epilepsy basic tutorial

YVETTE JONNA-MOORE

Epilepsy

Epilepsy (definition)

DEFINITION OF EPILEPSY

A physical condition that occurs when there is a sudden, brief change in how the brain works

Physical changes are called epileptic seizures

Epilepsy affects people in all nations and of all races

Seizure (definition)

A sudden attack, spasm, or convulsionThe act of taking a person by forceSeizures can include

Blackouts or periods of confused memory Episodes of staring or unexplained

unresponsiveness Involuntary movement of arms and legs Fainting spells with incontinence, then excessive

fatigue Odd sounds, distorted perceptions, or episodic

feelings of unexplained fear

Types of Seizures

There are many types of seizures. A person may experience only one type, or more than one. The type of seizure that a person has depends on what part and how much of the brain is affected by electrical disturbance.

•Generalized seizures affect both cerebral hemispheres (sides of the brain) from the beginning of the seizure. They can produce a loss of consciousness, either briefly or for a longer period of time, and are sub-categorized into several major types.

Type Duration Symptoms Postictal

Absence (petit mal seizure)

2 to 15 seconds

StareEyes

flutteringAutomatism (such as

lip smacking, picking at clothes,

fumbling) if

prolonged

Amnesia for seizure eventsNo confusion

Promptly resumes activity

Generalized Tonic-

Clonic (grand mal)

1 to 2 minutes

A cryFall

Tonicity (rigidity)Clonicity (jerking)May have cyanosis

Amnesia for seizure events

ConfusionDeep sleep

Types of Seizures

Partial seizures are the most common type of seizure experienced by people with epilepsy.

In partial seizures the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain). Partial seizures are subdivided into simple partial seizures (in which consciousness is retained); and complex partial seizures (in which consciousness is impaired or lost).

Type Duration Symptoms Postictal

Simple Partial

90 seconds No loss of consciousne

ss.Sudden jerkingsensory

phenomena

Possible transient weakness or loss of sensation

Complex partial

1 to 2 minutes

May have aura

Automatisms (such as lip smacking, picking at clothes,

fumbling)Unaware of environmentMay wander

Amnesia for seizure

eventsMild to

moderate confusion

sleepy

Epilepsy Statistics

By 20 years of age, one percent of the population can be expected to have developed epilepsy.

Prevalence of active epilepsy (history / seizure or use of antiepileptic medicine within the past 5 years) is estimated as almost 3 million in the United States.

Prevalence tends to increase with age. 45,000 children develop epilepsy every year. 326,000 school children through age 15 have epilepsy. More than 300,000 persons over the age of 65 have epilepsy. By 75 years of age, three percent of the

population can be expected to have beendiagnosed with epilepsy, and ten percent will have experienced some type of seizure.

70% of cases, no cause is apparent.

Special PopulationsSpecial Populations RemissionRemission

25.8 percent of children with mental retardation

13 percent of children with cerebral palsy

50 percent of children with both disabilities

10 percent of Alzheimer patients 22 percent of stroke patients 8.7 percent of children of mothers

with epilepsy 2.4 percent of children of fathers

with epilepsy 33 percent of people who have

had a single, unprovoked seizure

70 percent of people with epilepsy can be expected to enter remission-defined as 5 or more years seizure free on medication.

35 percent of people with mental retardation, cerebral palsy, or other neurological condition will enter remission.

75 percent of people who are seizure free on medication for 2 to 5 years can be successfully withdrawn from medication.

10 percent of new patients fail to gain control of seizures despite optimal medical management.

Epilepsy Statistics

Genetics and Causes

While some types of epilepsy tend to run in families, there is not a strong genetic factor

Other factors that seem to be involved in inheritance: Age when epilepsy begins Gender of parent with epilepsy

Causes of Epilepsy Congenital brain defects Metabolic diseases that children may be born with Serious brain injury Brain and CNS tumors or lesions Brain and CNS infections, including meningitis & encephalitis Degenerative diseases Kidney or liver failure

Seizure Triggers and Warning Signs

Warning Signs: Physical Sensory

Triggers Vary greatly depending on type of

epilepsy Internal External

Medical TreatmentMedical Treatment Seizure First AidSeizure First Aid

Doctor Medication Neurologist referral Ketogenic diet Vagus nerve stimulation Brain surgery

Stay calm, keep onlookers away Prevent injury- make sure nothing is

in reach that could harm victim if struck

Pay attention to the length of the seizure

Make the person as comfortable as possible-do not hold the person down.

Do not put anything in the person's mouth

Do not give the person water, pills, or food until fully alert

If the seizure continues for longer than five minutes, call 911

Be sensitive and supportive, and ask others to do the same

Treatment for Epilepsy

Famous People with Epilepsy

Vladimir Lenin- Politician Florence Griffith Joyner-

Athlete Fyodor Dostoyevsky- Author Prince- Musician Neil Young- Musician Bud Abbot (Actor- Abbott

and Costello) Danny Glover- Actor Retrospective Diagnosis:

Napoleon I Socrates Julius Caesar Joan of Arc

Can Movies or Video Games Trigger Seizures?

Physiological symptoms occurring during video games may trigger seizures in children with epilepsy, such as stress, fatigue, or hyperventilation.

About 3% of children may be photosensitive. Flashing lights, flickering, or certain color sequences can trigger seizures.

Most epileptic children should be able to watch movies, television, and play games with no problems.

Recently, there have been several reported seizures by audience members at screenings of the recent film “127 Hours”, starring James Franco. It is speculated that these were a result cinematography effects and stress.

Children with Epilepsy

About 400,000 children in the U.S. have epilepsy.

In 70% - 80% of children, epilepsy is completely controllable with medication.

• Most children who have epilepsy will outgrow the condition. • Most children with epilepsy are perfectly healthy and normal in other ways.

Logistical Impacts of Epilepsy

“He has a non-life. He cannot work or drive, cannot afford health insurance, cannot afford to see a neurologist. He gets very depressed about all this, and there is no way he or we can fix it. Something needs to be done. He is only 23 and he feels his life is over” (Epilepsy Foundation of Michigan, 2008).

Employment Only 27% of adult survey respondents work full-time 38% unemployed Mean annual income for full-time workers: $39,690 (U.S. average

was $52,703)

Lack of Transportation Difficulty getting to work, social isolation, and dependence on

others 17% rated this as the hardest thing about living with Epilepsy

Physical/Mental Impact of Epilepsy

“The uncertainty of normal living… I never know when a seizure is going to hit and hope like heck someone knows what to do should I have one while in their company” (Epilepsy Foundation of Michigan, 2008).

Seizures 41% of survey respondents said that seizures limited quality of life “a lot” 42% have at least 1 per month, 11% have them daily

Memory & Cognitive Problems Epilepsy can affect learning, development, and memory 80% of children experienced learning problems

Physical Health Injuries (24%), sleeping problems, weight gain, fatigue, shakiness

Medication Problems May not work, or may have disruptive side effects (over 50%)

Health Care Access and Cost Cost of—and access to—testing, surgery, medication and other treatment

Psychosocial Impact of Epilepsy

“I am always afraid of being in a social situation because I never know if I am going to have some type of seizure. I often feel alone and depressed” (Epilepsy Foundation of Michigan, 2008).

• Social Challenges-per survey responseo Social isolation- 48% report lonelinesso Restrictions /limitationo Dependence on otherso 26 experienced clinical depression in last yearo 26% suffer from anxiety disordero 48% report low self-esteem

• Public Misperceptions11% of adult s with epilepsy received incorrect seizure first aid from someone in the past year, while 40% of children with epilepsy reported being mistreated or left out because of epilepsy.

Education and Epilepsy

What issues might you see in a classroom?Problems in the Classroom:

underachievement in Reading, Language and Arithmetic 16% below grade level in Reading, 50% below grade level

in general knowledge 9% have I.Q.s below 70 (3x the general pop.)

attention problems delayed or impaired motor skills impairment of self-concept behavior issues social rejection from peers


Why are these issues occurring?Seizure-prevention medications

sleepiness & lack of energy

Seizures interfere with attention and could affect memory anxiety & fear over when the next seizure will come

Underlying brain conditions / Neurological impairment can affect learning, memory, and processing might be seen in Math, Reading, and memorization

Missed class time / Frequent seizures falling behind in assignments, assessments, and instruction


Students with Epilepsy are entitled to services under IDEA if the impairment adversely affects their educational performance. The right to be taught in a

regular classroom, and to be included in social and other activities. Establish the existence of a

disability Get a detailed picture of how

it affects the student functionally, developmentally and academically

Document the student’s special needs


Some Accommodations, Modifications & Services: A special class aide (A) Extra time for assignments (A) Monitor medication & seizures (A) Specially designed furniture (A) Replace fluorescent lighting with full spectrum lighting (A) Private area to rest or recover after a seizure (A) Separate programs in physical and/or music education (M) Education for teachers and school nurses (S) An education program for other students (S) Physical/occupational therapy (S) Counseling for social impairments/struggles (S)


Interview counselor re: student with epilepsyo Student was originally in special education classes, but now attends all general

education classes.o Student seizures uncontrolled with medication.o Student experiences up to 15 seizures a day.o Student receives all “G” grades in classes, has parapro, and is currently

repeating 7th grade.o Seizures have increased, and district demanded that she wear a helmet.o Typical procedure- teachers call office when seizing, continue with class.o Student is transported to office afterward

sometimes in wheelchair, have had to call 911 on occasion.

o When not seizing, is typically sleeping in class (due to medications, recovery, and exhaustion). Teachers try unsuccessfully to wake- no learning accomplished.


Concerns Counselor (also a former special education teacher) feels general ed

classroom is inappropriate placement, but parents wanted minimal services. Teachers concerned student will stop breathing, and that they are not

trained in CPR. Teachers unsure of expectations and workload for student. Has received many phone calls from concerned parents regarding the

stress the other students experience. Counselor feels more appropriate placement would be a program such as

Wing Lake. Counselor has concerns for student’s future. Counselor feels student’s cognitive ability may have significantly dropped in

last few years due to increased seizure activity. Student to be evaluated at end of school year- counselor feels she should be

recertified and returned to special education. Counselor expressed concerns about the severity and prevalence of

symptoms, as well as parental attitude, and has wondered whether she should call Children’s Protective Services.

References

o Epilepsy.com (n.d.). Education of Kids with Epilepsy. Retrieved from http://www.epilepsy.com /info/family_kids_education

o Epilepsy.com (n.d.). Seizure First Aid. Retrieved from http://www.epilepsy.com/EPILEPSY/firstaid

o Epilepsy.com (n.d.). Video Games and Epilepsy. Retrieved from http://www.epilepsy.com/info/ family kids video

o Epilepsy Foundation (n.d.) Epilepsy and Seizure Statistics. Retrieved fromhttp://www.epilepsyfoundation.org/about/statistics.cfm

o Epilepsy Foundation (n.d.). About Epilepsy & Seizures. Retrieved from http://www.epilepsy foundation.org/about/

o Epilepsy Foundation (n.d.). Helping Children Understand. Retrieved from

www.epilepsyfoundation.org/living/children/education/schoolsunderstand.cfmo Epilepsy Foundation (n.d.). Types of Seizures. Retrieved from

http://www.epilepsyfoundation.org/about/types/types/index.cfmo Epilepsy Foundation of Michigan (n.d.). About Epilepsy. Retrieved from

http://www.epilepsymichigan.org/template.php?pid=287

References

o Epilepsy Foundation of Michigan (2008). 2008 Epilepsy Needs Assessment Survey: Key Findings. Retrieved from

http://www.epilepsymichigan.org/docs/2008Needs AssessmentSummary.pdf

o Hartenburg, J. (personal communication, March 22, 2011)o National Dissemination Center for Children with Disabilities (2010). Epilepsy.

Retrieved from http://www.nichcy.org/disabilities/specific/pages/epilepsy.aspx

o VanAirsdale,S.T. (2011, January 4). 127 Hours' Causes Fainting, Vomiting, Seizures. Huffington Post. Retrieved from

http://www.huffingtonpost.com/2010/11/04/127-hours-causes-fainting_n_779118.html

o Wikimedia Foundation (2011). List of people with epilepsy. Retrieved fromhttp://en.wikipedia.org/wiki/List_of_people_with_epilepsy

Epilepsy (Handout)

When you see someone having a seizure: Stay calm Prevent injury Notice the length Make them comfortable Keep onlookers away Do not hold the person down Do not put something in

their mouth Do not give water/pills/food Call 911 (if longer than 5

min.) Be sensitive & supportive

Teaching students about seizures: What you just saw was a seizure Your friend's brain did not work

properly and sent mixed up messages to the rest of his body

Having seizures is part of a health condition called “epilepsy”

Epilepsy is not a disease and it can't be caught

Your friend takes medicine to prevent seizures, but sometimes one happens anyway

Seizures stop by themselves, but you should know how to keep your friend safe while it’s happening