Presentation of epilepsy Focus
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Transcript Presentation of epilepsy Focus
Seizures and
Epilepsy
PRESENTED BY
GERRY BROPHY
Training in Care Solutions
The brain is made up of billions of neurons, or
nerve cells. These are the electrically
charged units that, as they communicate with
each other, organize electrical energy to
make the brain work.
A neuron has three parts—
a cell body, an axon, and dendrites.
The enzymes and genetic material which directs the neuron are
contained in the cell body.
The cell body is surrounded by thin, branch-like projections, or
dendrites.
The axon is a long, thin, tail-like extension from the cell body,
insulated by a sheath of myelin. It carries an electrical charge to
the axon terminal, where it activates the release of neurotransmitting chemicals.
A. Primary Generalized Seizure
B. Partial Seizure
C. Partial Seizure with Secondary Generalization
Definitions: Clinical
An epileptic seizure :
is an intermittent stereotypical, usually unprovoked,
disturbance of consciousness, behaviour, emotion, motor
function or sensation that on clinical grounds results from
cortical neuronal discharge
Epilepsy is a condition in which seizures recur, usually
spontaneously
Definition of Epilepsy by cause
Idiopathic
Symptomatic
Drugs
Alcohol
Birth Trauma
Brain Tumour
CVA (stroke)
Infection
How Many People Have Epilepsy?
Epilepsy is the most serious neurological disorder affecting
people of all ages.
It is believed that, as an absolute minimum, 0.5% of the
population have Epilepsy, this equates to 1 person in every
200, (350,000 people).
20% of children, onset being before the age of 5 years.
30% are sufferers between the ages of 6 and 25 years
50% the onset is after the age of 25.
What causes seizures to happen
In most people with epilepsy, seizures are spontaneous
events without a clear cause?
However, in a few people, seizures can also be
triggered by specific stimuli such as flashing lights of
certain frequencies.
Lack of sleep exhaustion, boredom, anxiety, abrupt
stopping of anti-epileptic medication, to much
alcohol, recreational drugs, computer screens and
games and also a bang to the head or accident can all
cause them.
What types of seizures
do you know?
Classification of Seizures
Partial-onset seizures
Simple partial
Complex partial
Secondary generalised tonic-clonic
Classification of Seizures cond.
Generalised-onset seizures
Typical absence
Atypical absence
Myoclonic
Atonic
Primary generalised tonic-clonic
Clonic
Tonic
Partial-onset seizures
Commence at any age
Usually have an aura which reflects seizure origin and
initial spread.
Awareness may be retained (simple partial), partially
preserved or lost (complex partial)
Can be secondary generalised tonic clonic
Common patterns e.g. clustering
Generalised-onset Seizures
Childhood, adolescence, young adults
No warning
Abrupt loss of consciousness (except myoclonus)
Occur in normal e.g. typical absence or
diffusely abnormal brain e.g. tonic drop attacks
Common pattern; soon after wakening
Seizures involving
altered consciousness
or behaviour
Simple partial seizures
Twitching,
numbness,
sweating,
dizziness or nausea;
disturbances to hearing, vision, smell or taste; a
strong sense of deja vu.
Complex partial seizures
Plucking at clothes.
Smacking lips.
Swallowing repeatedly or wandering around.
The person is not aware of their surroundings or of
what they are doing.
Atonic seizures
Sudden loss of muscle control
Causing the person to fall to the ground.
Recovery is quick.
Tonic-clonic Seizures
Can be primary or secondary generalised
Distinction has implications for management
Myoclonic seizures
Brief forceful jerks which can affect the whole body or
just part of it.
The jerking could be severe enough to make the
person fall.
Absence seizures
The person may appear to be daydreaming or
switching off.
They are momentarily unconscious and totally
unaware of what is happening around them.
Diagnoses of Epilepsy
Blood tests.
These are done to check the general health of the
person and help exclude a metabolic cause for the
epilepsy.
CAT scan or MRI scan
These help to exclude structural cause for the epilepsy
and seizures.
EEC (Electroencephalogram)
This test measures the electrical activity of the surface
of the brain at the time of the test.
Prevalence of epilepsy in people
with Learning Disability
Up to 30% of people with LD have epilepsy
About 30% of people with epilepsy have LD
More common in people with severe to profound LD
50%+
Current antiepileptic drugs
Phenobarbitone 1912
Primidone
1952
Carbamazepine 1963
Clonazepam
1974
Vigabatrin
1989
Gabapentin
1993
Topiramate
1995
Oxcarbazepine 2000
Pregabalin
2004
Phenytoin
1938
Ethosuximide
1960
Sod. Valproate 1974
Clobazam
1982
Lamotrigine
1991
Piracetam
1993
Tiagabine
1998
Levetiracetam 2000
Zonisamide
2005
A Common Sense Approach
Issues Specific to Learning Disability
Communication
Care situation
Co-morbidity
Communication
People with Learning Disabilities are more
likely than the general population to have
communication difficulties.
This can make information gathering and
history taking difficult.
Communication
Various reasons:
• “Physical” e.g. dysarthria due to cerebral palsy,
deafness, cleft palate.
• “Psychological” e.g. specific deficits due to autism,
mute due to anxiety/ depression.
• “Pathological” e.g. due to the severity of
intellectual impairment – i.e. lacks ability to
understand and communicate.
Communication
May have no verbal communication, but may
communicate through:
• Signing – e.g. Makaton
• Pointing – e.g. to word cards
• Picture boards / communication passports
• Gesture
• Carers
• Facial expression
• Behaviour
So don’t make assumptions - ask!
Communication
May have verbal communication but :
• Do not properly understand questions
• Cannot adequately describe symptoms
• Cannot understand concept of time
• Cannot see this as important/ relevant
• Wishes to avoid talking about epilepsy
• Finds talking about other subjects more interesting
Carers
Clients now find themselves in a variety of care
settings:
Family home
Their own homes – with professional support - from
minimal to 24 hours
Shared tenancies
Group homes
Nursing Homes
Continuing NHS Care
Private Care Homes
Epilepsy Care Plans
These should include:
Contact details for all involved
Details of Medication
Summary of Seizure Types
Annual/ monthly Seizure Charts
Rescue Medication protocol
An epilepsy history
A section to record any contact the patient has with GP/
hospital/ nurse, etc
Carers - Training
Carers need to be trained in the following areas:
Epilepsy Awareness
Administration of Rescue medication
Rectal diazepam
Buccal Midazolam
First Aid and Basic Life Support
Moving and Handling
But also may need to be individualised for specific
patients/ circumstances
Co-morbidity - Physical
Genetic conditions predisposing to physical illness
• Downs Syndrome - hypothyroidism, leukaemia, heart
defects, diabetes
• Tuberous Sclerosis - kidney and cerebral tumours
Physical condition of which LD is a feature
• Cerebral Palsy – scoliosis, prone to urinary or respiratory
infections
• Encephalitis – epilepsy
Developmental disorders of which physical disorder is a
feature
• Autism - epilepsy
Co-morbidity - Difficulties
Investigations:
May not tolerate investigations (or presumed they will
not tolerate investigations)
May have non specific abnormal results (associated with
aetiology of Learning Disability but not necessarily of
seizures)
Consent issues – MCA 2005
Co-morbidity - Difficulties
Medications:
Drug interactions
Side effects
•
•
AEDs - Cognitive/ Behavioural/ Physical
Psychotropics - lower seizure threshold
Compliance
Consent
Formulations
•
PEG feeding, swallowing problems
Practical difficulties in LD and
epilepsy
Diagnostic difficulties
Difficulties getting accurate information from carers
Lack of carer education / experience of epilepsy
Mistaking stereotypes with seizure activity
Client tolerance of investigations
Non Epileptic Attack Disorder (NEAD)
Management Difficulties
Increased rates of side-effects
Patients may not be able to report side effects
Other behaviours and psychiatric disorder may be
masked by high levels of sedation
Informed consent about care plan may be impossible
Medical Emergencies
Status Epilepticus or Recurrent seizures (i.e. more
than 2/3 without apparent recovery in-between)
Unusually prolonged seizure (Depends upon
individual)
Not responding to Stesolid (Rectal valium)
Not known to have epilepsy
Medical Emergencies
Cluster of seizures without signs of stopping (Recurrent
seizures with recovery period between).
Suspected serious secondary injury (e.g. from fall during
tonic stage).
You are concerned and need further advice .
Remember - if in doubt do too much rather than too little
EMERGENCY FIRST AID
Tonic-Clonic seizures
The person loses consciousness, the body stiffens, then
falls to the ground.
This is followed by jerking movements. A blue tinge
around the mouth is likely. This is due to irregular
breathing.
Loss of bladder and/or bowel control may occur.
After a minute or two the jerking movements should
stop and consciousness may slowly return.
First Aid
Don’t panic .
Once a seizure has started there is nothing you can do
to stop it.
If you can get to the person quickly enough try to
gently lower them to the ground.
Remember to look after your back and if the person is
writhing violently it may be best to stand away and let
the person fall.
If you get injured you will be of no use to the person
having a seizure.
Make a note of the time.
First Aid
Once the person is on the floor try to loosen any
clothing such as belts, ties buttons etc. This is to
ensure an adequate blood and oxygen flow.
Do not restrain the person in any way. The violent
contractions of the muscles could results in bone
breakage.
If possible remove any objects that could cause further
injury to the person. Move chairs and tables out of the
way as well as knives and forks.
First Aid
Try to put something soft under their head to prevent
any head injuries e.g. cushions or blankets or even your
coat.
Never put anything in the mouth or try to remove the
tongue from between the teeth. If they are going to
bite their tongue or lips they will have already done so.
When the seizure has finished. Check the airway and
breathing, put the person gently in the recovery
position.
First Aid
After the seizure the person may simply fall asleep
where they are. They may be confused and dazed but
will almost certainly want to sleep.
Stay with the person and accompany them to their bed
or the nearest sofa. Let the person sleep and check on
them regularly.
Record the seizure.
Don't...
Restrain the person
Put anything in the person’s mouth
Try to move the person unless they are in danger
Give the person anything to eat or drink until they are
fully recovered
Attempt to bring them round
Call for an ambulance if...
You know it is the person’s first seizure
The seizure continues for more than five minutes
One tonic-clonic seizure follows another without the
person regaining consciousness between seizures
The person is injured during the seizure
You believe the person needs urgent medical attention
Recording a seizure.
There is no agreed standard for the recording of
epileptic seizures.
Partial seizures .i.e. absences may be difficult to spot
and therefore record accurately.
Generalised seizures are easier to record but activity
before the seizure took place may be of greater
importance in identifying and preventing triggers than
other details.
Recording a seizure
If someone has regular seizures it maybe possible to
break the recording down.
For example first try to identify what time of day the
seizures are most likely to occur .i.e. their duration.
Then concentrate on what the person is doing
immediately preceding a seizure to try and establish if
there are obvious triggers.
Finally concentrate on what actually takes place during
the seizure. For example; colour changes, movements,
breathing, and condition after the seizure.