EPILEPSY

EPILEPSY

Brenda Willis

Regional ManagerSouth West Region

Introduction

• Epilepsy Society is the largest epilepsy charity in the UK

• Founded in 1892

• Today: Research, Out Patients Clinics, Assessment Centre, Care Services, Training, Information Services and Awareness Raising

What is Epilepsy?

• A neurological condition where there is a tendency for people to have repeated seizures that start in the brain

• Symptom of underlying cause

• There are more that 40 types of epileptic seizures

• Up to 70% of people with epilepsy can have their epilepsy controlled by prescribed medication

Epilepsy in the UK – the facts

• 1 in 20 people will have a single seizure during their lifetime

• 1 in 50 people will develop epilepsy• Highest incidence in children and elderly• 75 people a day are newly diagnosed as having

epilepsy (that’s 27,400 per year)• More than 1 in 100 people have epilepsy at any one

time – more than half a million people….

Figures from Joint Epilepsy Council

What causes epilepsy?

• Structural damagetumour, scarring, lesions, stroke, drug or

alcohol abuse, birth trauma, brain parasites• Infection

Meniningitis, Encephalitis• Inherited causes

Seizure threshold, tuberous sclerosis, neurofibromatosis

• Unknown

What are epileptic seizures?

Brief events caused by disturbances of brain

activity that cause a change in the persons– Awareness– Behaviour– Emotion– Feelings– Movement

Different areas of the brain

They communicate with each other through small electrical impulses

PROBLEM SOLVING PERCEPTION

EYES

MEMORY

EARS

SENSATION

LEGS

ARMS

What is epilepsy? Usual activity

A B Epilepsy

A B

Seizures happen when…

• …a message is not switched off after it has been passed on

• disturbed activity causes a change in the way the brain is working = a seizure

Are all seizures the same..?

– Focal Seizures

• Affect part of the brain

• Consciousness

intact/impaired

– Generalised Seizures

• Affect all of the brain

• Consciousness is lost

Day One Training 10

Focal seizures

• Simple Focal (also known as simple partial)Déjà vu, pins & needles, fear, twitching, warnings, auras

• Complex Focal (also known as complex partial)Automatisms- lip smacking, chewing, screaming, posturing

Secondarily generalised• When seizure activity spreads to affect all of the brain

Generalised seizures

• Tonic Clonic - stiffening & jerking

• Absence - brief lapse in awareness

• Myoclonic - muscle jerk

• Tonic - stiffening of muscles

• Atonic - loss of muscle tone

Video Clips

007 Graham simple partial seizure.wmv

011 Terry complex partial seizure.wmv

014 Lloyd complex partial seizure.wmv

018 Priya - secondarily generalised seizure.wmv

032 Calum - atypical absences.wmv

034 Calum - myoclonic seizure.wmv

How to manage non-convulsive seizure

• If the person becomes confused, wanders around or behaves oddly– Stay calm– Do not restrain but gently guide away from danger– Reassure, stay with them until fully recovered

• If the person falls and recovers, with or without confusion– Reassure, check for injury and stay with them until fully

recovered

How to manage a convulsive seizure

During the seizure– Stay calm– Note the time– Stop others from crowding around– Put something soft under the person’s head– Don’t move them (unless in danger)– Don’t restrain the person– Don’t put anything in their mouth– Minimise embarrassment

After the seizure stops

– Roll them into the recovery position and check their breathing

– Stay with them, giving reassurance, until they have recovered fully

• A - Move the patient's nearest arm, as though they are stopping

traffic;

• B - Lift the patient's furthest knee, and bring their furthest hand to the

near side of their face;

• C - Using the patient's knee as a lever, pull them onto your knees

• D - Adjust the patient's position, as shown

The Recovery Position

This information is provided by St John’s Ambulance on their website www.halifax.sja.org.uk

When should you call an ambulance -

• If the person– stops breathing– was injured during the seizure– does not recover well– asks you to call an ambulance

• “Status Epilepticus”– When a seizure does not stop by itself or– When one seizure follows another without time to

recover in between

With tonic clonic seizures “status” is a medical emergency

Patient journey

• Funny turns• Collapses

• Go to GP or A&E• Referred to Neurologist

Seizures that are not epilepsy

• Heart conditions• Fainting (syncope)• Low blood sugar (hypoglycaemia)• Febrile convulsions (high temperature) • Psychological problems (dissociative)• Panic attacks

Investigations for Diagnosis• History & Witness statement• Electroencephalogram (EEG) • Magnetic Resonance Imaging (MRI)

• Blood test• Electrocardiogram (ECG) • Ambulatory EEG • Video Telemetry• Computerised Tomography (CT or CAT)

Day One Training 21

Epilepsy Awareness

Patient journey (2)• Eye witness accounts

of seizures

• Tests trying to ruling things out ECG

• EEG, MRI

• Diagnosis of epilepsy

Seizure control or limitation

Anti Epileptic Drugs

Vagal Nerve Stimulation

Surgery

Triggers for seizures

• Forgotten medication• Incorrect medication• “Recreational” drugs• Alcohol • Tiredness • Sleep deprivation• Stress• Unusual excitement• Boredom

• Illness • High temperature• Hormonal changes• Flashing lights• Patterns • Sounds

• OR OCCUR WITHOUT TRIGGERS

Epilepsy Awareness

Patient journey (3)

• Take these tablets • Come back in a month

• Take these tablets• Come back in a month

Some side effects of AEDs

• Nausea• Dizziness, headaches• Double vision• Skin rash• Weight gain• Change in mood• Change in behaviour

(particularly children)

Exhaustion• Tiredness• Drowsiness• Below par• The smallest thing can

be a huge effort• “Like wading through

treacle”

Memory• Thought processes slowed

down• Can’t remember names• Can be embarrassing• Learning memory

techniques• Retraining brain

Social issues - “A sense of loss”

• Self confidence/self esteem• Independence• Job & career prospects• Income• Social/leisure activities• Relationships• Driving Licence• Ability to care for children

Social issues - Other factors

• Unpredictability of seizures

• Hidden nature of the condition

• Social stigma (real or perceived)

However…………………..

• Laura Sandys (MP)• Edith Bowman• Rik Mayall• Dai Green• Neil Young• Max Clifford• Dean Ryan• Julius Caesar• Vincent Van Gogh

Epilepsy ResearchTripartite: Epilepsy Society, UCL, and UCLH• Attracts funding and facilitates integration of basic

science with clinical application• Developing new research programmes in both

depth and breadth• Major strengths in applications of genetics and

imaging, pharmacology and epidemiology • Application of low-power electronic device and

microsensors to epilepsy is emerging growth area

Further information on activities; awards & appointments; research grants; and research publications on website: www.epilepsysociety.org.uk.

Want to know more ?

Please contact us :

Helpline: Mon – Fri (9am-4pm)01494 601400

Website:www.epilepsysociety.org.uk

Regional Services: 01494 601391

join our digital community:

www.epilepsysociety.org.uk/digital