Seizures & Epilepsy

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

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?

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

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 Seizure Types

Partial Seizures

Each part of the brain is responsible for controlling various activities Parietal lobe – controls the reception and processing of sensory information from the body Frontal lobe – controls decision-making, problem solving and planning Temporal lobe – controls memory, emotion, hearing and language Occipital lobe – controls vision

Possible Affects of Partial Seizures Parietal lobe – seizures here can cause strange physical sensations, such as a tingling or warmth down one side of the body Frontal lobe – seizures here may cause disruptive behavior, running, screaming, fear, anger, undirected aggression or swearing Temporal lobe – seizures here produces illusions of sounds such as ringing sounds or music. Seizures in this area can also alter mood or consciousness Occipital lobe – seizures here create visual distortions and images of people 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

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

Seizures markedly reduced (30%) Seizures eliminated (50%) Seizures do not respond (20%) Factors that Determine Response to Medication • Consistent use • Inadequate dosage or ineffective medication • Drug factors • Disease

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

Seizures & Epilepsy