Seizures & Epilepsy Beth Blakeley, M.S. Director of Education Epilepsy Foundation of Kentuckiana

 Over 3 million Americans have epilepsy.  Roughly 181,000 new cases of seizures and epilepsy occur each year.  50% of people with epilepsy develop seizures by the age of 25; however, anyone can get epilepsy at any time.  Now there are as many people with epilepsy who are 60 or older as children aged 10 or younger. National Epilepsy Facts:

Kentucky Epilepsy Facts:  Over 90,000 of Kentucky’s residents have epilepsy.  This was discovered using the Centers for Disease Control & Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS).  BRFSS interviewed young – middle age adults via the telephone.  Because the very young nor very old were interviewed, experts at UK and UofL believe this number is actually closer to 180,000.

 Studies suggest that traumatic brain injury (TBI) leads to post- traumatic epilepsy (PTE) in approximately 20 – 25% of civilians with closed head injuries.  Approximately 1.4 million soldiers were recently deployed to and are now returning from missions in Afghanistan and Iraq, and many have sustained TBI’s because of improvised explosive devices (IEDs).  Approximately 50% of military head injuries lead to PTE.  Kentucky is home to two military bases (Forts Knox and Campbell), therefore epilepsy experts are expecting a wave of epilepsy diagnoses in the very near future. It is not getting better soon….

 Workers with epilepsy have a job performance record that compares favorably with the job performance record of workers who do not have epilepsy.  Most people with epilepsy do not need accommodations to do their jobs.  For those that do need accommodations, most are less than $500. Epilepsy & Employment Facts:

 In about 70% of people with epilepsy, the cause is not known.  In the remaining 30%, the most common causes are: Head trauma Brain tumor and stroke Lead poisoning Infection of brain tissue Heredity Prenatal disturbance of brain development What causes epilepsy?

 Most seizures are NOT medical emergencies.  Epilepsy is NOT contagious.  Epilepsy is NOT a form of mental illness, it is a medical condition.  People rarely die or have brain damage from a seizure.  A person can NOT swallow his/her tongue during a seizure Dispelling Misconceptions about Epilepsy

Who is at a risk for developing epilepsy?  Approximately 1% of the general population will develop epilepsy.  The risk is higher in people with certain medical conditions: Mental retardation Cerebral palsy Alzheimer’s disease Stroke Autism

What is a Seizure? Your brain cells (neurons) constantly send tiny electrical impulses (signals) that direct the functions of your body. All brain functions – including feeling, seeing, thinking and moving in the brain – depend on these electrical impulses passed between the neurons. A seizure occurs when too many neurons in the brain “fire” too quickly, causing an “electrical storm”. These uncontrolled electrical impulses can cause a change in awareness or movement.

Symptoms that may indicate a seizure disorder:  Periods of blackout or confused memory  Occasional “fainting spells”  Episodes of blank staring in children  Sudden falls for no apparent reason  Episodes of blinking or chewing at inappropriate times  A convulsion, with or without fever  Clusters of swift jerking movements in babies

Seizure – a brief, temporary disturbance in the electrical activity of the brain Epilepsy – a disorder characterized by recurring seizures A seizure is a symptom of epilepsy What is the difference between Epilepsy and Seizures?

There are over 20 different types of seizures. Some seizures cause people to shake, fall or have convulsions. Other seizures involve staring, confusion, muscle spasms, aimless wandering. Many seizure types do not cause loss of consciousness. Seizure Facts:

 Missed medication (#1 reason)  Stress/anxiety  Hormonal changes  Dehydration  Lack of sleep/extreme fatigue  Photosensitivity  Drug/alcohol use; drug interactions What can trigger a seizure?

Seizure Types  Generalized seizures Involve the whole brain and loss of consciousness Absence Generalized Tonic -Clonic  Partial seizures Involve only one part of the brain; may or may not include loss of consciousness Symptoms relate to the part of the brain affected Simple partial Complex partial

TypeDurationSeizures Symptoms Postictal Symptoms Simple Partial seconds No loss of consciousness Sudden jerking Sensory phenomenon Possible transient weakness or loss of sensation Complex Partial 1-10 minutes May have aura Staring Automatisms (such as lip smacking, picking at clothes, fumbling.) Unaware of environment May wander Amnesia of seizure events Mild to moderate confusion Sleepy Partial Seizures

Frontal lobe – controls decision- making, problem solving and planning Parietal lobe – controls the reception and processing of sensory information from the body Occipital lobe – controls vision Each part of the brain is responsible for controlling various activities Temporal lobe – controls memory, emotion, hearing and language

Frontal lobe – seizures here may cause disruptive behavior, running, screaming, fear, anger, undirected aggression or swearing Parietal lobe – seizures here can cause strange physical sensations, such as a tingling or warmth down one side of the body Occipital lobe – seizures here create visual distortions and images of people or things that are not actually there Temporal lobe – seizures here produces illusions of sounds such as ringing sounds or music. Seizures in this area can also alter mood or consciousness Possible Affects of Partial Seizures

Stay calm and track the time. Do not restrain the person. Remove dangerous objects from the person’s path. Calmly direct the person to sit down and guide him or her from dangerous situations. Use force only in an emergency to protect the person from immediate harm, such as walking out in front of an oncoming car. Observe, but do not approach a person who appears angry or combative. Remain with the person until he or she is fully alert. First Aid for Complex Partial Seizures No first aid is necessary for simple partial seizures.

TypeDurationSeizure SymptomsPostictal Symptoms Myoclonic 1 – 15 seconds may occur in clusters  Brief rapid muscle contractions  Usually affects both sides of body  Similar to leg jerks while sleeping -- Atonic (or Drop Attacks) 1 – 15 seconds may occur in clusters  Abrupt loss of muscle tone  Head drops  Loss of posture, or sudden collapse  Injuries – head gear -- Absence (petit mal) 2 – 15 seconds  Staring  Eyes fluttering  Automatisms if prolonged  Amnesia for seizure events  No confusion  Promptly resumes activity Generalized Tonic-Clonic (grand mal) 1 – 10 minutes  Sudden cry  Fall  Rigidity  Convulsions  Amnesia for seizure events  Confusion  Deep sleep Generalized Seizures

Stay calm and track the time. Do not restrain the person, but help them avoid hazards. Protect head, remove glasses, loosen tight neckwear. Move anything hard or sharp out of the way. Turn person on one side. Check for epilepsy or seizure disorder identification. Stay until person is fully aware and help re-orient them. Call ambulance if seizure lasts longer than 5 minutes, or if it is unknown whether the person has had prior seizures. First Aid for Generalized Tonic-Clonic Seizures

Safely pull over and stop bus Place student on his/her side across the seat facing away from the seat back (or in aisle if necessary) Follow standard seizure first aid protocol until seizure abates and child regains consciousness Continue to destination or follow school policy First Aid for Generalized Tonic-Clonic Seizures on School Bus

NEVER Put anything in the person’s mouth. Try to hold down or restrain the person. Attempt to give oral antiseizure medication. Keep the person on their back face up throughout convulsion.

 A convulsive seizure occurs in a person not known to have seizures or lasts more than 5 minutes.  A complex partial seizure lasts more than 5 minutes BEYOND its usual duration for the individual.  Another seizure begins before the person regains consciousness.  Also call if the person: Is injured or pregnant Has diabetes/other medical condition Recovers slowly Does not resume normal breathing When to call an ambulance

 Help person with epilepsy lead full and productive life.  Eliminate seizures without producing side effects. Treatment Goals

Medication Surgery Nonpharmacologic treatment Vagus nerve stimulation (VNS) Ketogenic diet Lifestyle modifications Treatment Options

Seizures eliminated (50%) Seizures do not respond (20%) Seizures markedly reduced (30%) Consistent use Inadequate dosage or ineffective medication Drug factors Disease Factors that Determine Response to Medication

Surgery Factors influencing decision: Likelihood seizures are due to epilepsy Likelihood surgery will help Ability to identify focus of seizures Other treatments attempted Benefits vs risks

Vagus Nerve Stimulation (VNS) Used to treat partial seizures when medication does not work. Vagus nerve serves many organs and structures, including: Larynx (voice box) Lungs Heart Gastrointestinal tract Vagus nerve has connections to areas of the brain that are instrumental in producing seizures. Pacemaker-like device is implanted in the left side of the chest with electrodes wrapped around the vagus nerve. Controls seizures by delivering electrical stimulation at pre-set time intervals to the left vagus nerve in the neck, which relays impulses to widespread areas of the brain.

The electrical stimulation produced by the VNS device can significantly decrease the brain’s ability to generate seizure activity in most patients. VNS therapy does not eliminate the occurrence of seizures in most cases. However, the VNS device can stop or decrease the time and severity of seizures when activated right before or during a seizure. Most patients will continue to take their anti-seizure medications. How does VNS work?

If a person has a seizure warning sign (aura), he/she or a trained observer may swipe the magnet over the VNS device to activate it and help abort the seizure. The magnet may be swiped during an actual seizure to shorten the length of the seizure. Once activated, the device will send an additional electrical impulse to the vagus nerve. The magnet may be swiped over the VNS device as often as needed with at least one minute between swipes. Stimulating the Vagus Nerve to Stop a Seizure VNS magnets are usually worn on a belt or on the wrist.

Based on finding that starvation – which burns fat for energy – has an antiepileptic affect. Used primarily to treat severe childhood epilepsy, has been effective in some adults and adolescents. High fat, low carbohydrate and protein intake. Usually started in the hospital. Requires a strong family commitment. Ketogenic Diet

Phone: Toll Free: Website: Beth Blakeley, M.S. Director of Education x14