General Epilepsy Flashcards
Incidence
3.1% of population (9 million people) suffer from epilepsy
Risk of epilepsy
5% of US population (15 million) will have a seizure at sometime in their lives
~1/2 of those will progress into epilepsy
Incidence rate of epilepsy
44/100,000 people in US
-61 for first time unprovoked seizures
39 for acute symptomatic seizures
100 for all seizures
Age with highest risk of epilepsy
> 75yo
Common etiology for epilepsy
- Stroke ~11%
- CP ~8%
First lifetime unprovoked seizure work up
Class B evidence:
EEG
MRI (pref 3 Tesla)
Types of abnormalities found on MRI after first unprovoked seizure
Tumors > developmental anomalies > hippocampal patholies > vascular malformations
Seen in ~14-23%
Recurrence rate for seizures
After 1st unprovoked sz: 40% within the first 2 years
After 2nd: 73%
After 3rdL 76%
After treated first unprovoked 15%
Seizure Recurrence after first unprovoked seizure according to Etiology and EEG findings
Etiology:
Idiopathic 32%
Symptomatic 57%
EEG
normal 27%
Epileptiform 58%
Etiology + EEG
Idiopathic +Normal 24%
Symptomatic + abnormal EEG 65%
Berg + Shinnar et all
Factors for seizure reucrrence
Focal >generalized Nocturnal seizures > daytime seizure Status epilepticus Abnormal interictal neuro exam Abnormal brain imaging Multiple or clustered seizures Strong family history of seizures
Percentage of seizure freedom
70% of epilepsy patients will eventually achieve seizure freedom
~11-41% will relapse after AED
-Less in children 20%
-Higher in adults 40%
Risk of relapse of epilepsy
Most within 1st year or AED withdrawal
More at risk if:
Severe and long lasting epilepsy before remission
JME 85%
Structural lesion
Risk from Epilepsy vs Surgery
- Injury
- SUDEP
- Quality of Life
- Side effects of medications
Temporal Lobe Epilepsy
Aura: epigastric, olfactory, gustatory sensation, emotional changes, sense of familiarity or strangeness, hallucinations, staring, automatisms
Abdominal aura 52% sensitivity and 90% specificitivity
Basal temporal lobe epilepsy presents with behavioral arrest or motor changes
Frontal lobe seizure semiology
Superior or Interhemispheric onset
Superior or Interhemispheric -> contralateral eye, head or body turning with tonic/dystonic posturing
Orbital frontal seizure semiology
unusual behaviors, hypermotor activity, rapid leg kicking/bicycling, autonomic findings, behavioral arrest, automatisms.
-Frequently in sleep, and are brief
Inferior frontal lobe seizures semiology
Referrable to face or to speech
Dorsolateral or dorsomedial frontal seizures
Contralateral motor findings
Premotor seizures semiology
Tonic version
Supplementary motor areas
Speech arrest
Fencer posturing
Bilateral hand motor findings
Head version
Insular seizure semiology
Visceral, gustatory, somatosensory symptoms (laryngeal constriction or paresthesias)
Parietal lobe seizure semiology
Somatosensory phenomena (pain/dysethesias)
Can be silent until propagated
-Can look like superior frontal lobe seizures or sensorimotor symptoms
Occipital lobe semiology
Visual auras and phenomena
Can be silent until propagation
Restrictions for Patients with Epilepsy
No working at unprotected heights (roofs, ladders)
No working around heavy machinery with moving parts
No construction equipment
No use of manufacturing equipment including fork lifts, heavy presses, conveyor belt systems
Avoid environmental triggers
Shower/bathe
Swim when supervised by someone and capable of helping
No cooking or working around open flames
No driving
Driving comercial Truck and Epilepsy
If seizure free on and off of meds 10 years can get license
One time event that is thought to be non-epileptic requiring no anti-seizure medication. Needs to be seizure free x 6mo
Single unprovoked seizure with no recurrence - 5 years off of medication
Acute symptomatic seizures with low risk of recurrence
No restriction if no seizures for 2+ years off of AED
Any one that has a procedure that penetrates the dura should not be considered eligible
Merchant Mariners and Epilepsy
If low risk recurrence and seizure free off of medication for at least 1 year
Seizures with high risk of recurrence - must be seizure free for 8 years on or off meds. If on meds, dose must be stable for 2 years. If off of meds, must be seizure free for 8 years from when stopping meds
Aircraft Pilots and Epilepsy
Disturbance of conciousness without satifsactory medical explanation - must report
Rolandic seizure - may be eligible if seizure free >4 years with normal EEG
Febrile seizure - without recurrence and off of meds for 3 years
Transient loss of neurologic function - required to report; FAA decision
Unexplained syncope, single siezure - denied
Special considerations: childhood epilepsy, but seizure free for number of years
Common seizure triggers
Stress Fatigue Medication compliance Excessive EtoH use Sleep deprivation
Accomodations in work setting for epilepsy
Minimize excessive stress
Limited work hours to 8-10hr/day
No third or midnight shift
No working at unprotected heights
No working around heaving moving and machinery
Avoided environmental situations that are known triggers
Providing assistive technology
Accomodations in school
Leniency on attendance
If seizures are active, they may need to rely on others for transportation
Can result in assignments not being completed or late
All night study sessions not possible
Avoidance of multiple exams on same day
Short term memory loss - no pop quizzes
Assitnace with reading, taking notes, or recording lectures.
Single room in college
Dogs/pets, single level home, access for rides, use of wheelchair
Disability and Epilepsy
What needs to be documented
EEG corroborating nature and frequency of seizures
Seizure semiology - observed by 3rd party or provider
History of treatment, response, recent changes
Compliance
Absorption or metabolism
AED levels - if low then explain,
