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Berkshire West Primary Care Trusts

EPILEPSY INTRODUCTION TRAINING

PROGRAMME

Berkshire West Primary Care Trusts is a collaboration between Newbury and Community, Reading and Wokingham PCTs

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INTRODUCTION TO EPILEPSYAims of the session

• to meet the training needs of staff who care for clients who have epilepsy

• to deliver information to enable staff to be better informed about epilepsy

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LEARNING OUTCOMES (EPILEPSY)

• have increased knowledge of epilepsy and its treatment

• be familiar with the signs and symptoms of an epileptic seizure and its management

• have received instruction in the appropriate use of the documentation required

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WHAT IS EPILEPSY?

The tendency to recurrent seizures

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WHAT IS A SEIZURE?

The result of intermittent and abnormal bursts of electrical activity within

the brain

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INVESTIGATIONS AND DIAGNOSIS

• Referral to doctor

• History

• EEG (electroencephalogram)

• MRI Scan (Magnetic Resonance

Imaging)

• Videotelementry

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CAUSES OF EPILEPSYIn 7 out of 10 cases the cause will be

unknown• Developmental anomalies in pregnancy• Trauma to the skull• Encephalitis• Brain tumours• Alcohol abuse• Serious brain infections such as meningitis• Brain surgery

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TYPES OF EPILEPSY

• IDIOPATHIC

• SYMPTOMATIC

• CRYPTOGENIC

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TYPES OF EPILEPSYThere are 3 types of epilepsy:

• Symptomatic - where a • cause is found e.g. head injury,

structural abnormality• Idiopathic - no cause but may be due

to an inherent tendency to experience seizures

• Cryptogenic - no cause is found but a structural rather than genetic cause is suspected

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SEIZURE

Partial Generalised

Seizure activity Seizure activity starts in one part involves the

of the brain whole brain

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PARTIAL SEIZURE

Simple Complex With secondary Generalisation

Seizure activity Seizure activity Seizure activitywhile the person with change in begins in oneis alert awareness of area and

surroundings spreads to whole brain

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GENERALIZED SEIZURE

Absence Myoclonic Tonic-clonic Tonic Atonic

Staring and blinking without falling

Jerking movements of the body

Stiffening, falling and jerking of the body

Stiffening, tends to fall backwards if standing

Falling heavily to the ground

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SEIZURE MONITORING

OBSERVATION – BEFORE

• Aura/unusual sensation

• Automatisms

• Change in sleep pattern

• Behaviour change

• Lethargy

• Scream/cry out

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SEIZURE MONITORINGOBSERVATION – DURING• Automatisms (lipsmacking, chewing, confused behaviour)• Rigidity• Floppy• Involuntary/jerky movements (face, whole body, left arm, right

arm, left leg, right leg)• Cyanosis• Cold and clammy • Frothing at mouth• Change in level of consciousness• Change in breathing pattern• Glazed/fixed stare• Unusual sounds• Grind teeth• Bite tongue• Undressing

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SEIZURE MONITORINGOBSERVATION – AFTER• Confusion• Aggression• Drowsy• Headache• Tearful• Alteration in appetite• Thirsty• Hyperactive• Partial seizures• Automatisms

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SEIZURE MONITORINGOBSERVATIONSSheet 3Client Name ……………………………………………………………………………DoB ……………………………………

Date Time Seizure Length Recovery Time

Observations Before Seizure

During Seizure

After Seizure

Signature

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INJURY

Please record any injury sustained during a seizure

DATE TYPE OF SEIZURE DETAILS OF INJURY EMERGENCY TREATMENT GIVEN

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POSSIBLE SEIZURE TRIGGERS

• Hungry • Missed medication

• Tired • Lack of sleep

• Hormonal • Photosensitivity

• Excitement • Alcohol

• Boredom • Illness

• Stress

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WHEN THE SEIZURE STARTS:-

• Note the time• Clear a space around the person, moving

objects which may be harmful• Reassure others and explain what you are

doing• Make the person comfortable• Cushion the head to prevent facial injury• Loosen tight neckwear• Remove spectacles and high heeled shoes if

worn

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WHEN THE MOVEMENTS HAVE STOPPED:-

• Turn the person on their side (first aid recovery position)

• Wipe away any excess saliva from the mouth

• Check that vomit or dentures are not blocking the throat

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AT THE END OF THE SEIZURE:-

• Reassure the person if they seem confused and tell them what has happened

• Check for signs of injury and apply first aid, if necessary

• Observe the person and stay with them until recovery is complete (they may need assistance to return to their routine or find their way home)

• Provide privacy and offer assistance if there has been incontinence

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RECOVERY

• Some people have seizures which put them temporarily into a state of altered consciousness

• Behaviour may seem inappropriate e.g. they may wander around aimlessly with a glazed expression

• During this type of seizure, the person should be accompanied and gently led away from any source of danger

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DO’S AND DON’TS

• DON’T put anything in the mouth

• DON’T restrain movements

• DON’T move the person from the site unless in danger

• DON’T assume recovery as soon as the seizure ends

• DON’T panic

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DO’S AND DON’TS• DO keep calm• DO put the person on their side if you

need to ensure the airway is clear/they need to have rectal diazepam

• DO support the head to prevent injury• DO check for anything in the mouth

and remove it ONLY when the seizure ends

• DO stay with the person

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THE RECOVERY POSITION

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RECOGNITION OF A SEIZURE

• any warning• description of events• alteration or loss of consciousness• change in colour• abnormal bodily movements• change in breathing pattern• inappropriate actions

TIME THE SEIZURE FROM WHEN ANY CHANGE FROM NORMAL BEHAVIOUR IS

NOTED

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SEIZURES THAT MAY REQUIRE MEDICAL INTERVENTION

• Status Epilepticus

• Serial Seizures

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STATUS EPILEPTICUS

• Status epilepticus is defined as a condition in which epileptic seizures continue, or are repeated without regaining consciousness for a period of 30 minutes or more.

• Status epilepticus can occur with all the different seizure types.

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SERIAL SEIZURES

Serial seizures are defined as seizures recurring at

frequent intervals with full recovery between attacks

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EMERGENCY PROCEDURES

999

CPR

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NON-EPILEPTIC ATTACK DISORDER (NEAD)

• Non Epileptic Attack (NEAD)• Not caused by Epilepsy• In the past referred to as pseudo-seizures• Many underlying reasons• Physical• Hypoglycaemia (low blood sugar)• Faints• Psychological• Panic attack• Delayed response to extreme stress and emotional

cut off• Post traumatic stress disorder

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GENERAL LIFESTYLE IMPLICATIONS

• Leisure Activities

• Sport

• Alcohol and Drugs

• Education

• Work

• Driving and Travel

• General Safety Measures

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DEATH IN EPILEPSY

• accidents

• status epilepticus

• SUDEP– sudden unexpected

death in epilepsy

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WHAT IS SUDEP?

• SUDEP is a recognised syndrome where a person with epilepsy dies suddenly and no other cause of death is found

• Prevalence is 1:1000 per year

• For people with severe epilepsy it increases to 1:100-300 per year

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SUDEP RISK FACTORS

• young adults• generalised tonic-clonic seizures• poor seizure control• unwitnessed seizures• abrupt and frequent changes in medication• non-compliance• alcohol• people with epilepsy whose seizures are not

recorded in medical notes• Seizures during sleep

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MEDICATION USED TO TREAT EPILEPSY• Carbamazepine- Tegretol and Tegretol Retard• Ethosuximide - Emeside and Zarontion• Lamotrigine - Lamictal• Phenytoin - Epanutin• Sodium Valporate - Epilem and Epilem Chrono• Acetazolamide - Diamox• Clobazam - Frisium• Clonazepam - Rivotril• Gabapentin - Neurontin• Keppra - Leveretacetam• Phenobarbitone - Phenobarbitone• Piracetam - Nootropil• Primidone - Mysoline• Topiramate - Topamax• Vigabatrin - Sabril• Tiagabine - Gabitril

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THE HUMAN CEREBRAL HEMISPHERE SHOWING THE DIFFERENT LOBES

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CONTACT DETAILS

READING LOCALITY Fiona Simpson/Barbara Chandler, ReadingCommunity Team for People with Learning

Disability, PO Box 2624, Reading, RG1 7WB

0118 955 3742

NEWBURY LOCALITY Nicky Macdonald, Newbury Community Team

for People with Learning Disability, Northcroft Wing, Avonbank House, West Street,

Newbury, RG14 1BZ 01635 503120

WOKINGHAM LOCALITY Mary Codling, Wokingham Team for People with Learning Disability, 2nd Floor,

Wellington House, Wellington Rd, Wokingham, RG40 2AG

0118 974 6832/0118 949 5000