, muscle
spasms, aimless wandering. Many seizure types do not cause loss of
consciousness.
Seizure Facts:
Missed medication (#1 reason) Stress/anxiety Hormonal changes Dehydration Lack of sleep/extreme fatigue Photosensitivity Drug/alcohol use; drug interactions
What can trigger a seizure?
Seizure Types
Generalized seizures
Involve the whole brain and loss of consciousness• Absence• Generalized Tonic -Clonic
Partial seizures
Involve only one part of the brain; may or may not include loss of consciousness
Symptoms relate to the part of the brain affected
• Simple partial• Complex partial
Type Duration Seizures SymptomsPostictal Symptoms
Simple Partial
10-90 seconds
No loss of consciousness
Sudden jerking
Sensory phenomenon
Possible transient weakness or loss of sensation
Complex Partial
1-10 minutes
May have aura
Staring
Automatisms (such as lip smacking, picking at clothes, fumbling.)
Unaware of environment
May wander
Amnesia of seizure events
Mild to moderate confusion
Sleepy
Partial Seizures
Frontal lobe – controls decision-making, problem solving and planning
Parietal lobe – controls the reception and processing of sensory information from the body
Occipital lobe – controls vision
Each part of the brain is responsible for controlling various activities
Temporal lobe – controls memory, emotion, hearing and language
Frontal lobe – seizures here may cause disruptive behavior, running, screaming, fear, anger, undirected aggression or swearing
Parietal lobe – seizures here can cause strange physical sensations, such as a tingling or warmth down one side of the body
Occipital lobe – seizures here create visual distortions and images of people or things that are not actually there
Temporal lobe – seizures here produces illusions of sounds such as ringing sounds or music. Seizures in this area can also alter mood or consciousness
Possible Affects of Partial Seizures
Stay calm and track the time. Do not restrain the person. Remove dangerous objects from the person’s path. Calmly direct the person to sit down and guide him or her from
dangerous situations. Use force only in an emergency to protect the person from immediate harm, such as walking out in front of an oncoming car.
Observe, but do not approach a person who appears angry or combative.
Remain with the person until he or she is fully alert.
First Aid for Complex Partial Seizures
No first aid is necessary for simple partial seizures.
Type Duration Seizure Symptoms Postictal Symptoms
Myoclonic 1 – 15 seconds may occur in clusters
Brief rapid muscle contractionsUsually affects both sides of bodySimilar to leg jerks while sleeping
--
Atonic (or Drop Attacks)
1 – 15 seconds may occur in clusters
Abrupt loss of muscle toneHead dropsLoss of posture, or sudden collapseInjuries – head gear
--
Absence(petit mal)
2 – 15 seconds
StaringEyes flutteringAutomatisms if prolonged
Amnesia for seizure eventsNo confusionPromptly resumes activity
Generalized Tonic-Clonic
(grand mal)1 – 10 minutes
Sudden cryFallRigidity Convulsions
Amnesia for seizure eventsConfusionDeep sleep
Generalized Seizures
Stay calm and track the time.
Do not restrain the person, but help them avoid hazards.Protect head, remove glasses, loosen tight neckwear.
Move anything hard or sharp out of the way.
Turn person on one side.
Check for epilepsy or seizure disorder identification.
Stay until person is fully aware and help re-orient them.
Call ambulance if seizure lasts longer than 5 minutes, or if it is unknown whether the person has had prior seizures.
First Aid for Generalized Tonic-Clonic Seizures
• Safely pull over and stop bus
• Place student on his/her side across the seat facing away from the seat back (or in aisle if necessary)
• Follow standard seizure first aid protocol until seizure abates and child regains consciousness
• Continue to destination or follow school policy
First Aid for Generalized Tonic-Clonic
Seizures on School Bus
NEVER• Put anything in the person’s mouth.• Try to hold down or restrain the person.• Attempt to give oral antiseizure medication.• Keep the person on their back face up throughout
convulsion.
A convulsive seizure occurs in a person not known to have seizures or lasts more than 5 minutes.
A complex partial seizure lasts more than 5 minutes BEYOND its usual duration for the individual.
Another seizure begins before the person regains consciousness.
Also call if the person:Is injured or pregnantHas diabetes/other medical conditionRecovers slowlyDoes not resume normal breathing
When to call an ambulance
Help person with epilepsy lead full and productive life.
Eliminate seizures without producing side effects.
Treatment Goals
Medication Surgery Nonpharmacologic treatment
Vagus nerve stimulation (VNS)Ketogenic dietLifestyle modifications
Treatment Options
Seizures eliminated (50%)
Seizures do notrespond (20%)
Seizuresmarkedlyreduced (30%)
Consistent use Inadequate dosage
or ineffective medication
Drug factors Disease
Factors that Determine Response to Medication
Surgery
Factors influencing decision: Likelihood seizures are due to
epilepsy Likelihood surgery will help Ability to identify focus of
seizures Other treatments attempted
Benefits vs risks
Vagus Nerve Stimulation (VNS)
Used to treat partial seizures when medication does not work.
Vagus nerve serves many organs and structures, including:
Larynx (voice box)
Lungs
Heart
Gastrointestinal tract
Vagus nerve has connections to areas of the brain that are instrumental in producing seizures.
Pacemaker-like device is implanted in the left side of the chest with electrodes wrapped around the vagus nerve.
Controls seizures by delivering electrical stimulation at pre-set time intervals to the left vagus nerve in the neck, which relays impulses to widespread areas of the brain.
The electrical stimulation produced by the VNS device can significantly decrease the brain’s ability to generate seizure activity in most patients.
VNS therapy does not eliminate the occurrence of seizures in most cases.
However, the VNS device can stop or decrease the time and severity of seizures when activated right before or during a seizure.
Most patients will continue to take their anti-seizure medications.
How does VNS work?
If a person has a seizure warning sign (aura), he/she or a trained observer may swipe the magnet over the VNS device to activate it and help abort the seizure.
The magnet may be swiped during an actual seizure to shorten the length of the seizure.
Once activated, the device will send an additional electrical impulse to the vagus nerve.
The magnet may be swiped over the VNS device as often as needed with at least one minute between swipes.
Stimulating the Vagus Nerve to Stop a Seizure
VNS magnets are usually worn on a belt or on the wrist.
Based on finding that starvation – which burns fat for energy – has an antiepileptic affect.
Used primarily to treat severe childhood epilepsy, has been effective in some adults and adolescents.
High fat, low carbohydrate and protein intake. Usually started in the hospital. Requires a strong family commitment.
Ketogenic Diet
Phone: 502-637-4440Toll Free: 1-866-275-1078Website: www.efky.org
Beth Blakeley, M.S. Director of Education
502-637-4440 [email protected]