RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling Epilepsy

The most common of the chronic neurological disorders – 1: Epilepsy is not contagious and people with epilepsy are NOT “crazy” Etymology of the word comes from a Greek word meaning “to possess, seize or hold.” Historical figures with Epilepsy Julius Ceaser George Fredrick Handel Fyodor Dostoevsky Peter the Great Napoleon Bonaparte Vincent Van Gogh Pope Pius IX

Epilepsy Diagnosed with the occurrence of two or more seizures A seizure involves the disruption of the normal activity of the brain through neuronal instability Seizures prevent the brain from interpreting and processing incoming sensory signals & controlling muscles. Sometimes people know when they are about to have a seizure because they see, hear or feel something different – this is known as an “aura.” Auras can act as an early warning for a person that a seizure is about to happen.

Seizures “Provoked” Metabolic disorders Hypoglycemia Electolyte imbalance Withdrawal from massive amounts of alcohol or sedatives Massive sleep deprivation High fever Hypoxia Substance abuse Excessive use of stimulants

Seizures “Unprovoked” TBI Birth trauma Anoxia Brain tumors Infectious diseases in the mother Parasitic infections Genetic Vascular diseases affecting the brain’s blood vessels Neurotransmitter GABA (gamma-amino butyric acid) imbalance

Epilepsy 1-2% of people with epilepsy will have a diagnosable genetic etiology for their seizure occurrence The general incidence of epilepsy is between 1% and 4% Two major type so seizures: Generalized and Partial Generalized – uncontolled discharge of neurons on BOTH sides of brain. Seizure starts in one area and spreads across the brain. Partial – abnormal electrical activity involving only a small part of the brain - although sometimes a partial seizure can spread to the whole brain

Generalized Seizures Tonic-clonic seizures “grand mal” – massive discharge of neurons on both cerebral hemispheres. Body becomes rigid and jerks. “Tonic-clonic” means “stiffness-violent” “grand mal” means “great sickness” Absence seizures Non-convulsive. Person may be unaware of surroundings and stare off. Lasts only 5-30 seconds Atonic seizures Loss of muscle tone – causes person to fall down Myoclonic seizures Involves motor cortex and causes twitching or jerking of certain body parts. Status epilepticus Frequent, long-lasting electrical activity with no regaining of consciousness between attacks. Very dangerous and requires immediate medical attention.

Partial seizures Simple partial seizures “Jacksonian” or “focal” seizures. Short seizures with no loss of consciousness People may see, hear or smell something odd & their body may jerk. Complex partial seizures “Psychomotor” seizures A seizure with a change, but no loss, in consciousness. People may hear or see things or have a memory resurface. Déjà vu may occur.

Conditions that may look like a seizure Syncope “Psychogenic” seizures Breath-holding spells Paroxysmal REM sleep behavior Panic attacks

International classification of epilepsies Originally established in 1989 – currently under revision Current system comprises two major categories: Localization-related syndromes  Idiopathic  Symptomatic Generalized-onset syndromes  Idiopathic with age-related onset  Idiopathic &/or symptomatic  Symptomatic  Nonspecific etiology  Specific syndromes

Evaluation of single seizure History of event Medical History Family History Social History Physical Examination Neurological Examination Laboratory Evaluation EEG MRI Routine lab work

Treatment and Prognosis Antiepileptic (anticonvulsant) medications Carbamazepine (Tegretol) Clobazam (Frisium) Clonazepam (Rivotril) Diazepam (Valium) Divalproex sodium (Depakote) Ethosuximide (Zarontin) Phenobarbital (many different names) Phenytoin (Dilantin) Valproic Acid (Depakene)

Surgery Temporal Lobe surgery removal of cortex of temporal lobe where the epileptic seizure starts. May also remove hippocampus and amygdala. Corpus Callostomy the corpus callosum is cut to separate the right and left cerebral hemispheres. This procedure is done to prevent the spread of the seizure from one side of the brain to the next. Hemispherectomy one cerebral hemisphere is removed. Not done very often. Children CAN function reasonably well, but often find using their arm on the opposite side of the body to be difficult. Some surgeries remove just a specific lobe of the brain.

Other treatments Vagal nerve stimulation Electrical stimulator placed in the Vagus nerve (cranial nerve X) Vagus nerve function: sensory, motor and autonomic functions of viscera (glands, digestion, heart rate) Ketogenic diet High fat, low protein/carbohydrate diet

Vocational Implications For an individual client, the counselor must understand the following: Specific type of seizure with a clear description of what happens What type of seizure control the person has achieved If the person has a specific warning or aura What is involved in the recovery period If the person has ever been injured as a result If the person has any other disabilities The type of medication and compliance

Vocational Implications Driving – Florida’s Law Seizure-free for 6 months and under regular medical supervision with doctor’s recommendation No waiver provision for people with epilepsy in regards to a commercial license Can drive taxi if meet personal requirements Not eligible to drive school bus or buses designed to seat more than 15 people No provision to require doctors to report to a central state agency – anyone may report

Additional Resources and Information from the Web Epilepsy Foundation of America ( Epilepsy Foundation of Northeast Florida ( Online resource of Epilepsy Project ( JAN’s webpage (