1. Berkshire West Primary Care Trusts EPILEPSY INTRODUCTION TRAINING PROGRAMME Berkshire West Primary Care Trusts is a collaboration between Newbury and Community, Reading and Wokingham PCTs

2. INTRODUCTION TO EPILEPSY Aims of the session
to meet the training needs of staff who care for clients who have epilepsy
to deliver information to enable staff to be better informed about epilepsy

3. LEARNING OUTCOMES (EPILEPSY)
have increased knowledge of epilepsy and its treatment
be familiar with the signs and symptoms of an epileptic seizure and its management
have received instruction in the appropriate use of the documentation required

4. The tendency to recurrent seizures
WHAT IS EPILEPSY?
The tendency to recurrent seizures

5. WHAT IS A SEIZURE?
The result of intermittent and abnormal bursts of electrical activity within the brain

6. INVESTIGATIONS AND DIAGNOSIS
Referral to doctor
History
EEG (electroencephalogram)
MRI Scan (Magnetic Resonance Imaging)
Videotelementry

7. CAUSES OF EPILEPSY In 7 out of 10 cases the cause will be unknown
Developmental anomalies in pregnancy
Trauma to the skull
Encephalitis
Brain tumours
Alcohol abuse
Serious brain infections such as meningitis
Brain surgery

8. TYPES OF EPILEPSY
IDIOPATHIC
SYMPTOMATIC
CRYPTOGENIC

9. TYPES OF EPILEPSY There are 3 types of epilepsy:
Symptomatic - where a
cause is found e.g. head injury, structural abnormality
Idiopathic - no cause but may be due to an inherent tendency to experience seizures
Cryptogenic - no cause is found but a structural rather than genetic cause is suspected

10. SEIZURE Partial Generalised
Seizure activity Seizure activity starts in one part involves the
of the brain whole brain

11. PARTIAL SEIZURE Simple Complex With secondary Generalisation
Seizure activity Seizure activity Seizure activity
while the person with change in begins in one
is alert awareness of area and
surroundings spreads to whole brain

12. GENERALIZED SEIZURE Absence Myoclonic Tonic-clonic Tonic Atonic
Staring and blinking without falling
Jerking movements of the body
Stiffening, tends to fall backwards if standing
Falling heavily to the ground
Stiffening, falling and jerking of the body

13. SEIZURE MONITORING OBSERVATION – BEFORE Aura/unusual sensation
Automatisms
Change in sleep pattern
Behaviour change
Lethargy
Scream/cry out

14. SEIZURE MONITORING
OBSERVATION – DURING
Automatisms (lipsmacking, chewing, confused behaviour)
Rigidity
Floppy
Involuntary/jerky movements (face, whole body, left arm, right arm, left leg, right leg)
Cyanosis
Cold and clammy
Frothing at mouth
Change in level of consciousness
Change in breathing pattern
Glazed/fixed stare
Unusual sounds
Grind teeth
Bite tongue
Undressing

15. SEIZURE MONITORING OBSERVATION – AFTER Confusion Aggression Drowsy
Headache
Tearful
Alteration in appetite
Thirsty
Hyperactive
Partial seizures
Automatisms

16. SEIZURE MONITORING OBSERVATIONS Sheet 3 Client Name ……………………………………………………………………………DoB ……………………………………
Date
Time
Seizure Length
Recovery Time
Observations Before Seizure
During Seizure
After Seizure
Signature

17. INJURY Please record any injury sustained during a seizure
DATE
TYPE OF SEIZURE
DETAILS OF INJURY
EMERGENCY TREATMENT GIVEN

18. POSSIBLE SEIZURE TRIGGERS
Hungry • Missed medication
Tired • Lack of sleep
Hormonal • Photosensitivity
Excitement • Alcohol
Boredom • Illness
Stress

19. WHEN THE SEIZURE STARTS:-
Note the time
Clear a space around the person, moving objects which may be harmful
Reassure others and explain what you are doing
Make the person comfortable
Cushion the head to prevent facial injury
Loosen tight neckwear
Remove spectacles and high heeled shoes if worn

20. WHEN THE MOVEMENTS HAVE STOPPED:-
Turn the person on their side (first aid recovery position)
Wipe away any excess saliva from the mouth
Check that vomit or dentures are not blocking the throat

21. AT THE END OF THE SEIZURE:-
Reassure the person if they seem confused and tell them what has happened
Check for signs of injury and apply first aid, if necessary
Observe the person and stay with them until recovery is complete (they may need assistance to return to their routine or find their way home)
Provide privacy and offer assistance if there has been incontinence

22. RECOVERY
Some people have seizures which put them temporarily into a state of altered consciousness
Behaviour may seem inappropriate e.g. they may wander around aimlessly with a glazed expression
During this type of seizure, the person should be accompanied and gently led away from any source of danger

23. DO’S AND DON’TS DON’T put anything in the mouth
DON’T restrain movements
DON’T move the person from the site unless in danger
DON’T assume recovery as soon as the seizure ends
DON’T panic

24. DO’S AND DON’TS DO keep calm
DO put the person on their side if you need to ensure the airway is clear/they need to have rectal diazepam
DO support the head to prevent injury
DO check for anything in the mouth and remove it ONLY when the seizure ends
DO stay with the person

25. THE RECOVERY POSITION

26. RECOGNITION OF A SEIZURE
any warning
description of events
alteration or loss of consciousness
change in colour
abnormal bodily movements
change in breathing pattern
inappropriate actions
TIME THE SEIZURE FROM WHEN ANY CHANGE FROM NORMAL BEHAVIOUR IS NOTED

27. SEIZURES THAT MAY REQUIRE MEDICAL INTERVENTION
Status Epilepticus
Serial Seizures

28. STATUS EPILEPTICUS
Status epilepticus is defined as a condition in which epileptic seizures continue, or are repeated without regaining consciousness for a period of 30 minutes or more.
Status epilepticus can occur with all the different seizure types.

29. SERIAL SEIZURES
Serial seizures are defined as seizures recurring at frequent intervals with full recovery between attacks

30. EMERGENCY PROCEDURES
999
CPR

31. NON-EPILEPTIC ATTACK DISORDER (NEAD)
Non Epileptic Attack (NEAD)
Not caused by Epilepsy
In the past referred to as pseudo-seizures
Many underlying reasons
Physical
Hypoglycaemia (low blood sugar)
Faints
Psychological
Panic attack
Delayed response to extreme stress and emotional cut off
Post traumatic stress disorder

32. GENERAL LIFESTYLE IMPLICATIONS
Leisure Activities
Sport
Alcohol and Drugs
Education
Work
Driving and Travel
General Safety Measures

33. DEATH IN EPILEPSY accidents status epilepticus
SUDEP– sudden unexpected death in epilepsy

34. WHAT IS SUDEP?
SUDEP is a recognised syndrome where a person with epilepsy dies suddenly and no other cause of death is found
Prevalence is 1:1000 per year
For people with severe epilepsy it increases to 1: per year

35. SUDEP RISK FACTORS young adults generalised tonic-clonic seizures
poor seizure control
unwitnessed seizures
abrupt and frequent changes in medication
non-compliance
alcohol
people with epilepsy whose seizures are not recorded in medical notes
Seizures during sleep

36. MEDICATION USED TO TREAT EPILEPSY
Carbamazepine - Tegretol and Tegretol Retard
Ethosuximide - Emeside and Zarontion
Lamotrigine - Lamictal
Phenytoin - Epanutin
Sodium Valporate - Epilem and Epilem Chrono
Acetazolamide - Diamox
Clobazam - Frisium
Clonazepam - Rivotril
Gabapentin - Neurontin
Keppra - Leveretacetam
Phenobarbitone - Phenobarbitone
Piracetam - Nootropil
Primidone - Mysoline
Topiramate - Topamax
Vigabatrin - Sabril
Tiagabine - Gabitril

37. THE HUMAN CEREBRAL HEMISPHERE SHOWING THE DIFFERENT LOBES

38. CONTACT DETAILS
READING LOCALITY Fiona Simpson/Barbara Chandler, Reading
Community Team for People with Learning Disability, PO Box 2624, Reading, RG1 7WB 
NEWBURY LOCALITY Nicky Macdonald, Newbury Community Team
for People with Learning Disability, Northcroft Wing, Avonbank House, West Street, Newbury, RG14 1BZ 
WOKINGHAM LOCALITY Mary Codling, Wokingham Team for People with Learning Disability, 2nd Floor, Wellington House, Wellington Rd, Wokingham, RG40 2AG
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