Epilepsy

Question 1

Epilepsy is:

Answer 1

A chronic brain disorder that causes unprovoked, recurrent seizures. A seizure is a sudden rush of electrical activity in the brain. Epilepsy defined by any of the following conditions:

• At least two unprovoked (or reflex) seizures occurring more than 24 hours apart
• One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures (at least 60% over the next 10 years)
• Diagnosis of an epilepsy syndrome

Question 2

Epilepsy is likened to an:

Answer 2

electrical storm in the brain – billions of connected neurones that short circuit and temporarily stop working. Can affect awareness, movement, sensation and consciousness depending on the severity.

Question 3

Causes of epilepsy include:

Answer 3

• Genetic tendencies – passed down from one or both parents (inherited) or a genetic tendency that is not inherited, but is a new change in the person’s genes
• Structural (symptomatic) brain change – the brain not developing properly, or damage caused by a brain injury, infections like meningitis, a stroke or a tumour. Structural changes due to genetic conditions such as tuberous sclerosis, or neurofibromatosis, which can cause growths affecting the brain.

Question 4

Pathology of a seizure:

Answer 4

For seizure activity not to occur in a healthy brain, there needs to be a proper balance between inhibitory and excitatory neurons. If there is an imbalance of excitatory neurons vs. inhibitory neurons seizures will occur, i.e. if there is not enough GABA (inhibitory neurotransmitter) being released or too much glutamate (excitatory neurotransmitter) released, too much excitation will occur leading to seizure activity

Question 5

Seizures tend to last for:

Answer 5

a few seconds up to a few minutes, majority happen without warning and vary significantly in frequency, some happen only at night, morning.

Question 6

Epileptic seizures can result in:

Answer 6

many physical injuries

Question 7

Types of seizures include:

Answer 7

Seizures vary depending on where in the brain they are happening - two main types are generalised (affecting the whole brain) and focal/partial (affecting just one part of the brain):

• Focal seizures – focal onset aware seizures (also called simple partial seizures), focal impaired awareness (also called complex partial seizures) and focal to bilateral tonic clonic
• Generalised seizures - tonic-clonic seizures (formerly known as grand mal seizures), absence (petit-mal) seizures, atonic (drop attacks) seizures, myoclonic seizures, tonic seizures, and clonic seizures.

Question 8

Stages of seizures include:

Answer 8

Prodromal, Aura, Ictus, Post ictus

Question 9

Prodromal is:

Answer 9

when symptoms start to appear prior to the seizure, i.e. depression, anger, issues sleeping, anxiety, GI and urinary issues. Can start days before seizure

Question 10

Aura is:

Answer 10

eferred to as warning sign before seizure but not everyone gets them. More common in focal seizures or tonic-clonic seizures and happens within seconds or minutes. Seen as: altered vision/hearing, anxiety or dread, déjà vu, weird taste/smell, dizzy, speech, visual spots, inability to speak.

Question 11

Ictus is:

Answer 11

Seizure time: Usually 1-3 mins, if > 5 mins or starts to have back-to-back seizures = status epilepticus - requires immediate medical treatment.

Question 12

Post ictus is:

Answer 12

time taken for the brain to recover: Can be immediate (absence) or take hours-days (tonic-clonic). Often symptoms include: very tired, confused, headache, injury (tongue, cheek, body)

Question 13

Tonic-clonic is when:

Answer 13

the patient loses consciousness and the patient may experience an aura (warning sign) before the seizure. Then the patient will experience: tonic episode: body stiffens (may bite the inside of the cheek or tongue, cry out, and experience apnea), and this is followed by the clonic episode, which is recurrent jerking of the extremities. The patient may have incontinence as well. The post ictus stage can take hours to days, and the patient may report feeling very tired, sore, have a headache etc.

Question 14

Absence is:

Answer 14

most common in children. Hallmark is staring (patient may appear to be daydreaming). This type of seizure is very short and may go undetected by others. The post ictus stage is immediate recovery but won’t remember event.

Question 15

Atonic is:

Answer 15

drop attacks: this is complete loss of muscle tone. The patient will suddenly lose muscle tone and is at risk for head injury. Patients should be advised to wear a helmet with this type of seizure.

Question 16

Myoclonic is:

Answer 16

jerking of the muscles. The patient is aware of their surrounding during this type of seizure.

Question 17

Tonic is when:

Answer 17

Patients can experience just a tonic seizure: body stiffens (may bite the inside of the cheek or tongue, cry out, and experience apnea)

Question 18

Clonic is when:

Answer 18

Patients can experience just a clonic seizure: recurrent jerking of the extremities. The patient may have incontinence as well

Question 19

Focal Onset Aware is

Answer 19

simple partial: the patient is AWARE of their surroundings during the seizure. The signs and symptoms vary due to the specific location of the brain being affected. For instance, some patients may experience vision changes if the occipital lobe is being affected. The seizure is very short and the post ictus stage is immediate. This is sometimes referred to as an aura, and can happen prior to a complex partial seizure (focal impaired awareness).

Question 20

Focal Impaired Awareness is:

Answer 20

complex partial: this is different from the other type of focal seizure because the patient is NOT aware of their surroundings and will experience motor symptoms (automatisms). Automatisms are movements performed by the patient that they are don’t know they are performing, such as hand rubbing, smacking of the lips, grasping for an object that isn’t there. Temporal lobe most commonly involved

Question 21

Triggers of a SEIZURE:

Answer 21

Stress
Trauma
Overexertion
Pregnancy, periods
Sleep loss
Electrolyte and metabolic issues (acidosis, hypoglycemia, dehydration)
Illness
visualiZation disturbances, sounds or smells
Under medicated
Recreational Drugs - withdrawal
Etoh (alcohol) - withdrawal

Question 22

Seizure precautions:

Answer 22

• At bedside have suction and oxygen ready
• IV access (to given anti-seizure medication, if needed)
• padded side rails
  pillow under head (to protect head)
• bed in the lowest position
• remove objects that can cause injury (remove any restrictive clothing or items the patient may be wearing….eye glasses etc. )

Question 23

Emergency procedure/First Aid of a convulsive seizure includes:

Answer 23

During a convulsive seizure what you should do is: stay calm, make sure they are in a safe place, note the time the seizure starts, cushion their head with something soft, after the seizure has stopped put them into the recovery position, remove anything that can impede breathing or break (eye glasses, tight clothing etc. ), stay with them until they are fully recovered. If a convulsive seizure doesn’t stop after 5 mins, call for an ambulance. If their breathing sounds difficult after the seizure has stopped, call for an ambulance

During a convulsive seizure you should NEVER hold the person down or put anything in their mouth

Question 24

MYTH 1:
You convulse (shake and jerk) when you have epilepsy:

Answer 24

Not every seizure means a person jerks convulsively, nor is a person always unconscious during a seizure

• Focal seizures: reassurance, if Aura occurs guide away from danger, gentle approach.
• Focal to bilateral tonic clonic: sometimes spreads to affect both sides of the brain “Aura” warning , safe place.
• Convulsions while unconscious are usually associated with tonic clonic seizures.

Question 25

MYTH 2: | Flashing lights cause seizures in everyone with epilepsy:

Answer 25

- Around 1 in 100 people has epilepsy in the UK, and of these people, around 3% have photosensitive epilepsy. - Seizures triggered by flashing lights and some geometric patterns (photosensitive epilepsy) is more common in children and young people (up to 5%) and is less commonly diagnosed after the age of 20

Question 26

MYTH 3: | Epilepsy is rare:

Answer 26

- Epilepsy is anything but rare, about 1:100 people in the UK have epilepsy and approx 60 million people with epilepsy in the world - Can affect anyone from any walk of life - Similar number to those living with autism and four times higher than those with Parkinson’s Disease - 1:220 children will have a diagnosis of epilepsy, that's an average of one child with epilepsy in every primary school and 5 in every secondary school

Question 27

MYTH 4: | The only side effects of a seizure are tiredness and being confused

Answer 27

Having epilepsy can affect people in different ways. Knowing that a person ‘has epilepsy’ does not tell you very much about what happens for them or how epilepsy affects them. Some people after seizures may have problems with sleep or memory and for some people epilepsy may affect their mental health: Living with a long term condition, driving regulations, health and safety at work, equality law and benefits, leisure, travel, female hormonal influences.

Question 28

Paediatrics patients treatment may be:

Answer 28

Ketogenic diet: high fat, low carb, diet. Used when seizures not controlled by medication