C21 Epilepsy and Seizure Disorders https://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_tools/epilepsy_overview_slideshow/webmd_rm_photo_of_seizure_illustration.jpg

Overview Define Epilepsy Identify Different Types of Seizures Diagnosing Epilepsy Discuss Treatment Options Prognosis Living with Epilepsy

Epilepsy A neurologic disorder resulting from an abnormality of the brain and ends up causing a specific type of seizure It can affect anyone of any age group and will cause a change in behavior Epilepsy cannot be prevented, but there are ways to living a healthy, adequate life with this disorder https://www.epilepsysociety.org.uk/sites/default/files/styles/gallery_image/public/images/mindmap.jpg?itok=kVd1GwRX

Different Types of Seizures Generalized clonic-tonic (Grand-Mal) Absence (Petit-Mal) Partial (Focal)

Different Types of Seizures Generalized clonic-tonic (Grand Mal): This type of seizure is more violent when observing signs and symptoms. It can be identified when the individual is hypersalivating (foaming at the mouth), loss of muscle control, has loss of consciousness and unable to control urination and defecation. During a Grand-Mal seizure, respirations may cease due to the tonic spasm of the diaphragm muscle and the patient can become cyanotic from lack of breathing. As a result, the patient will most likely go into a postictal state after seizing, wake up in a confused mental status and may not recall what just happened. Postictal state can range anywhere from 5-30 minutes Different Types of Seizures Generalized clonic-tonic (Grand Mal):

Different Types of Seizures Absence (Petit-Mal): This kind of seizure is harder to recognize with the specific signs it has. For the observer, the patient may look as though they are daydreaming or absentmindedness. More common in younger children, usually no earlier than the age of four and no later than ages of puberty. A good sign to tell if someone is having a Petit-Mal seizure is if they suddenly stop talking or responding while looking off into the distance. Another symptom is a rapid movement of the eyelids, fingers or facial muscles. Unlike Grand-Mal seizures, with Petit-Mal seizures the patient will usually return to normal activity or behavior after seizing. Different Types of Seizures Absence (Petit-Mal):

Different Types of Seizures Partial (Focal): Focal seizures affect the contralateral side or one side of the body (only one specific part of the brain) and have the potential to damage the patient’s speech, language and certain areas of movement in the body. With Focal seizures, it is important to understand, one may not tell when an individual is having this type of seizure because they can be fully aware while seizing. Different Types of Seizures Partial (Focal):

Diagnosing Epilepsy Electroencephalogram (EEG *most common) Computed Tomography (CT) Magnetic Resonance Imaging (MRI *gold standard) Positron Emission Tomography (PET)

Electroencephalogram (EEG *most common) https://i.imgur.com/ZrmxJRu.jpg Small metal wires are attached to the scalp where the device measures electrical brain activity Not all EEGs are accurate, findings from this test may present as normal in 55 percent of patients who have epileptogenic lesions https://www.researchgate.net/profile/Saeed_Masoudnia/publication/270523871/figure/fig1/AS:295103303307266@1447369518607/An-exemplary-of-raw-normal-seizure-free-and-epileptic-seizure-of-EEG-signals.png

Computed Tomography (CT) Abnormal CT contrast enhanced scan of the brain with seizure activity involving the left cerebral hemisphere. Better visualization and demonstration of hard and some of the soft tissues in the cranium If CT results come back as negative or undetermined, MRI imaging may be required https://pmj.bmj.com/content/postgradmedj/75/890/757/F1.medium.gif

Magnetic Resonance Imaging (MRI *gold standard) High resolution that can detect underlying abnormalities in the brain and the diagnosis of epilepsy MRI can detect changes in white matter of the brain that occur usually after withdrawing of an antiepileptic medication, along with any cerebellar signal changes after a seizure

https://encrypted-tbn0. gstatic. com/images https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcT76cGF-CsZQQ-0US_V29Fx9LpmgptVHutbYOaIF1IjCydYMibH MRI of the brain. Image to the left shows a normal brain and tissues. Image to the right demonstrates abnormal tissue on the left side of the brain as a result of seizure activity.

Positron Emission Tomography (PET) Use F-Fluorodeoxyglucose to trace metabolic activity or detect malignant tissues PET scans are more sensitive by 70-80 percent and have a low percentage of false- positive results https://karmanhealth-karmanhealthcare.netdna-ssl.com/wp-content/uploads/2014/09/epilepsy-wheelchair-disability.jpg PET scan of the brain. The image to the left shows a normal brain with the radioactive tracer material. The image to the right visualizes damage to the right side of the brain as a result of seizure activity.

Ways to Treat Epilepsy Prescribed anticonvulsant medications *most common Different medications for the certain type of seizure Vagus Nerve Stimulator (VNS) device implant Natural Remedies: Cannabidiol (CBD) oil Keto diet Surgery

Prescribed anticonvulsant medications *most common For Grand-Mal and Petit-Mal seizures, medications commonly used are valproic acid (Depakote®) and phenytoin (Dilantin®) For Partial (Focal) seizures, medications commonly used are called levetiracetam (Keppra®) or oxcarbazepine (Trileptal®) The goal of these types of medications are to reduce or eliminate the number of seizures

Vagus Nerve Stimulator (VNS) Device Implant Implanted into the chest wall and electrodes stimulate the vagus nerve at the left carotid bifurcation to help reduce the amount of seizures This device can last anywhere from three to eight years and will not interact with any other medications https://www.pacificneuroscienceinstitute.org/assets/vns-diagram-labels-LivaNova-med.jpg

Natural Remedies Cannabidiol (CBD) oil: Keto Diet: Is administered to epileptic patients in an encapsulated gelatin capsule that is taken orally CBD oil causes less adverse effects compared with traditional AEDs, because cannabis products are derived from natural sources and are unlikely to be harmful Keto Diet: Due to research, being on the diet could reduce the amount of anticonvulsant medications

Surgery Able to remove abnormal brain cells that are creating the seizures for those who have chronic epileptic seizures, lesions or tumors from traumatic brain injury Typically surgery is the last option due to it being an invasive procedure and the risks for the patient. Risks include but are limited to: Infection Brain bleeds Death, in rare cases Surgical procedures for epileptic patients have been proven to be successful long term http://hybridoperatingroom.com/hybrid-operating-room-imaging-system-imris-intraoperative-mri-ct/

Prognosis of Epilepsy Little is known when it comes to life expectancy If a patient has a seizure that lasts longer than 5 minutes, the mortality rate can increase substantially Sudden unexpected death in epilepsy (SUDEP) Those with idiopathic epilepsy (Grand-Mal seizures) have a life expectancy up to 2 years shorter Prognosis of Epilepsy

Living with Epilepsy Avoiding triggers that set off seizures such as; Bright, flashing lights Drug and/or alcohol abuse Loud noises Stress and lack of sleep Life long condition that can be controlled by certain methods In some cases, a healthy diet and exercise are beneficial Those with epilepsy can lead normal lives May have limitations Examples include; driving, swimming, etc. http://www.justscience.in/wp-content/uploads/2017/12/why-do-people-get-epilepsy-how-can-it-best-be-treated.jpg

Facts/Statistics of Epileptic Disorder 3 million adults and 470,000 children have epilepsy in the US There is no cure currently for epilepsy Epilepsy is most commonly diagnosed in people under 20 and people over 65 Roughly, 1 out of 26 people in the U.S. may have a seizure during their lifetime November is National Epilepsy Awareness Month https://www.sutterhealth.org/images/health-topics/imaging/physician-viewing-brain-scan-600x300.jpg

Epilepsy Recap Click on any topic to go back to that slide Different Types of Seizures: Generalized clonic-tonic (Gran... Absence (Petit-Mal) Partial (Focal) Diagnosing Epilepsy: Electroencephalogram (EEG *most common) Computed Tomography (CT) Magnetic Resonance Imaging (MRI *gold standard) Positron Emission Tomography (PET) Ways to Treat Epilepsy: Prescribed anticonvulsant medications *most common Vagus Nerve Stimulator (VNS) Device Implant Natural Remedies Surgery Prognosis of Epilepsy Living with Epilepsy Facts/Statistics of Epileptic Disorder

References Hinners J. Epilepsy and Magnetic Resonance Imaging. American Society of Radiologic Technologists. 2018;89(5):467-481. Eisenberg RL, Johnson NM. Epilepsy and Convulsive Disorders. Comprehensive Radiolograhic Pathology. 6th ed. St. Louis, MO: Mosby Inc.; 2016:326-327. Rodriguez D. Preventing Epilepsy Seizures. EverydayHealth.com. https://www.everydayhealth.com/epilepsy/preventing-epilepsy-seizures.aspx Published February 21, 2012. Accessed October 14, 2018. Living with Epilepsy. Epilepsy Foundation. https://www.epilepsy.com/living-epilepsy Accessed March 9, 2019. Epilepsy Awareness Month. EFEPA - Epilepsy Foundation Eastern Pennsylvania. https://www.efepa.org/get-involved/neam/ Accessed March 9, 2019.