Epilepsy Basics         ANDWorking Effectively with      Your Doctor    Jennifer A. Vickers, MD    Carla Fedor, RN, CDDN  ...
OutlineEpilepsy Basics      Definition      Epilepsy vs. Seizures      Statistics      CausesSeizure Classification    Tre...
Outline– Getting the Most out of Your Doctors Visit–  Types of Office Visits–  What is an emergency–  Routine Care–  Healt...
Definitions:• Seizure: An episode of pathological,  hyperactive, hypersynchronous brain  activity, expressed as abnormal m...
What is the difference between epilepsy and a   Seizure disorder?• Nothing, they are the same thing.
Prevalence• Single Seizure: 9%• Recurrent Seizures: 0.5%
Age of onset30%25%20%15%10%5%0%      5   10   15   20   25   30   35   40   45   50+                          years
What are some of theknown causes of epilepsy?
Cerebrovascular Disease
Bacterial infections
encephalitis
Brain tumors
Trauma
Severe anoxic injury
Degenerative diseases
Congenital malformations
Unknown – 50%
Etiology and age100%80%                                            other60%                                            Deg...
Seizure Classification            Clinical observation                      +                EEG findingsPartial seizure  ...
Partial Seizures• More common in adults than children• Involves a focal area of the brain at onset• A warning (aura) often...
Auras – patient’s          perspective•   Visual hallucination•   Auditory hallucination•   Tactile sensation•   Motor sen...
Auras – a bystanders         perspective•   Pause in activity with a blank stare•   May have an inability to talk•   May h...
Partial Seizures
Partial seizure
Partial seizure types                    Partial seizures          Simple partial               Complex partialConsciousne...
Simple Partial Seizures•   Patient may pause, or slow down.•   Aware of seizure•   Able to comprehend and speak•   Duratio...
Complex Partial Seizures• Usually begin with an aura.• Alteration of consciousness.• May exhibit automatisms:  –   Lip sma...
Complex partial seizures• Duration: usually 2 – 3 minutes• Post ictal phase is variable in length.  –   Confused  –   Frig...
Partial SeizureSimple partial        Complex partial   seizure               seizures     Secondary Generalization
Generalized Seizures•   Occur in 20 – 40%•   More common in children•   Genetic cause suspected with most•   They begin wi...
Generalized Seizures
Generalized Epilepsy
Generalized seizure            types•   Generalized tonic clonic or clonic•   Absence or Atypical Absence•   Myoclonic•   ...
Tonic Clonic seizures:    aka Grand mal Seizures•   Abrupt onset•   Loss of consciousness•   Stiffening of the extremities...
Tonic Clonic seizures• Often associated with tongue biting,  and loss of bowel or bladder control• Post ictal phase  – Con...
Absence seizures• Brief loss of consciousness (10 – 20  seconds)• Blank stare• No post ictal period associated• May have s...
Absence seizure
Atypical Absence
Myoclonic seizures• Generally look like a fast tonic  seizure or startle• Patient will often fall to the ground• Brief – l...
Tonic seizures• Patient often yell at the onset• Arms are up, and extended to the front or  side.• Head drops, and legs ma...
Atonic Seizures•   Sudden loss of muscle tone•   Fall to the ground•   No warning•   Duration: a few seconds
Seizure provoking          factors• Insomnia• Constipation• Febrile illnesses• Excessive  Excitement• Excessive Stress• Me...
Treatments• Medications• Surgery• Dietary
Medications for     Generalized seizures•   Depakote•   Lamictal•   Klonopin•   Felbatol•   Zonegran
Medications for Partial          seizures•   Tegretol•   Neurontin•   Gabatril•   Trileptal
Medications for either            type•   Phenobarbital•   Dilantin•   Topamax•   Keppra
Surgical intervention• Vagal Nerve  Stimulator• Temporal  lobectomy• Corpus Callosotomy• Subpial transection
Dietary intervention• Ketogenic Diet• Atkins Diet?
Non epileptic events• Syncope              • Esophageal reflux• Cardiac arrhythmia   • Sleep disorder• Breath holding     ...
Seizures First-Aid        and  Safety Issues        Carla Fedor, RNContinuum of Care Project, UNM
The Do’sDO• Stay Calm• Protect from  injury• Move surrounding  objects away• Position on floor or  soft surface
The Do’sDO• Protect airway• Place head on pillow• Loosen clothing• Place on left side
The Don’ts•   Do not   panic!•   Do not   try to stop the seizure•   Do not   place objects in mouth•   Do not   try to re...
A Seizure Becomes an     Emergency           • Any first time seizure           • When it compromises             respirat...
Special ConsiderationsIn a Wheelchair, Stroller or Bus• Do not try to remove them from this  Position  – The seat provides...
Special Considerations-Loosen but do not unfasten seat belts-They may need to be taken out of the  chair after the seizure...
Safety Issues    • At home    • At work
Safety Issues: HOME• Around the House  –   Pad corners, rounded corners  –   Carpet with extra padding underneath  –   No ...
Safety Issues: HOME• Bathroom:  – Supervise shower  – Do not lock doors  – Keep water levels low in    tub  – Set lower te...
Safety Issues: HOME• Kitchen  – Use Plastic containers/dishes  – Use microwave instead of stove as much    as possible  – ...
Safety Issues: WORK• In the workplace:  – have a place to rest  – keep extra set of    clothes  – take regular breaks    t...
Getting the Most outof Your Doctors Visit  Working Effectively with        Physicians
Working Effectively with      Your Doctor  Getting the Most out of Your Doctors Visit    Types of Office Visits    What is...
3 Types of Doctor Visits• Emergency room – The client requires immediate attention• Acute care visit – Will not improve un...
Appropriate ER Visits•   Difficulty breathing•   Severe chest pain or heart attack•   Severe Bleeding/wound requiring stit...
Appropriate ER Visits•   Severe allergic Reaction•   Unconsciousness•   Severe Pain•   Vomiting Blood or “coffee grounds”•...
Acute Care• Same Day or next day Appointments in  the PCP’s office    – Usually a 15 minute appointment    – The physician...
Appropriate Urgent Care         Visits • Broken Bone (during office hours) • Persistent dizziness • Eye or Ear pain or dra...
Appropriate Urgent          Care Visits•   Change in type or frequency of seizures•   Persistent change in skin color•   S...
Health Care MaintenanceAnnual Physical appointments are longer so the PCP  has enough time to:•   Spend time to listen to ...
Health Care Maintenance• These appointments must be made weeks or even  months in advance.• Notify the appointment schedul...
Health Maintenance/Routine           Office Visits•   Annual physical•   Referrals to specialists•   Routine follow-up of ...
Health      Maintenance/Routine          Office Visits•   Unexplained weight loss or gain•   Desire to lose weight, begin ...
HealthMaintenance/Routine    Office Visit• Chronic Minor complaints  – Headaches  – Nervous stomach  – Allergies  – Itchin...
When you call to make    appointment:Tell them:• Why you need to see  the doctor.• How soon you need to  be seen.• Any acc...
Getting ReadyMake a list of things to  tell the doctor:• Concerns about  Behavior, Pain,• Has this happened  before?• Chan...
Medical Information To          Bring• List of medications    • Immunizations• Allergies              • Family History• Me...
Communication• Communication with the Physician  – Know the reason for the doctor’s visit  – Write Down Questions from Gua...
Follow Up Care• Who is responsible?• How will the Appropriate People Get  the Information?
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
Epilepsy basics
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Epilepsy basics

  1. 1. Epilepsy Basics ANDWorking Effectively with Your Doctor Jennifer A. Vickers, MD Carla Fedor, RN, CDDN Toni Benton, MD
  2. 2. OutlineEpilepsy Basics Definition Epilepsy vs. Seizures Statistics CausesSeizure Classification TreatmentsMedications Surgical Interventions Dietary Non-Epileptic Events Emergencies Status Epilepticus ClustersSeizure First AidPersonal Care and SafetyMobility
  3. 3. Outline– Getting the Most out of Your Doctors Visit– Types of Office Visits– What is an emergency– Routine Care– Health Maintenance– Communication– Talking to the Doctors– Forms– Getting Your Questions Answered– Follow Up Care– Who is responsible to make sure recommendations are done?– Scheduling Appointment for Follow ups– Specialists/Referrals– Tests/Results
  4. 4. Definitions:• Seizure: An episode of pathological, hyperactive, hypersynchronous brain activity, expressed as abnormal motor, sensory, or psychologic behavior.• Seizure Disorder: A chronic brain disorder characterized by recurrent unprovoked seizures.
  5. 5. What is the difference between epilepsy and a Seizure disorder?• Nothing, they are the same thing.
  6. 6. Prevalence• Single Seizure: 9%• Recurrent Seizures: 0.5%
  7. 7. Age of onset30%25%20%15%10%5%0% 5 10 15 20 25 30 35 40 45 50+ years
  8. 8. What are some of theknown causes of epilepsy?
  9. 9. Cerebrovascular Disease
  10. 10. Bacterial infections
  11. 11. encephalitis
  12. 12. Brain tumors
  13. 13. Trauma
  14. 14. Severe anoxic injury
  15. 15. Degenerative diseases
  16. 16. Congenital malformations
  17. 17. Unknown – 50%
  18. 18. Etiology and age100%80% other60% Degen. CVD40% brain tumor20% trauma 0% infection 0 to 4 5 to 15 to 25 to 45 to 65+ Devel. 14 24 44 64
  19. 19. Seizure Classification Clinical observation + EEG findingsPartial seizure Generalized seizure
  20. 20. Partial Seizures• More common in adults than children• Involves a focal area of the brain at onset• A warning (aura) often precedes the seizure• May or may not be associated with an alteration of consciousness• Usually symptomatic
  21. 21. Auras – patient’s perspective• Visual hallucination• Auditory hallucination• Tactile sensation• Motor sensation• Autonomic sensation
  22. 22. Auras – a bystanders perspective• Pause in activity with a blank stare• May have an inability to talk• May have hand or arm posturing• Eye deviation• May appear apprehensive• May turn in a circle• May run away - random
  23. 23. Partial Seizures
  24. 24. Partial seizure
  25. 25. Partial seizure types Partial seizures Simple partial Complex partialConsciousness preserved Impaired consciousness
  26. 26. Simple Partial Seizures• Patient may pause, or slow down.• Aware of seizure• Able to comprehend and speak• Duration: variable• Post ictal phase: may feel tired
  27. 27. Complex Partial Seizures• Usually begin with an aura.• Alteration of consciousness.• May exhibit automatisms: – Lip smacking – Hand posturing – Pick at clothing or reach out without purpose – Move about in a purposeless manner
  28. 28. Complex partial seizures• Duration: usually 2 – 3 minutes• Post ictal phase is variable in length. – Confused – Frightened – Combative or angry – Sleepy or may become hyperactive – Amnestic for the event
  29. 29. Partial SeizureSimple partial Complex partial seizure seizures Secondary Generalization
  30. 30. Generalized Seizures• Occur in 20 – 40%• More common in children• Genetic cause suspected with most• They begin without warning• Always associated with an alteration of consciousness
  31. 31. Generalized Seizures
  32. 32. Generalized Epilepsy
  33. 33. Generalized seizure types• Generalized tonic clonic or clonic• Absence or Atypical Absence• Myoclonic• Tonic• Atonic
  34. 34. Tonic Clonic seizures: aka Grand mal Seizures• Abrupt onset• Loss of consciousness• Stiffening of the extremities• Decreased ability to breathe• Rhythmic jerking• Duration: 1 – 3 minutes (usually)
  35. 35. Tonic Clonic seizures• Often associated with tongue biting, and loss of bowel or bladder control• Post ictal phase – Confusion – Sleepy may sleep 30 minutes to 4 hours
  36. 36. Absence seizures• Brief loss of consciousness (10 – 20 seconds)• Blank stare• No post ictal period associated• May have subtle twitching (myoclonic movements)• May have simple automatisms
  37. 37. Absence seizure
  38. 38. Atypical Absence
  39. 39. Myoclonic seizures• Generally look like a fast tonic seizure or startle• Patient will often fall to the ground• Brief – lasting only a few seconds• Usually occur in clusters• No post ictal phase
  40. 40. Tonic seizures• Patient often yell at the onset• Arms are up, and extended to the front or side.• Head drops, and legs may become stiff• Patient may drop abruptly.• Duration usually 1 minute or less• Often poor respiratory effort• Post ictal phase is variable
  41. 41. Atonic Seizures• Sudden loss of muscle tone• Fall to the ground• No warning• Duration: a few seconds
  42. 42. Seizure provoking factors• Insomnia• Constipation• Febrile illnesses• Excessive Excitement• Excessive Stress• Medication changes
  43. 43. Treatments• Medications• Surgery• Dietary
  44. 44. Medications for Generalized seizures• Depakote• Lamictal• Klonopin• Felbatol• Zonegran
  45. 45. Medications for Partial seizures• Tegretol• Neurontin• Gabatril• Trileptal
  46. 46. Medications for either type• Phenobarbital• Dilantin• Topamax• Keppra
  47. 47. Surgical intervention• Vagal Nerve Stimulator• Temporal lobectomy• Corpus Callosotomy• Subpial transection
  48. 48. Dietary intervention• Ketogenic Diet• Atkins Diet?
  49. 49. Non epileptic events• Syncope • Esophageal reflux• Cardiac arrhythmia • Sleep disorder• Breath holding • Benign nocturnal spell jerks• Panic attacks • Psychogenic• Movement disorder episodes• Hypoglycemic • Menses episodes • trauma
  50. 50. Seizures First-Aid and Safety Issues Carla Fedor, RNContinuum of Care Project, UNM
  51. 51. The Do’sDO• Stay Calm• Protect from injury• Move surrounding objects away• Position on floor or soft surface
  52. 52. The Do’sDO• Protect airway• Place head on pillow• Loosen clothing• Place on left side
  53. 53. The Don’ts• Do not panic!• Do not try to stop the seizure• Do not place objects in mouth• Do not try to restraint them
  54. 54. A Seizure Becomes an Emergency • Any first time seizure • When it compromises respiration • When it has lasted >5 minutes • >2 seizures in 10 minutes • Unusual event for the client • As defined in the Client’s ISP or Crisis Intervention Plan • Associated with trauma
  55. 55. Special ConsiderationsIn a Wheelchair, Stroller or Bus• Do not try to remove them from this Position – The seat provides support. – Moving the person puts you and the client at risk of injury. – You may provide extra padding, move footrests or take steps to protect limbs from injury. – Always continue to monitor airway
  56. 56. Special Considerations-Loosen but do not unfasten seat belts-They may need to be taken out of the chair after the seizure-Always follow the protocols in the clients ISP or Crisis Prevention Plan-Follow Agency Protocol for follow up care
  57. 57. Safety Issues • At home • At work
  58. 58. Safety Issues: HOME• Around the House – Pad corners, rounded corners – Carpet with extra padding underneath – No top bunks – Low bed or mattress on the floor – Place guards around fireplace or woo stoves – Monitor in the bedroom
  59. 59. Safety Issues: HOME• Bathroom: – Supervise shower – Do not lock doors – Keep water levels low in tub – Set lower temperature on water heater – Doors opening outwards instead of inwards
  60. 60. Safety Issues: HOME• Kitchen – Use Plastic containers/dishes – Use microwave instead of stove as much as possible – Supervision with knives or sharp objects
  61. 61. Safety Issues: WORK• In the workplace: – have a place to rest – keep extra set of clothes – take regular breaks to avoid fatigue – avoid flashing lights – special safety around machinery
  62. 62. Getting the Most outof Your Doctors Visit Working Effectively with Physicians
  63. 63. Working Effectively with Your Doctor Getting the Most out of Your Doctors Visit Types of Office Visits What is an emergency Routine Care Health Maintenance Communication Talking to the Doctors Forms Getting Your Questions Answered Follow Up Care Who is responsible to make sure recommendations are done? Scheduling Appointment for Follow ups Specialists/Referrals Tests/Results
  64. 64. 3 Types of Doctor Visits• Emergency room – The client requires immediate attention• Acute care visit – Will not improve until treated, but can wait a short time until the office opens or the doctor is available.• Health Maintenance – Can be arranged several weeks in advance
  65. 65. Appropriate ER Visits• Difficulty breathing• Severe chest pain or heart attack• Severe Bleeding/wound requiring stitches• Severe Burn• Persistent fever of 103 degrees or over• Known or suspected poisoning• Status Epilepticus or prolonged seizure• Broken Bone (after hours)• Broken Bone with open wound
  66. 66. Appropriate ER Visits• Severe allergic Reaction• Unconsciousness• Severe Pain• Vomiting Blood or “coffee grounds”• Suicide Attempt• Eye Trauma• Possible Sexual Abuse within the past 72 hours• Open Human Bite wound• Sudden/Acute Mental status changes
  67. 67. Acute Care• Same Day or next day Appointments in the PCP’s office – Usually a 15 minute appointment – The physician will focus on only the urgent problem Not appropriate for…• Thorough work-up of chronic problems• Prescription refills• Annual Physical• Having the Level of Care and Outlier Paperwork signed for Tomorrow’s IDT meeting
  68. 68. Appropriate Urgent Care Visits • Broken Bone (during office hours) • Persistent dizziness • Eye or Ear pain or drainage • Fever 101 degrees or higher during office hours • Flu Symptoms beyond the third day • Persistent cough • Nausea and Vomiting (inability to keeps down fluids or meds) • Pain not improved by over the counter pain relievers • Lethargy or irritability during office hours • Severe Rash
  69. 69. Appropriate Urgent Care Visits• Change in type or frequency of seizures• Persistent change in skin color• Skin breakdown or pressure sores• Severe Sore throat• Sunburn with blisters• Painful urination/possible urinary tract infection• Persistent constipation• Small wound requiring stitches during office hours (within 12 hours)
  70. 70. Health Care MaintenanceAnnual Physical appointments are longer so the PCP has enough time to:• Spend time to listen to questions or concerns• Do a thorough physical exam• Order labs• Immunizations• Write prescription refills• Complete paperwork
  71. 71. Health Care Maintenance• These appointments must be made weeks or even months in advance.• Notify the appointment scheduler if this appointment needs to be longer (annual physical).• Notify the scheduler of any special needs.• Anticipate and prepare so the appointment will be more productive.
  72. 72. Health Maintenance/Routine Office Visits• Annual physical• Referrals to specialists• Routine follow-up of chronic conditions• Follow-up of ongoing acute or sub acute conditions• Follow-up of test results or labs• Preventative health (immunizations, cholesterol, diet/exercise counseling)
  73. 73. Health Maintenance/Routine Office Visits• Unexplained weight loss or gain• Desire to lose weight, begin exercise program• Birth control• Changes in: – Appetite – Mood – Behavior – Sleep
  74. 74. HealthMaintenance/Routine Office Visit• Chronic Minor complaints – Headaches – Nervous stomach – Allergies – Itching – Menstrual changes – Arthritis – Dermatitis
  75. 75. When you call to make appointment:Tell them:• Why you need to see the doctor.• How soon you need to be seen.• Any accommodations you need.Ask them:• What to bring?• Any special instructions?
  76. 76. Getting ReadyMake a list of things to tell the doctor:• Concerns about Behavior, Pain,• Has this happened before?• Changes in mood, amount of energy, sleep, eating, bathroom habits, other changes.• List of Medications
  77. 77. Medical Information To Bring• List of medications • Immunizations• Allergies • Family History• Medical History • Accommodations you need• Surgeries or serious • Insurance or Medicaid illness in the past card
  78. 78. Communication• Communication with the Physician – Know the reason for the doctor’s visit – Write Down Questions from Guardian, Team or Agency Nurse prior to Visit – Fax forms ahead of time so the Physician has more time with the Patient• Communication with the Team – Take good notes – Get the answers to your questions in writing – Take home written Instructions
  79. 79. Follow Up Care• Who is responsible?• How will the Appropriate People Get the Information?
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