3/27/2013 1 Cynthia Samantha Valle-Oseguera, PharmD PGY1-Pharmacy Resident BVAMC ISHP Spring Meeting 2013 • To understand the different types of seizure disorders • To identify the basic pharmacological principles in management of seizure disorders • To identify the common non-pharmacologic therapies for seizures disorders http://schuylerpwr.blogspot.com/2011/03/imma-let-you-finish-but-this-video-may.html • T/F Seizures are waves of abnormal electrical activity in the brain http://www.zmescience.com/medicine/epilepsy-seizure-rats-10082012/
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3/27/2013
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Cynthia Samantha Valle-Oseguera, PharmD
PGY1-Pharmacy Resident BVAMC
ISHP Spring Meeting 2013
• To understand the different types of seizure disorders
• To identify the basic pharmacological principles in management of seizure disorders
• To identify the common non-pharmacologic therapies for seizures disorders
• Seizure is a sudden change in behavior due to brain dysfunction
• Epilepsy is characterized by recurrent epileptic seizures due to an acquired brain disorder or genetically determined disorder• <1% of the population has epilepsy
• Some seizures are provoked• Drug or alcohol withdrawal
• Acute neurologic disorders
• Nonepileptic seizures (NES) are sudden changes in behavior that resemble epileptic seizures but are not associated with the typical neurophysiological changes of epileptic seizures
• Clinicians neither suspend nor grant driving privileges
• Physicians should counsel patients regarding the risks associated with driving and epilepsy
• Clinicians are required to report patients with seizures to driving authorities in six states (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania)
• Physicians not reporting when required are open to legal actions
• “Any person who in the opinion of the department, based upon recommendation of the person's physician, is afflicted with or subject to any condition which brings about momentary or prolonged lapses of consciousness or control, which is or may become chronic,” shall have his or her license suspended, revoked, or denied [IDAHO CODE ANN. § 49-326(1)(c)(1) (2011)]
• Idaho Department of Transportation officials can request that a person submit to a medical examination for public safety reasons, based on observations or other evidence [IDAHO CODE ANN. § 49-202 (2011)]
State Idaho
Seizure-Free PeriodNo set seizure-free
period
Periodic Medical Updates Required After
LicensingAt discretion of DMV
Doctors Required to Report Epilepsy No
DMV Appeal of License Denial Within 20 days
Table obtained from epilepsyfoundation.org
• Keep calm and gently reassure other people who may be in close proximity
• Don’t physically hold the person down
• Time the duration of the seizure with your watch or cell phone
• Clear the area around the person of anything hard or sharp
• Loosen ties that may make breathing more difficult
• Put something flat and soft (such as a folded jacket) under their head
• Turn a seizing person onto their side
• Do not try to force the mouth open with any hard instrument or with fingers
• Don’t attempt artificial respiration
• Stay with the person until the seizure ends naturally
• Be friendly and reassuring as consciousness returns
• Offer to call a relative to help the person get home
Epilepsyidaho.org
• Watch the person carefully and explain to others what is happening
• Speak quietly in a friendly way
• Guide the person away from any danger
• Don’t grab them unless there is a danger of immediate threat to their safety
• Stay with the person until full consciousness returns
• Offer help in arranging their transport back to a residence
Epilepsyidaho.org
3/27/2013
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• The person is pregnant, injured, or diabetic
• The seizure continues for more than five minutes
• The seizure takes place in water
• Another seizure begins shortly after the first has ended
• There’s no medical I.D., and no way of knowing the nature of the seizure
• Consciousness does not start to return after the shaking has ended