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THE SEIZURE AND EPILEPSY PRESENTATION The KAPT

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THE SEIZURE AND EPILEPSY PRESENTATION The KAPT Powered By Docstoc
					Seizures & Epilepsy




  Beth Blakeley, M.S.
    Director of Education
   Epilepsy Foundation of
        Kentuckiana
National Epilepsy Facts:

  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.
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.
It is not getting better soon….
   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.
Epilepsy & Employment Facts:
  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.
What causes epilepsy?
   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
Dispelling Misconceptions about 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
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
What is the difference between Epilepsy and
Seizures?

     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
Seizure Facts:

     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.
What can trigger a seizure?

    Missed medication (#1 reason)
    Stress/anxiety
    Hormonal changes
    Dehydration
    Lack of sleep/extreme fatigue
    Photosensitivity
    Drug/alcohol use; drug interactions
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
Partial Seizures

                                                      Postictal
 Type      Duration   Seizures Symptoms               Symptoms
 Simple    10-90      No loss of consciousness        Possible transient
 Partial   seconds    Sudden jerking                  weakness or loss
                      Sensory phenomenon              of sensation

 Complex   1-10       May have aura                   Amnesia of
 Partial   minutes    Staring                         seizure events
                      Automatisms (such as lip        Mild to moderate
                      smacking, picking at clothes,   confusion
                      fumbling.)                      Sleepy
                      Unaware of environment
                      May wander
Each part of the brain is responsible for controlling   Parietal lobe –
various activities                                      controls the reception
                                                        and processing of
                                                        sensory information
        Frontal lobe –
                                                        from the body
        controls decision-
        making,
        problem solving
        and planning




           Temporal lobe –
           controls memory,
           emotion, hearing                                    Occipital lobe –
           and language
                                                               controls vision
                         Possible Affects of Partial Seizures

                                               Parietal lobe –
Frontal lobe –                                 seizures here can cause
seizures here                                  strange physical
may cause                                      sensations, such as a
disruptive                                     tingling or warmth down
behavior, running,                             one side of the body
screaming, fear,
anger, undirected
aggression or
swearing



    Temporal lobe –
    seizures here
    produces illusions
    of sounds such as                                 Occipital lobe –
    ringing sounds or                                 seizures here
    music. Seizures in                                create visual
    this area can also                                distortions and
    alter mood or                                     images of people
    consciousness                                     or things that
                                                      are not actually
                                                      there
  First Aid for Complex 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.


No first aid is necessary for simple partial seizures.
                                                                Generalized Seizures

      Type               Duration                   Seizure Symptoms                Postictal Symptoms

                                            Brief rapid muscle contractions
                    1 – 15 seconds          Usually affects both sides of body
  Myoclonic                                                                                   --
                    may occur in clusters
                                            Similar to leg jerks while sleeping
                                            Abrupt loss of muscle tone
    Atonic          1 – 15 seconds          Head drops
                                                                                              --
(or Drop Attacks)   may occur in clusters   Loss of posture, or sudden collapse
                                            Injuries – head gear
                                                                                   Amnesia for seizure
                                            Staring                               events
   Absence                                                                         No confusion
                     2 – 15 seconds         Eyes fluttering
   (petit mal)                                                                     Promptly resumes
                                            Automatisms if prolonged
                                                                                   activity

 Generalized                                Sudden cry                            Amnesia for seizure
 Tonic-Clonic                               Fall                                  events
                     1 – 10 minutes                                                Confusion
   (grand mal)                              Rigidity
                                            Convulsions                           Deep sleep
First Aid for Generalized Tonic-Clonic 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 on School Bus


• 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
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.
 When to call an ambulance
 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 pregnant
          Has diabetes/other medical condition
          Recovers slowly
          Does not resume normal breathing
Treatment Goals

  Help person with epilepsy lead full and
   productive life.
  Eliminate seizures without producing side
   effects.
Treatment Options

        Medication
        Surgery
        Nonpharmacologic treatment
            Vagus nerve stimulation (VNS)
            Ketogenic diet
            Lifestyle modifications
Factors that Determine Response
to Medication

     Consistent use           Seizures
                               markedly
     Inadequate dosage or     reduced
      ineffective medication   (30%)      Seizures
                                          eliminated
     Drug factors                        (50%)
     Disease

                               Seizures
                               do not
                               respond
                               (20%)
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.
How does VNS work?
   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.
                                        Stimulating the Vagus Nerve to
                                        Stop a Seizure


                                   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.




VNS magnets are usually worn on a belt or on the wrist.
Ketogenic Diet

    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.
                             Beth Blakeley, M.S.
                            Director of Education
                              502-637-4440 x14
                             bblakeley@efky.org




  Phone: 502-637-4440
Toll Free: 1-866-275-1078
 Website: www.efky.org