Lecture 20: Seizures

Question 1

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

Question 2

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

Question 3

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

Question 4

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)

Question 5

Types of Seizure Activity - Tonic, Atonic, Myoclonic, Clonic

Question 6

What is a Tonic seizure activity?

Answer 6

Muscles become stiff

Question 7

What is a Atonic seizure activity?

Answer 7

Sudden, unexpected loss of muscle strength or tone
* so in these seizures they go down quick - probs wont catch them

Question 8

What is myoclonic seizure activity?

Answer 8

Short, lightning-quick, jerking movements
* very uncontrolled

Question 9

What is clonic seizure activity?

Answer 9

Periods of rhythmic shaking or jerking movements

Question 10

What are the 2 kinds of focal seizures?

Answer 10

Focal Impaired Awareness

Focal Aware
* no LOC

so you’re either aware or your not

Question 11

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

Question 12

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”

Question 13

Rememebr w/ focla seizures they may or may not be aware, w/ generalized they are unaware (LOC)

Question 14

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)

Question 15

What kind of seizures are tonic clonic?

Answer 15

Generalized seizures (motor)

Question 16

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

Question 17

Treatment for seizures
* Medication
* Surgical procedures
* Seizure devices
* Diet

Question 18

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

Question 19

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

Question 20

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

Question 21

What is status epilepticus

Answer 21

Seizure lasting >5 minutes

Question 22

Diet for seizures:
* Ketogenic Diet
* Strict
* High-fat
* low carb
* Prescribed by health care provider
* Moniored by dietition

Question 23

Question 24

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

Question 25

dont want people running ontop of someone w/ a seizure nothing in mouth time seizure

Answer 25

get them to floor because they're going to lose consciousness

Question 26

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)

Question 27

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

Question 28

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

Question 29

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

Question 30

Question 31

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

Question 32

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