Epilepsy and Parkinsonism Flashcards
1
Q
Does massage therapy attempt to treat epilepsy?
A
No, massage therapy does not treat epilepsy. It may be provided for stress reduction, care of a seizure-related injury, or for unrelated reasons.
2
Q
What is the key concern of a massage therapist when working with a patient with epilepsy?
A
The patient’s safety is the primary concern. The therapist must understand epilepsy, minimize seizure risk, and know what to do if a seizure occurs.
3
Q
What factors influence the decision to provide massage to a person with epilepsy?
A
The therapist must have case history information, understand the potential impact of massage, and use sound judgment based on the individual case.
4
Q
In some cases, what is the best course of action regarding massage therapy for a patient with epilepsy?
A
Avoid massaging altogether or avoid massage during the patient’s unstable periods.
5
Q
Why is case history important for massage therapists working with epileptic patients?
A
It helps assess the nature and stability of the patient’s epilepsy and the potential seizure risk from massage.
6
Q
Who should provide case history information about a patient with epilepsy?
A
The patient and, in most cases, their neurologist.
7
Q
What medical indicators help assess an individual’s epilepsy status?
A
• Seizure frequency
• Seizure intensity
• Seizure type
• Seizure duration
• Duration of the disorder
• Associated disability/impact on quality of life
8
Q
What should the massage therapist look for in the patient’s general case history form?
A
Conditions that may correlate with seizures, such as:
• Diabetes
• Cerebral palsy
• History of head trauma
• Brain infection
• Stroke
9
Q
Why is it important to ask about co-existing conditions?
A
Patients may forget to mention them, and they can impact seizure stability.
10
Q
What is an important question to include on a standard case history form?
A
“Have you ever had seizures?”
11
Q
What physical impacts of epilepsy should the therapist consider?
A
Whether the individual has Chronic Cerebral Hypoxia and Fatigue (CCHF) and previous injuries related to seizures.
12
Q
Why is it important to check for seizure triggers regularly?
A
Life changes (e.g., injuries, illnesses, stressful events) can reduce seizure control.
13
Q
What medical factors can lead to seizure instability?
A
Starting new medications (related or unrelated to epilepsy) or changing dosages.
14
Q
What recreational habits may be relevant to seizure control?
A
Any habits that may influence seizure stability should be discussed in a comfortable manner.
15
Q
What aspects of seizure patterns should a massage therapist ask about?
A
• Seizure type(s)
• Whether the patient experiences an aura before a seizure
• Description of the aura(s)
• Whether the patient can communicate during an aura
• Typical seizure triggers
• Usual seizure duration and intensity
• Post-seizure state
• History of serious occurrences during seizures
• Frequency and date of last seizure
16
Q
How can auras be helpful for seizure management during massage?
A
If a patient can communicate an aura onset, it allows time to prepare for the seizure.
17
Q
Why should a therapist know a patient’s seizure triggers?
A
Some triggers may be easily produced during a massage or in the clinic environment.
18
Q
List common seizure triggers related to massage therapy.
A
• Allergic reactions (e.g., nut oils, substances in clinic)
• Aromas (e.g., aromatherapy products, perfumes, fresh paint)
• Pain (especially sudden or unexpected)
• Rhythmic percussive stimuli (e.g., tapotement)
• Extremes of hot and cold
• Water immersion
• Complex visual patterns (wallpaper, wall art, clothing)
• Fluorescent lighting
• Startling or rhythmic sounds (e.g., construction noise, dripping taps, ticking clocks)
• Specific trigger zones in body tissues
• Passive or active movement, tendon tap, muscle stretch responses
• Electrical stimulation in seizure-prone areas
19
Q
Why is it important to ask about a history of serious seizure occurrences?
A
If a patient has had dangerous complications and is highly sensitive to triggers, massage may not be advisable.
20
Q
Why do tonic-clonic seizures require special attention?
A
They have a high incidence of complications, requiring a thorough case history and vigilance during treatment.
21
Q
Why should a massage therapist ask about a patient’s medications?
A
To understand seizure control, medication stability, and potential side effects affecting treatment.
22
Q
During what life phases are medication needs likely to shift?
A
• Puberty
• Pregnancy
• Menopause
• Rapid growth phases
• Illness
• Injury
23
Q
Why is monitoring medication changes important for massage therapy?
A
Medication changes can cause ictal instability, affecting seizure risk.
24
Q
What is a common issue with epilepsy medication compliance?
A
Patients may struggle with compliance due to:
• Side effects
• Forgetfulness (as part of epilepsy or medication effect)
• Depression affecting self-care
25
What should the massage therapist do if medication noncompliance is suspected?
Be tactful, maintain awareness, and consider instability as a possible risk factor.
26
List common side effects of anti-ictal medications.
• Headache
• Nausea
• Lethargy
• Poor concentration and short-term memory
• Reduced problem-solving and new learning
• Blurred or double vision
• Ataxia (lack of coordination)
• Tremor
• Hyperactivity
• Belligerence
• Sleep disorders
27
What is a concerning long-term side effect of some epilepsy medications in children?
IQ deterioration.
28
What is a significant side effect of long-term Dilantin use?
Osteoporosis, especially in high-risk individuals (e.g., small-boned females over 40).
29
What condition may develop from long-term phenobarbital use?
Dupuytren’s contracture.
30
Does massage therapy attempt to treat epilepsy?
No, massage therapy does not treat epilepsy. It may be used for stress reduction, care of seizure-related injuries, or unrelated concerns.
31
What is the key concern for a massage therapist working with a person who has epilepsy?
The patient’s safety. The therapist must have a reasonable understanding of epilepsy, minimize the risk of triggering a seizure, and know what to do if one occurs.
32
What are important considerations when deciding whether to provide massage therapy to a person with epilepsy?
1. Case history information
2. Understanding the impact of massage treatment
3. Individual case judgment based on knowledge of the condition
33
Why is taking a thorough case history important when working with a patient with epilepsy?
It helps assess seizure risk and determine necessary treatment adaptations.
34
What indicators are used by the medical community to assess epilepsy severity?
• Seizure frequency
• Seizure intensity
• Seizure type
• Duration of seizures
• Duration of disorder
• Associated disability/impact on quality of life
35
What general health information should a massage therapist consider when reviewing a case history form for a patient with epilepsy?
• Conditions like diabetes, cerebral palsy, history of head trauma, brain infection, stroke
• Physical impacts of epilepsy, such as chronic cerebrospinal fluid hypertension (CCHF)
• Inventory of past injuries and healing status
36
Why should the presence of potential seizure triggers be reassessed over time?
Life changes (injury, illness, stress, new medications, dosage changes) can affect seizure control.
37
What seizure-related information should a massage therapist ask about?
1. Seizure type(s)
2. Presence of aura before seizures
• Description of aura(s)
• Can the patient communicate during an aura?
3. Typical triggers
4. Usual seizure duration and intensity
5. Usual post-seizure state
6. History of serious occurrences during seizures
7. Frequency and date of last seizure
38
Why are auras important in case history taking?
Auras act as prodromal signs, giving the therapist and patient time to prepare for an upcoming seizure.
39
Why is it important to ask about serious complications during past seizures?
If a patient has a history of dangerous seizures, especially those triggered by massage-related stimuli, treatment may not be advisable.
40
Why do tonic-clonic seizures require extra attention in case history taking?
They have a high incidence of complications, making thorough assessment and monitoring crucial.
41
Why should a massage therapist ask about medications when working with an epilepsy patient?
• Medication changes can impact seizure control.
• Some medications cause side effects that may affect treatment tolerance.
• Noncompliance with medication can lead to instability.
42
When are medication changes most common in epilepsy patients?
During puberty, pregnancy, menopause, rapid growth, illness, or injury.
43
What are some common side effects of anti-ictal medications?
• Headache
• Nausea
• Lethargy
• Poor concentration and short-term memory
• Blurred/double vision
• Ataxia
• Tremor
• Hyperactivity
• Belligerence
• Sleep disorders
• IQ deterioration (long-term use, especially in children)
44
What are two long-term medication side effects that are particularly relevant for massage therapists?
1. Osteoporosis – especially in small-boned females over 40 (due to long-term Dilantin use)
2. Dupuytren’s contracture – linked to phenobarbital use
45
Why should a massage therapist learn about a patient’s lifestyle, occupation, and support systems?
1. To assess epilepsy stability and general support needs
2. To understand limitations in daily life due to epilepsy
3. To be sensitive to concerns about prejudice and acceptance
46
How has epilepsy historically been perceived, and how can this affect patients?
It was often attributed to evil influences or personal defects, leading to fear, shame, and social limitations. This stigma can still impact patients today.
47
What case history findings might indicate that massage therapy should be avoided?
1. The patient is physically frail due to illness, injury, or epilepsy complications.
2. The epilepsy is currently unstable.
3. History of prolonged or dangerous seizures, especially recent ones.
4. Strong correlation between frequent seizures and triggers easily reproduced in a massage setting.
5. The patient is non-compliant or unwilling to communicate openly.
48
Why is trust important in the patient-therapist relationship for epilepsy patients?
• Patients need to communicate health updates and potential triggers.
• Therapists need to inform patients about treatment risks.
• A lack of trust makes safe treatment impossible.
49
What should a therapist do if a patient is a binge drinker?
Avoid massage during drinking phases, as alcohol can destabilize epilepsy.
50
How should a therapist address concerns about potential seizure triggers in a non-judgmental way?
By emphasizing patient safety and ensuring confidentiality.
51
Why can consent be a complex issue with epilepsy patients?
Seizures can alter consciousness, affecting a patient's ability to consent to treatment.
52
What should a therapist do if a patient who normally consents to treatment becomes incapable of doing so?
Immediately stop treatment and wait for the patient to regain the ability to consent.
53
When is it generally NOT advisable to resume treatment after a seizure?
If the seizure involved a change in consciousness (except for absence seizures).
54
What should a therapist consider if a patient arrives for treatment within 48 hours of a seizure?
Assess the patient’s usual recovery pattern and ability to respond normally.
55
Why are people with epilepsy less likely to be physically active?
• Fear of seizures/injuries
• Lack of driver’s license
• Fear of embarrassment
• Medication-induced fatigue/depression
• Doctor-imposed exercise restrictions
56
How does exercise benefit people with epilepsy?
• Seizure control
• Side effects of antiseizure medications
• Mood (reduces depression and anxiety)
• Sleep quality
• Cognition (thinking, memory, attention)
• Overall quality of life
57
What is the most commonly encountered neurological disorder in obstetrical practice?
Epilepsy.
58
What percentage of females experience an increase in seizure activity during pregnancy?
15-30%.
59
What are possible triggers for increased seizure activity during pregnancy?
Hormone changes, water and sodium retention, stress, and decreasing blood levels of antiepileptic medications.
60
Why are seizures more dangerous during pregnancy?
Risks include trauma from falls or burns, increased risk of premature labor, miscarriages, and lowering of the fetal heart rate.
61
What is the risk of congenital abnormalities in the general population?
2-3%.
62
How does the risk of congenital abnormalities change in females with epilepsy?
It doubles to about 4-6%, but overall remains low.
63
How can the risk of congenital abnormalities be increased in pregnant women with epilepsy?
Using more than one type of medication and taking a higher dose of medication.
64
How does genetics play a role in congenital abnormalities?
A previous pregnancy or family history of congenital abnormalities increases the risk during the current pregnancy. Genetic counseling is recommended.
65
What are the most common congenital abnormalities associated with epilepsy and pregnancy?
Cleft lip, cleft palate, cardiac defects, and urogenital defects.
66
What ongoing research is being conducted related to epilepsy and pregnancy?
Research on the risks of developmental delay.
67
What should a massage therapist recognize about pregnancy and epilepsy?
Pregnancy is a potential seizure trigger, and efforts should be made to avoid seizures.
68
Should pregnant patients with epilepsy avoid massage therapy?
Not necessarily. A thorough evaluation and consultation with a physician are necessary to determine suitability.
69
What happens to seizure frequency after delivery?
It typically returns to pre-pregnancy levels.
70
What is the primary focus of a treatment plan for a pregnant patient with epilepsy?
Patient safety.
71
Why might a standard treatment plan (e.g., for an ankle sprain) need modification for a patient with epilepsy?
To minimize seizure risk and ensure safe responses if a seizure occurs.
72
How should a massage therapist approach treatment for a patient with epilepsy?
With a slow and cautious approach, ensuring predictability and trust.
73
What special considerations should be taken when introducing new techniques?
Techniques involving pain or temperature should be introduced gradually.
74
What should be pre-established if a patient cannot communicate verbally during a seizure?
A signal to indicate seizure onset.
75
What topics should be discussed in a prior agreement about handling seizures?
1. Patient expectations and wishes.
2. The therapist’s responsibility for patient safety.
3. Conditions under which an ambulance should be called.
76
When should an ambulance be called during a seizure?
If the patient:
• Stops breathing
• Goes into cardiac arrest
• Seizures for more than 5 minutes
• Appears injured
77
What essential information should a therapist have on file?
• Doctor’s name, address, and phone number
• Preferred hospital
• Emergency contact person
78
What should be done if a patient has a seizure during a massage appointment?
Contact someone to pick them up rather than allowing them to leave alone.
79
What environmental factors should be controlled to minimize seizure triggers?
Lighting, scents, allergens, visual patterns, and sound stimuli.
80
What is the safest treatment setting for a patient prone to seizures?
A mat on the floor (unless the person is reliably seizure-free or small enough to be safely held on the table).
81
How should the massage space be arranged for seizure safety?
• Move furniture and sharp objects out of the way.
• Have at least six pillows available.
82
Are massage therapy modalities compatible with anti-epileptic drugs (AEDs)?
Generally, yes, but caution is advised regarding possible increased medication uptake from massage and hydrotherapy.
83
When is the best time to schedule a massage for a patient taking anti-seizure medication?
In the first half of the medication interval (e.g., before mid-afternoon if medication is taken in the morning and evening).
84
What additional considerations are needed for patients on muscle relaxant medications?
More modifications may be necessary in treatment due to altered muscle tone.
85
Why should therapists be extra attentive to patient feedback during treatment?
Patients taking anti-seizure drugs may have impaired focus and less precise feedback.
86
What should you NEVER do during a seizure?
1. Give medications unless directed by a doctor.
2. Place anything in the person’s mouth.
3. Attempt to immobilize the patient.
87
Why should nothing be placed in the patient’s mouth during a seizure?
Risk of choking or injury to both the patient and the helper.
88
What is the priority when a patient is having a tonic-clonic seizure?
Keeping the airway clear.
89
What are the steps to take during a Generalized Convulsive Seizure?
1. Move the person into the recovery position (three-quarter prone) immediately.
• Preferably on the floor, or on the table if necessary.
• This position helps keep the airway clear.
2. Protect the head and body.
• Place a pillow under the head.
• Position other pillows to cushion any body parts that may hit the floor or objects in the room.
3. Monitor the patient.
• Check that they are breathing by placing a hand near their nose and mouth.
• Watch for carotid artery pulsation in the neck or feel for a heartbeat.
4. Time the seizure.
• If it lasts more than 5 minutes, call 911.
5. After the seizure subsides:
• Move the patient into a supine position.
• Keep one or two pillows under the head.
• Cover them with a blanket if they feel cold.
90
What should you do if a patient reports having a seizure between appointments?
Be alert for new injuries and adjust treatment accordingly.
91
How do seizures affect the body postictally?
• Energy stores are drained.
• Muscles may experience overuse and toxicity syndromes for several days.
92
What long-term considerations should be monitored in a patient with recurrent seizures?
• Physical status changes.
• Changes in the patient’s ability to provide feedback or consent to treatment.
93
What is Parkinsonism?
Parkinsonism is an umbrella term for conditions characterized by Basal Ganglia dysfunction causing movement problems similar to Parkinson's Disease (PD).
94
What are the two main subtypes of Parkinsonism?
1. Parkinson’s Disease (PD)
2. Parkinsonian Syndromes
95
What is Parkinson’s Disease (PD)?
Parkinson's Disease (PD), formerly known as Paralysis Agitans, is the second-most common neurodegenerative disease, primarily affecting movement and caused by dopamine insufficiency due to degeneration of substantia nigra cells in the brain.
96
What is the primary risk factor for Parkinson's Disease (PD)?
The primary risk factor for PD is age, with approximately 1% of individuals over the age of 60 being affected.
97
What is the gender distribution for Parkinson's Disease (PD)?
Parkinson's Disease incidence is higher in males, with males being 1.5 times more likely to develop PD than females.
98
What geographic regions have higher incidence rates of Parkinson’s Disease (PD)?
Higher incidence rates are found in the "Rust Belt" (northwestern and midwestern U.S.), Southern California, Southeastern Texas, Central Pennsylvania, and Florida.
99
What causes Parkinson's Disease (PD)?
PD results from insufficient dopamine, the main neurotransmitter used by the basal ganglia. This occurs due to degeneration of substantia nigra cells and the presence of Lewy bodies in neurons.
100
At what point do symptoms of Parkinson's Disease (PD) typically appear?
Symptoms tend to appear after an 80% decline in dopamine availability.
101
What is the progression of symptoms in Parkinson's Disease (PD)?
Symptoms usually start gradually with unilateral resting tremor, followed by rigidity, bradykinesia, hypokinesia, motor weakness, diminished postural reflexes, and stability. Over time, symptoms become bilateral and intensify.
102
How is Parkinson's Disease (PD) diagnosed?
PD diagnosis is based on the presence of bradykinesia plus one or more of the following:
• Resting tremor in a limb
• Stiffness or rigidity in arms, legs, or trunk
• Trouble with balance and falls
103
What are the primary motor symptoms of Parkinson’s Disease (PD)?
• Resting tremor (especially in arms, jaw, head, face, and legs)
• Bradykinesia (which may progress to akinesia), including freezing during movement, and difficulty changing pace or direction
• Rigidity (e.g., leadpipe and cogwheel rigidity)
• Mask-like face (mask of Parkinsonism)
• Rigid dysarthria (speech changes)
• Reduced ribcage excursion, apical breathing, and shortness of breath
• Smooth muscle impairments leading to dysphagia/aphagia, constipation, bladder control issues, and sexual dysfunction
• Impaired postural control and balance issues
• Festination (shuffling gait)
• Frequent falls
104
What secondary symptoms are common in Parkinson’s Disease (PD)?
• Contracture
• Compression syndromes
• Arthritic changes
105
What autonomic nervous system (ANS) dysfunction symptoms may occur in Parkinson’s Disease (PD)?
• Excessive sweating
• Salivation
• Lacrimation (tear production)
• Sebaceous gland activity
• Bladder and sexual response issues
• Blood pressure stability problems
106
How does Parkinson's Disease (PD) affect sleep?
Individuals with PD may experience insomnia and other sleep disorders.
107
How does reduced dopamine volume affect emotional well-being in Parkinson’s Disease (PD)?
Reduced dopamine promotes anhedonia (inability to feel pleasure), which can lead to depression.
108
What percentage of people with Parkinson’s Disease (PD) develop dementia?
Up to 70% of people with Parkinson's will develop dementia as part of the disease progression.
109
How common are hallucinations or delusions in people with Parkinson’s Disease (PD)?
Between 20-40% of people with Parkinson's report experiencing hallucinations or delusions.
110
How does Parkinson's Disease (PD) affect sensation?
People with Parkinson’s typically have normal sensation, but their rigidity and other physical symptoms may cause considerable pain.
111
What is Parkinsonism?
Parkinsonism is an umbrella term for conditions characterized by basal ganglia dysfunction, causing movement problems similar to Parkinson's Disease. It is subdivided into Parkinson’s Disease (PD) and Parkinsonian Syndromes.
112
What are Parkinsonian Syndromes?
Parkinsonian Syndromes are a range of syndromes caused by damage to one or more basal nuclei, reflecting a broader range of symptoms and dysfunctions compared to Parkinson’s Disease.
113
What are the most common causes of Parkinsonian Syndromes?
The most common causes include:
1. Drugs that block or interfere with dopamine action (e.g., antipsychotic drugs).
2. Degenerative disorders (e.g., Alzheimer’s, multiple system atrophy, corticobasal degeneration, frontotemporal dementia, progressive supranuclear palsy).
3. Viral encephalitis (e.g., West Nile virus).
4. Structural brain disorders (e.g., brain tumors, stroke).
5. Head injury (e.g., repeated injury in boxing).
6. Wilson disease (mainly in young people).
7. Certain spinocerebellar ataxias.
8. Drugs (e.g., metoclopramide, prochlorperazine, antipsychotics).
9. Toxins (e.g., manganese, carbon monoxide, methanol, trichloroethylene).
114
What are some examples of drugs and toxins that can cause Parkinsonian
Drugs include metoclopramide, prochlorperazine, and antipsychotics. Toxins include manganese, carbon monoxide, methanol, and trichloroethylene (TCE).
115
What is the medical treatment for Parkinsonism?
Treatment mainly consists of drug therapies and supportive measures. Research also suggests that nutrition, exercise, and stress reduction can help maximize function and energy.
116
Why can't dopamine be given as a medication for Parkinsonism?
Dopamine cannot cross the blood-brain barrier, so it is not effective as a direct treatment. However, its precursor, levodopa, can cross the barrier in small amounts and help.
117
What is levodopa, and how does it work in treating Parkinsonism?
Levodopa is a dopamine precursor that can cross the blood-brain barrier (1-3%) and is used to increase dopamine levels in the brain. It was initially promising but can cause severe side effects when used in the doses needed for symptom relief.
118
What types of medications are used in the treatment of Parkinsonism?
Medications fall into several categories:
1. Increase dopamine levels (e.g., levodopa, levodopa-carbidopa, pramipexole, amantadine, MAO-B inhibitors).
2. Slow dopamine breakdown (e.g., COMT inhibitors like entacapone).
3. Anticholinergic drugs to help balance excitatory and inhibitory stimulation and reduce tremor and rigidity.
4. Medications for secondary symptoms and side effects (e.g., constipation, headaches).
119
What is the role of anticholinergic drugs in Parkinsonism treatment?
Anticholinergic drugs help offset motor problems caused by an imbalance between excitatory and inhibitory stimulation. They are effective for symptoms like tremor and rigidity.
120
What are the common side effects when using multiple medications for Parkinsonism?
Drug mixtures can produce undesirable effects, so practitioners must be cautious about interactions between medications.
121
What are some surgical treatments for Parkinsonism?
Surgical treatments include:
1. Deep Brain Stimulation – Electrodes implanted to stimulate dopaminergic function or suppress cholinergic function.
2. Duopa – A pump delivers carbidopa-levodopa directly to the intestines for better absorption.
3. Excision of malfunctioning centres in the brain.
4. Implantation of fetal or stem cells to regenerate dopamine-producing cells.
