Lecture 20: Seizures Flashcards
Seizure info:
2.9 million US adults 18 and older
about 1% of all us adults
Active Epilepsy/Seizure Disorder
* Taking medication to control or had at least one seizure in the last 12 months (or both)
Annual health care spending for epilepsy and seizures 24.5 billion in US
Barries to care
* Harder time getting health care - family doctors wont want to give you care “out of my scope”
* Have trouble finding health care provider or specialists - not loads of neurologists, especially for kids
* Delay care because of transportationbarriers
* Unable to afford medicine or specialty care
* Unable to afford dental or vision care - because you dont want to have a seizure while getting dental care
* Skip doses of medicine to save money
Types of seizures
* Named based on where seizure starts in the brain
* Focal seizures
* Generalized seizures
* Epilepsy: can have more than one type of seizure - everytime they have a seizure it can be something different
* Neurologists: Doctors who specialize in the brain and nervous system
* Epileptologists: Neurologists who specialize in epilepsy
Focal seizures
* Focal onset seizures
* begin on one side of the brain
May cause changes in:
* Awareness
* Behavior
* Sensation
* Abnormal movements-usually one side of body - and smaller - because its coming fomr one side of the brain
Possible to spread to both sides of the brain-Cam caise loss of consciousness and movements on both sides of the body
Generalized Seizures:
* Generalized onset seizures
* Begin (or appear to begin) on both sides of the brain at the same time
* Usually cause LOC or awareness
* May cause abnormal movements on BOTH sides of the body (makes sense ebcause the entire brain is impacted)
Types of Seizure Activity - Tonic, Atonic, Myoclonic, Clonic
What is a Tonic seizure activity?
Muscles become stiff
What is a Atonic seizure activity?
Sudden, unexpected loss of muscle strength or tone
* so in these seizures they go down quick - probs wont catch them
What is myoclonic seizure activity?
Short, lightning-quick, jerking movements
* very uncontrolled
What is clonic seizure activity?
Periods of rhythmic shaking or jerking movements
What are the 2 kinds of focal seizures?
Focal Impaired Awareness
Focal Aware
* no LOC
so you’re either aware or your not
Focal onset Aware Seizures:
* No LOC
* Can sometimes talk during
* May remember them after they happen
* Used to be called “simple partial seizures”
* May have abnormal movements - think twitching of jaw - typically smaller
Focal Impaired Awareness Seizures
* LOC
* May or may not cause abnormal movements
* Used to be called “complex partial seizures”
* Confused or dazed
* Pick at cloths
* Smack lips
* Unable to respond to questions or directions for a few minutes
sometimes parents will just say “the zone out”
Rememebr w/ focla seizures they may or may not be aware, w/ generalized they are unaware (LOC)
Generalized motor seizurs:
** Loss of awareness / consciouness** - always
* Muscle movements (stiffen, relax, jerk, spasm, or shake)
* Tonic clonic seizures: generalized motor seizure with muscle stiffness and rhythmic jerking - note this is a big seizure
* May cause confusion and tiredness afterwards - because they’re big
* Used to be called “grand mal seizures” - because they’re the big bad ones
can lose control of bowel or bladder w/ these (motor)
What kind of seizures are tonic clonic?
Generalized seizures (motor)
Generalized Nonmotor (absence) seizures
** Short, sudden lapses of consciousness** - because generalized
* May not be noticed
* Used to be called petit mal seizurses
* Stare into space
* Blink eyes quickly - you can see it in their eyes typically
* make chewing or hand movements
Treatment for seizures
* Medication
* Surgical procedures
* Seizure devices
* Diet
Medication:
* Anti-seizure medications limit spread of seizures in brain
* Work w/ 2/3 of people w/ epilepsy
Side effects of these medications:
* Fatigue
* Slowed cognitive
Cannot skip or stop taking seizure medication
Withdrawal symptoms include life threatening seizures - so increase seizure activity
Surgery for seizures
* Single area of brain (focal)
* Remove affected area
* May stop fiture seizures or make easier to contorl w/ meds - think cutting corpus collosum - keeps it from jumping sides of brain
* Risks
Seizure Devices:
Vagus nerve stimulation: - helps prevent seizures
* Epectrical device placed under the skin on upper chest
* Energy pulses to brain through vagus nerve
* Can stop seizures
Responsive nerve stimulation
* Electrical device palced in brain to find where seizures are coming from
* Sends energy pulses to that area to prevent seizures
What is status epilepticus
Seizure lasting >5 minutes
Diet for seizures:
* Ketogenic Diet
* Strict
* High-fat
* low carb
* Prescribed by health care provider
* Moniored by dietition
Seizure management for pts
* Check w/ physician before taking other medications or supplemnets - dont recommend supplements to these pts
* Track seizures to understand patterns
* Understand triggers
* Practice a healthy lifestyle
* 7-8 hours of sleep each night
* EX regularly and sately each day
* Eat a well balanced diet and keep healthy wt
* dont use tobacco
* limit alc
* Avoid illegal drugs prescription drugs in ways other than prescribed
* Keep other health conditions in check - when your body gets out of homeostasis seizures increase
* Take care of mental health
* Practice ways to lower stress - stress does trigger seizures
* Get help for emotional problems
* Use stratgies to help with memory problems - uncontrolled seizures leads to memory problems
* joint self mangement programs
dont want people running ontop of someone w/ a seizure
nothing in mouth
time seizure
get them to floor because they’re going to lose consciousness
Things to not do to people who are having seizures
* Dont hold person down to stop their movements
* Dont put anything in their mouth
* Dont give mouth to mouth breaths during the seizure
* People suaully start breathing again on their own following a seizure
* Dont offer water or food until they are fully alert (choking risk)
Call 911 if:
* Seizure lasts longer than 5 minutes (status epilepticus)
* Another seizure soon after - so 2 back 2 back - espeically if they dont typically have multiple seizures
* Have trouble breathing or waking up after seizure
* Injured during seizure
* Happens in water
* Never had a seizure before
* Have diebetes
* Preggo
Sudden unexpected death in epilepsy
* Major concern
* Death in people w/ epilepsy not caused by injury, drowning, status epilecticus
* rare: 1/100 = adults
* less common in children 1/4,500 under age 17
Causes of this
* Most occur with generalized seizure during sleep
* Breathing problems: Seizure may cause apnea-can reduce o2 in blood
* Suffocation from covered or obstructed airway
* heart rhythm changes or bradycardia
Risk factors for sudden unexpected death in epilespy
* Generalized seizures
* Uncontrolled or frequent seizures
* Possible risk factors
* Having seizures from a young age
* Living w/ epilespy for many years
* Male
* Missing doses of seizure medicine
* Having seizures during sleep
Driving:
* Some US states have driving restrictions to address public safety concerns for people with certain health conditions including epilepsy. Restrictions vary from state to state.
* Most states will not issue drivers license to someone w/ epilesy unless they can prove they have not had a seizure for a specific amount of time
* Seizure free periods range from a few months to over a year, depending on the state
Overall health and safety
* Most people w/ epilesy live a full life
* Feel cut off from others, sad, or stressed
* Controlling seizures can reduce risk of brain damage or death
* Uncontrolled seizurs can limit some activities
* Mental health issues
* Regression in skills: cognitive and motor
controlling seizures = controlling risk of brain damage
