Epilepsy Flashcards
what is epilepsy?
common condition that affects the brain and causes frequent seizures
what are seizures?
bursts of electrical activity in the brain
temporarily affects how the brain works
can cause a wide range of symptoms
when does epilepsy start?
any age
usually starts either in childhood or in people over 60
lifelong but can get slowly better over time
general symptoms of epilepsy?
uncontrollable jerking and shaking - fit
losing awareness and staring blankly into space
becoming stiff
strange sensations
collapsing
when to get medical help?
see GP if seizure experienced for the first time - may not be epilepsy there are several causes
when to call 999?
having a seizure for first time
has a seizure that lasts more than 5 mins
has lots of seizures in a row
has breathing problems or has serious injury
what are the general treatments for epilepsy?
anti-epileptic drugs
surgery
small electrical device implanted into the body to control the seizures
keto diet
what do treatments for epilepsy do?
can reduce the number of seizures or stop them completely
some need treatment for life
treatment can be stopped if seizures disappear over time
general living advice for people with epilepsy
most children can go to mainstream school driving certain jobs swimming contr
what needs to be considered in people with epilepsy?
swimming using contraception planning pregnancy bathing/showering driving
what are the causes of seizures?
stroke brain tumour severe head injury drug abuse/alcohol misuse brain infection lack of oxygen during birth
what happens to the brain in epilepsy?
electrical signals in the brain become scrambled and there are sudden bursts of electrical activity which causes seizures
family history of epilepsy
some genetic link
1/3 people with epilepsy have a family member with it as well
what are the different types of seizures?
simple partial/focal seizures/auras complex partial/focal seizures tonic-clonic seizures absence seizures myoclonic seizures clonic seizures tonic seizures atonic seizures status epilepticus
what are the triggers of seizures?
can be random or can have a trigger: stress lack of sleep waking up drinking alcohol medications illegal drugs menstrual cycle/periods flashing lights
simple partial/focal seizures or auras
general strangle feeling rising feeling in tummy deja vu unusual smells/tastes tingling in arms/legs intense feeling of fear or joy stiffness or twitching in the body awake and aware while these happen can be known as warnings/auras because they can be a sign that another seizure type is going to happen
complex partial/focal seizures
lose sense of awareness random body movements, such as: lip smacking rubbing hands random noises moving arms around picking at clothes fibbling with objects chewing swallowing non-responsive no memory of the events
tonic-clonic seizure
grand mal
has 2 stages - tonic and then clonic stage
tonic stage of tonic-clonic seizure
loss of consciousness
body goes stiff
fall to the floor
clonic stage of tonic-clonic seizure
limbs jerk about
lose bladder control or bowel control
may bite tongue or inside of cheek
difficulty breathing
post-drome of tonic clonic seizure
normally stops after a few minutes some last longer headache or difficulty remembering what happened tiredness confusion
absence seizures
petit mal
lose awareness of surroundings for short time
blank staring into space
look like daydreaming
flutter eyes
make slight jerking movements of body or limbs
who do absence seizures affect?
children mainly
what happens after an absence seizure?
last up to 15 seconds
unable to remember them
can happen several times a day
myoclonic seizures
where some or all of the body suddenly twitches or jerks
like an electric shock
often happens after waking
only last a fraction of a second
several can occur in a short space of time
normally remain awake
clonic seizures
causes the body to shake and jerk like a tonic-clonic seizure without the stiffness
last a few minutes and can cause loss of consciousness
tonic seizures
cause all muscles to suddenly become stiff
can cause loss of balance and falling over
atonic seizures
all muscles relax and people fall to ground
tend to be brief and people can usually get up again straight away
status epilepticus
any seizure that lasts a long time or a series of seizures where the person doesn’t regain consciousness in between
medical emergency
who will someone see after a seizure?
neurologist
how long will it take to see a neurologist?
within 2 weeks of referral
need to be cautious of another seizure while waiting - contact GP if there is another seizure
recording seizures
describe what happens when seizure happened what patient was doing when it happened feeling before, during and after write notes to take to appointment get a witness account - video or someone that saw it
what tests can be done?
electroencephalogram - EEG
brain scan
diagnosis of epilepsy
based on symptoms
checking brain activity
EEG used to check for unusual electrical activity in the brain that can happen in people with epilepsy
what happens in an EEG?
small sensors attached to scalp to pick up electrical signals and recorded by a machine
brain scans
can be used to identify causes of epilepsy - tumour, damage, stroke, scarring
MRI
anti-epileptic drugs
control seizures in 7/10 people
change chemicals in brain
don’t cure epilepsy
common anti-epileptic drugs
sodium valproate carbamazepine lamotrigine levetiracetam topiramate
how to choose an anti-epileptic drug?
depends on type of seizures
age
chance of having a baby
forms of anti-epileptic drugs
tablets, capsules, liquids and syrups
how are anti-epileptic drugs started?
low dose
gradually increase dose until the seizure stops
if first medication doesn’t work will recommend another
taking anti-epileptics
most need to be taken daily
never suddenly stop taking
don’t take other medications including OTCs or complementary meds without speaking to GP/specialist first
stopping anti-epileptics
if no seizure for a few years ask doctor before stopping and if safe dose will be reduced slowly
side effects of anti-epileptics
common
some appear soon after starting treatment and pass in a few days/weeks but others may not appear for a few weeks
what are the common side effects of AEDs?
drowsiness lack of energy agitation headaches uncontrollable shaking/tremour hair loss unwanted hair growth swollen gums rashes
too high dose of anti-epileptic
can cause symptoms similar to being drunk - unsteadiness, poor concentration, vomiting - need to contact GP/specialist
brain surgery for epilepsy
surgery to remove part of brain - can stop seizures completely
when is surgery an option for epilepsy treatment?
anti-epileptics are not controlling the seizures
tests show that seizures are caused by a problem in small part of brain that can be removed without causing serious effects
tests before surgery
brain scans EEG memory tests learning ability tests mental health tests
what is involved in surgery?
general anaesthetic
opening in skull
remove affected part of brain
close opening in skull
recovery of surgery
few weeks-months to get back to normal
seizures may not stop straight away so may need to keep taking anti-epileptics for 1-2 years
complications/risks of surgery
memory problems
mood changes
vision problems
problems may improve over time or can be permanent
other non-medication and non-surgical options for epilepsy
vagus nerve stimulation
deep brain stimulation
keto diet
complementary therapies
vagus nerve stimulation
small device under skin of chest attached to wire which connects to vagus nerve
bursts of electricity sent along wire to nerve to help control seizures by changing electrical signals to brain
doesn’t stop seizures completely but can reduce severity and frequency
still need anti-epileptics
side effects of vagus nerve stimulation
hoarse voice
sore throat
cough on activation of device - every 5 mins for 30 seconds
how long does vagus nerve stimulation last?
battery lasts up to 10 years, needs another procedure to replace
deep brain stimulation
device under skin in chest connected to wires that go to brain
bursts of electricity send to brain to prevent seizures
when is deep brain stimulation used?
new procedure
not used often
efficacy unclear
risks of deep brain stimulation
bleeding on brain
depression
memory problems
ketogenic diet
high in fat
low in carbs and protein
used to make seizures less likely by changing levels of chemicals in brain
who is a ketogenic diet recommended for?
children only when anti-epileptics don’t work
not used in adults due to increased risk of diabetes and CVD
requires dietician supervision
complementary therapies
no evidence
cautious of herbal remedies due to interactions with epilepsy medications - especially st john’s wort which can reduce efficacy of anti-epileptics
stress relieving and relaxation therapies
aromatherapy can trigger seizures
living with epilepsy
identify and avoid seizure triggers
regular reviews
take medicine
identify and avoid triggers
keep seizure diary to work out if there are triggers
deal with stress, avoid tiredness, cut down alcohol
regular reviews
done by GP or epilepsy specialist team
annually
more often if poor control of epilepsy
talk about treatment, problems, feelings
risky activities
cooking
driving
swimming
staying safe at home
heater and radiator guards
smoke detectors to alert burning food if loss of awareness
cover furniture edges/corners
shower rather than bath
don’t lock bathroom door
saucepans on back burners with handles turned away from edge
sports/leisure safety
avoid swimming/ water sports especially alone
wear helmet while cycling/horse riding
avoid certain gym equipment
driving issues
stop driving
tell DVLA
reapply for licence under certain circumstances
further info on gov.uk website
getting pregnant with epilepsy
can have healthy pregnancy
discuss plans with doctor
anti-epileptic drugs - sodium valproate can cause harm to baby
contact doctor if suddenly pregnant
contraception
some anti-epileptics can affect contraceptives’ efficacy - combined oral contraceptive pill
best contraceptives for people in anti-epileptics
IUD IUS progestogen-only injection condoms discuss emergency contraception with GP/pharmacist
advice for school/education
make sure teachers are aware of epilepsy, what medicine the child takes, how to spot and deal with seizures, impact epilepsy may have on attendance and schoolwork
some children need extra support
working with epilepsy
speak to employed if condition makes working difficult - change working hours, make sure no driving is involved, written rather than spoken instructions and extra breaks/time off for medical appointments
stopping working
entitled to financial support
what financial support is available?
statutory sick pay - if job but cannot work
no job and cannot work due to epilepsy = employment and support allowance
<64 years old and need personal care/walking aims = personal independence payment
>65 = attendance allowance
carer of someone with epilepsy = carer’s allowance
free prescriptions
anti-epileptics are free of charge and other meds for people on anti-epileptics
support groups for epilepsy
epilepsy action - helplines, online forums, general advice, support groups
epilepsy society = helplines
sudden unexpected death in epilepsy action = advice and support for SUDEP or loss of loved one
sudden unexpected death in epilepsy
person with epilepsy dies during or after a seizure with no obvious reason rare sometimes preventable well controlled epilepsy reduces risk avoid triggers take medication
SUDEP
sudden unexplained death in epilepsy
what to do in relation to driving if you have a fit/seizure/convulsion?
must tell DVLA if not there is risk of £1000 fine or prosecution if you have an accident as a result
what to do if you have a seizure and you have a car/motorcycle licence
fill in form FEP1 and send to DVLA
what to do if you have a seizure and a bus/coach/lorry licence?
fill in FEP1V form and send to the DVLA
what happens when you fill in FEP1/FEP1V form ?
may have licence taken away
what affects when you can reapply for licence?
what type of seizure, medications and how long since last seizure
what happens if you have epileptic seizures while awake that cause loss of consciousness?
licence will be removed
can reapply if you haven’t had a seizure for at least a year. This is different if there has been a change/reduction in anti-epileptic medication
when can you reapply for licence after change/reduction in anti-epileptics
seizure has to be more than 6 months ago
you have been back on previous medication for 6 months - following the seizure
not had another seizure since
driving rules if you have had a one-off seizure while awake and lost consciousness?
licence will be removed
can reapply
when can you reapply for driving licence if you have had a one-off seizure while awake and lost consciousness?
haven’t had a seizure for 6 months
DVLA medical advisors decide that there is not a high risk you will have another seizure
otherwise reapply after a year
what do DVLA medical advisers base their decisions on?
information from person and doctors
may need to carry out investigations
what happens with driving if you’ve had seizures while asleep and awake?
can qualify for a licence if only seizures have occurred while asleep for the last 3 years
fill in form and DVLA will let you know
stop driving until DVLA contact
driving if you’ve had seizures while asleep?
can qualify for a licence if it has been 12 months or more since first seizure
DVLA will inform once form has been sent
stop driving until contact from DVLA
driving if you’ve had seizures that don’t affect consciousness/driving?
if these are the only type of seizures and they haven’t occurred for 12 months then can keep licence but DVLA will contact with a decision once form is filled in. Must stop driving until then
bus/coach/lorry driving if had more than 1 seizure
before reapplying must show:
- no seizures for 10 years
- you haven’t been taking anti-epileptics for 10 years
- you haven’t got a 2% or higher risk of another seizure according to DVLA medical advisers
You need to have a car/motorbike licence as well
bus/coach/lorry driving if experienced a one-off seizure
no epileptic seizure for 5 years
no anti-epileptic medication for 5 years
must have a car/motorbike licence
must have been assessed in the past 12 months by a neurologist
must have results from medical investigations for epilepsy that are satisfactory to DVLA’s medical advisers
