Explaining epilepsy

Question 1

How would you explain the normal physiology of the brain in an ‘Explaining epilepsy’ station?

Answer 1

Our brain controls how we move, what we say and do, our memories and emotions, and how we see, hear and feel things.
It does all of this through many areas that talk to each other using special signal to coordinate all of the things that we do during the day.
Different areas of the brain have different roles, and they usually take turns working depending on what we are doing at that moment
Signals go 2 ways - input and output
Pick up a stimulus, recognise it, then the brain tells us what to do

Question 2

How would you explain epilepsy to a patient?

Answer 2

Epilepsy is a condition that affects the brain and causes a person to have repeated seizures.
There are different types of epilepsy and therefore the symptoms and seizures can differ across the different types.

Question 3

How would you explain a seizure to a patient?

Answer 3

A seizure is an event that occurs when there is a chaotic burst of signalling that interferes with the brain’s normal function.
Most seizures only last a few seconds to 1 minute.
Some people have warning signs before they experience a seizures - this could be anything from a particular sound, a warm feeling in your stomach, to a smell or any other sensation.
We call these symptoms before a seizure, ‘aura’

Tailor the seizure description - some patients stay awake, some shake, some stay still

After a seizure you might feel very tired, confused, and need sleep to recover.
Full recovery typically happens within several hours.

Question 4

What are the causes of epilepsy?

Answer 4

Epilepsy doesn’t have one specific cause. Some people are born with it, but most people develop epilepsy during childhood.
Epilepsy can also develop later in life due to a brain injury, infection, tumour, or stroke.
In most cases of epilepsy, the cause is unknown.

Question 5

What are the potential triggers for epileptic seizures?

Answer 5

• Heavy alcohol use
• Dehydration
• Lack of sleep
• Use of certain medications
• Recreational drugs
• Fever
• Flashing lights
• Missing doses of epilepsy medication

Question 6

How might epilepsy have an impact on a patient’s life?

Answer 6

• Because seizures can happen at any time, you should consider avoiding activities that put you at an increased risk of injury if a seizure does occurs - baths/swimming alone, mountain climbing, or skiing
• If seizures are not controlled, you will have to avoid driving by law until 1 year passes without any seizures
• Important that you are aware that you may injure your head if you hit it whilst having a seizure

Question 7

How do you counsel a patient about status epilepticus?

Answer 7

• If prolonged seizure activity occurs without recovery, this is known as status epilepticus
• When a seizure lasts longer than 5 minutes
• It is a medical emergency as it an cause permanent brain damage if not recognised and treated promptly
• Really important that you inform your friends. family, and work colleagues about your epilepsy and if you are carrying emergency medicine to help stop the seizure
• Also need to be aware to call an ambulance once a seizure has continued for 5 minutes

Question 8

How would you explain sudden unexplained death in epilepsy to a patient?

Answer 8

• In rare instances, people with epilepsy may die suddenly for reasons that are unexplained, often during sleep or when no one else is around
• This may occur during or after a seizure
• Only happens to about 1 in every 1,000 people with epilepsy per year
• It is important to be aware of this as you can reduce your risk by taking your medications as prescribed and going to see your doctor if your seizures are not controlled

Question 9

What side effects from medication should patients with epilepsy be aware of?

Answer 9

• Varies based on the medication that your are taking

- Can include fatigue, depression, nausea, vomiting, dizziness, and sleep disturbance

Question 10

How should woman of child-bearing age with epilepsy be counselled?

Answer 10

• Medications may affect the development of your baby if you were to become pregnant
• Important to use an effective form of contraception whilst taking this treatment
• If you decide that you want to try conceive, you should speak with your doctor so that your medications can be reviewed and potentially change to ones that are safer to take during pregnancy
• This will help reduce the risk of development abnormalities whilst ensuring that your seizures are well controlled
• Also take 5mg folic acid every day before conceiving and for the first 12 weeks of pregnancy

Question 11

What is the mainstay of treatment in epilepsy?

Answer 11

Anti-epileptic drugs

1. Generalised tonic-clonic seizures:
   - sodium valproate
   - second line: lamotrigine, carbamazepine
2. Absence seizures* (Petit mal):
   - sodium valproate or ethosuximide
   - sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy
3. Myoclonic seizures:
   - sodium valproate
   - second line: clonazepam, lamotrigine

4, Focal seizures:

• carbamazepine or lamotrigine
• second line: levetiracetam, oxcarbazepine or sodium valproate

Also avoidance of triggers

Question 12

What are the management options for refractory epilepsy?

Answer 12

• Epilepsy surgery to remove the seizure foci
• Ketogenic diet
• Vagus nerve stimulation
• Deep brain stimulation