EPILEPSY
Epilepsy is a disorder that temporarily changes the way the nerve impulses of
the brain work. Messages usually travel in the brain in an orderly way,
however with epilepsy, the messages can become scrambled due to too
many nerve impulses firing too fast. The disturbed nerve activity causes
seizures.
Not all seizures are convulsive (involving stiffness and jerking of the limbs).
There are about 40 different types of seizures. There are four main categories
of seizures. There is the tonic-clonic seizure (grand mal seizure) whereby the
muscles contract and then they jerk. There are absence seizures in which the
person loses awareness of their surroundings briefly (petit mal seizure). The
third type is the complex partial seizure where consciousness and recall are
impaired plus there is also repetitive behaviour such as wandering, repeating
words, speech disturbance, and lip smacking. The fourth type is the simple
partial seizure where only one side of the brain misfires the signals. There
may be sudden jerking movements, dizziness, numbness, speech disturbance
or other disturbances of the senses. The symptoms occur whilst the person is
fully aware.
Prevalence:
Up to 3% of people have epilepsy, it is the second most serious form of brain
disorder after strokes.
Epilepsy can affect people of all ages, geographical regions and socio-
economic status. Slightly more males have epilepsy than females. Most
people have their first seizure before the age of 20, however the onset can
occur at any age.
60-75% of people can have their seizures reduced or controlled through using
anti-epileptic drugs. There is no cure for epilepsy.
People with epilepsy are at special risk of having two life-threatening
conditions, these are Status Epilepticus and Sudden Unexplained Death.
Cause:
For the majority of people the causes of epilepsy cannot be identified. Other
people who have epilepsy have it due to conditions such as: head injury,
stroke, lack of oxygen at birth, brain infections (such as meningitis) or brain
tumours.
Triggers for an epileptic fit:
Illnesses such as ear infections or tonsillitis in children can cause fits.
Diarrhoea and vomiting may cause seizures, as either condition can reduce
the absorption of anti-epileptic medication.
Allergies can also provoke seizures.
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There are many lifestyle factors that increase the chance of having an
epileptic fit. These include:
Drinking excess alcohol.
Increased anxiety or stress.
Patterns of flickering light.
Fatigue.
Too many late nights.
Lack of sleep (such as with shift work, or caring for a baby).
High fevers during illness. (This is more common in children than in
adults).
Hormones: Many women have an increased prevalence of seizures
immediately before or during the menstrual cycle.
Poor nutrition.
Skipping meals.
Treatments:
There are a range of treatments for people with epilepsy. The most common
form of treatments are medications, however some people have surgery when
management with medications do not work for them.
There are many medications used for epilepsy. Some of the main medications
are Tegretol, Dilantin, Epilim, Rivotril, Gabitril, and Neurontin. As with any use
of medications there are side effects.
The following medication information is from the brochure “Guide to
medications for people with epilepsy” produced by the Epilepsy Association.
The most noticeable side effects of:
Tegretol are nausea, dizziness, rash, blurred vision, drowsiness and
unsteady movements.
Dilantin are hair growth, acne, and gum swelling.
Epilim are nausea, weight gain, temporary hair loss and drowsiness.
Rivotril are drowsiness, nausea, poor coordination, behaviour
problems, learning difficulties, excessive salivation and drooling.
Gabitril are dizziness, tiredness, agitation diarrhoea, feeling depressed
or emotional and tremour.
Neurontin are drowsiness, fatigue, dizziness, unsteadiness, double
vision and weight gain.
Signs and Symptoms of Absences (Petit Mal Seizure).
In an “absence” the person stops what they are doing and stares, blinks or
looks vague for a few seconds and then they continue with the task they were
doing. Very young or very old people may drool during an absence.
What to do for an Absence (Petit Mal seizure):
Do not try to “wake” the person up from an absence, they will do this
themselves.
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Tell the person what has happened during their seizure as this space of time
will be a gap in their memory.
Reassure the person.
Orient the person if necessary.
Signs and Symptoms of a Tonic-clonic (Grand Mal Seizure).
The person with epilepsy may feel light headed prior to the seizure.
Seizures usually start with a cry, as the diaphragm spasms pushing air out of
the lungs.
After the person collapses the muscles collapse, and then there are jerking
movements.
The person may lose control of their bladder or bowel.
The person may appear blue or red in the face. After three minutes the person
will usually gain control of their tongue and will commence breathing normally.
The person will probably be drowsy after the seizure.
What to do for a Tonic-clonic Seizure (Grand Mal seizure):
Time the seizure.
Stay Calm.
Clear the space of harmful objects
Protect the person from obvious injury
Loosen the person’s collar or tie.
Place something soft under the head and shoulders.
DO NOT APPLY CPR
DO NOT PUT ANYTHING IN THE PERSON’S MOUTH
DO NOT RESTRAIN THE PERSON
DO NOT GIVE THE PERSON ANYTHING TO DRINK UNTIL THEY
HAVE RECOVERED CONSCIOUSNESS AND ARE NOT DROWSY.
As soon as possible roll the person onto their side to keep the airway
open.
You may notice bleeding from the person’s mouth, this is most likely
because they have bitten their tongue, rather than being from an
internal injury.
Stay with them and reassure them until they have fully recovered.
If necessary send for a friend or relative to take them home.
If the person is in a wheelchair, pram or stroller:
Do not remove them from the chair.
Prevent them from falling if the chair does not have a seat belt.
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Support their head if there is no head rest on the chair.
IF THE AIRWAY IS BLOCKED AT THE END OF THE SEIZURE,
TAKE THEM OUT OF THE CHAIR AND LIE THEM ON THEIR
SIDE, ENSURE THE AIRWAY IS CLEAR.
Call an ambulance if:
The person has fitted for more than five minutes
If the person has not regained consciousness after the seizure.
If it is possibly the first time a person has had a seizure.
The person has another seizure shortly after the first seizure.
The person has been injured.
You are in doubt as to whether the person is OK.
Environmental considerations to reduce the risk of someone with
epilepsy being injured:
Fit a thermostat to the hot water in the kitchen and bathroom to reduce
the risk of the being burnt. (The NSW health standards are:40.5º C to
43.5º C with a cut off at 46º C for adults. For children the temperature
is: 38ºC to 40.5ºC with a cut off at 43.5º C. This standard is currently
being revised, the website: http://www.health.gov.au/fcsd/rmc/cib/ has
revised circulars, that will provide up to date information.)
Install shatter proof glass and mirrors if possible.
Install doors that swing outwards, or sliding doors in the bathroom and
other small rooms. It increases the chance of help being able to reach
the person if they have collapsed in the room, and have blocked the
door.
Where possible, use appliances that switch off automatically eg. the
kettle.
Use the microwave rather than the stove if possible.
If the stove is used, use the back elements rather than the front ones.
Place safety guards in front of heaters. Where possible have fan
heaters or bar heaters that can be fixed high on the wall.
Try to have furniture with rounded edges, or place small rubber
stoppers on the sharp edges of furniture.
Associations:
The Epilepsy Association can be contacted on ph: 1300 366162 from
anywhere in NSW or ACT.
The Epilepsy Association provides a range of help including provision of
advice and education sessions.
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References:
Australian Broadcasting Commission. Radio National: The Health Report with
Norman Swan. 24.5.99. Epilepsy Misdiagnosis. Available online:
http://www.abc.net.au
Australian Broadcasting Commission. 7:30 Report 3.7.02.Support groups
lobby for research into SUDEP (sudden unexplained death in Epilepsy).
Available online: http://www.abc.net.au
Australian Epilepsy Associations. 2001.Epilepsy and Health: Guide to
medications for Epilepsy. Epilepsy Association Australia, Sydney.
Australian Epilepsy Associations. 2001.Epilepsy: What to do. Epilepsy
Association Australia, Sydney.
Epilepsy Action. 2002. Epilepsy Information: Introduction. Available online:
http://www.epilepsy.org.uk
Epilepsy Action. 2002. Epilepsy Information: Seizure Types. Available online:
http://www.epilepsy.org.uk
Epilepsy Foundation of Victoria, Australia. 2002. Epilepsy and Lifestyle
issues. Available online: http://www.epinet.org.au
Epilepsy Foundation of Victoria, Australia. 2002. First Aid and Epilepsy-
Wheelchair. Available online: http://www.epinet.org.au
Epilepsy Foundation of Victoria, Australia. 2002. Key points about Epilepsy.
Available online: http://www.epinet.org.au
Epilepsy Foundation of Victoria, Australia. 2002. Seizure Trigger Factors.
Available online: http://www.epinet.org.au
Epilepsy Foundation of Victoria, Australia. 2002. Understanding Epilepsy.
Available online: http://www.epinet.org.au
National Institute of Neurological Disorders and Stroke. 2002. NINDS Epilepsy
Information Page. Available online: www.ninds.nih.gov
Parasol. EMT Pty Ltd. 2002. Epilepsy. Available online:
http://www.parasolemt.com.au
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