U3A SCIENCE GROUP 15TH JUNE 2018 FITS, FAINTS AND FALLS -a discussion Dr Marion Overton

Why the title? FAINTS affect ¼ to ½ adult population at some time in their lives FITS: commonest cause affects 1% of the population FALLS in the over 65s per year 30%

FAINTS Temporary Spontaneous Loss of consciousness With complete recovery

Causes of Faints Psychogenic Temporary lack of oxygen to the brain a) pooling of blood in the extremities b) heart problems –arrhythmias/ coronary artery spasm c) reduction of oxygen in the blood

How can we know what the cause is? History, including witness account before the event during it during the recovery period Personal/family history of heart disease Medication

Referral to hospital? Loss of consciousness during exertion Known heart problem Family death from heart disease under age 40 Over 65 with no prodromal symptoms NO DRIVING until you have been seen!

FITS –a tendency to Spontaneous Intermittent Abnormal electrical activity, in part of the brain, manifest as seizures

Features of Epilepsy History and witness account Before –change in mood/behaviour -identifiable precipitants -aura During –occurs when lying down/asleep –bitten tongue –tonic/clonic phase -incontinence After the event –amnesia, confusion, sleep

Types of Epilepsy “Not everything that twitches is Epilepsy; Not all Epilepsy twitches” 1) Grand mal –generalised, LOC, tonic/clonic 2) Complex Partial –starts in one area; may become generalised 3) Petit Mal/Absence –may stop talking, pause, then carry on where left off 4) Myoclonic –muscle suddenly contracts 5) Atonic –muscle suddenly relaxes

Causes of seizures Epilepsy may be caused by genetic mutations or abnormalities eg tuberous sclerosis Seizures may also be caused by Infections –meningitis, HIV, syphilis Tumours Strokes (bleeds into or clots in the brain) Subdural or extradural haemorrhages Metabolic –low sodium/glucose; high glucose/calcium Alcohol or drug withdrawal

Why does a diagnosis of Epilepsy matter? Stigma Implications for employment, insurance and driving (one year ban after any part of a seizure or change in medication) Side effects of medication, including on unborn child Sudden death in epilepsy

FALLS Interaction with our surroundings Illnesses at the time of the fall, Both acute eg faints And chronic eg epilepsy

Prevention of Falls Improve balance, coordination and muscle strength Attention to foot problems (and footwear) +other joints Correct poor vision and lighting Vitamin D supplements Medication review Safety in the home and garden BE SENSIBLE!