epilepsy - part ii

8/11/2019 Epilepsy - Part II

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EPILEPSYPART II

Sam Lazuardi


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EPILEPSY PREVENTION - 1

1.Head injury prevention: seatbelts, helmets

2.Medication after 2ndseizure or complicatedfebrile seizures

3.Good prenatal care (hypertension, infectionsin pregnancy)

4. Childhood immunizations


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EPILEPSY PREVENTION - 2

5. Manage risk factors such as high blood

pressure, diabetes & high cholesterol to reduce

your chances of stroke

6. Identifying genes, genetic screening

3


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TREATING EPILEPSY ?

Even mild seizures may require treatment,

because they can be dangerous during

activities (driving, swimming)

Treatment incl. medications and sometimes

surgery -> to eliminate /reduces frequency &

intensity

Many children outgrow with age

4


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13-Aug-14 5

WHEN TO START TREATMENT

Absence seizure rarely isolatedth/

Isolated febrile seizureno th/

Isolated unprovoked generalized tonic-clonic seizuresno th/

Seizure recurrence when focal deficit,

mental retarded, EEG abn

th/ Provocative etiologytreat underlying

process rather seizure


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13-Aug-14 6

WHEN TO STOP TREATMENT

Benign epileptic syndromes

Absence seizures outgrow their seizures

Benign childhood epilepsy with centro-temporal spikes

Seizurefree for 2 yrs adult (1/3) &

children (1/4) will relapse followingtermination of drug


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RECURRENCE RISK FACTORS

Prolonged duration before seizures were

controlled

High frequency of seizures before control

Neurological abnormalities

Mental retardation

Complex partial seizures Consistently abnormal EEG


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EPILEPSY MANAGEMENT (1)

After D/ start therapy right away

No cure for epilepsy, but medicine can control

seizures for most people

If not, surgery, implanted device (vagus nerve

stimulators) & diet

80 % can be controlled, 20 % intractable


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1.Try monotherapy first, combination - polyth/

may cause side effects

2.Start with a low dose & monitor blood levels

3.Sudden stopping of medicationstatus

epilepticus


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4. 75 % could stop medication if seizure free

for 3 yrs & normal EEG

5. Never stop medication for people with

family history of epsy (+), who need multiple

medication, focal seizures and have abnormal

EEG while on medication


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ADVANTAGES OF MONOTH/

7089 % CONTROLLED

FEWER SIDE EFFECTS

REDUCED TERATOGENICITY NO DRUG INTERACTIONS

EASIER DOSINGGREATER

COMPLIANCE LOWER COST


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ADVANTAGES OF POLYTH/

MAY CONTROL AN ADDITIONAL 20 %

MAY OFFER SYNERGISTIC OR ADD-ON

EFFECTS


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ANTICONVULSANT SIDE EFFECTS (1)

Sedation, slurring of speech & unsteadiness,

but slowly resolve as body accustomed

Double vision, weight gain, hyperactivity in

children, irritability, gum dysplasia

Life-threatening skin reactions (Stevens

Johnson sy)Asian ancestry genetic test

before th/ carbamazepine


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ANTICONVULSANT SIDE-EFFECT (2)

Side effect warning signs :

Prolonged fever, rash, severe sore throat,

mouth ulcers, easy bruising, pinpoint bleeding,

weakness, excessive fatigue, swollen glands,

lack of appetite, increased seizures,

inflammation of liver - pancreas

Report to the doctor at once


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ANTICONVULSANT SIDE EFFECTS (3)

Side effects of medication in pregnancy

birth defects : cleft lip / palate, cardiac

abnormalities, spinal tube defectsfolic acid

400 microgram prior & during pregnancy

Osteoporosis

May raise suicide risk


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TREATMENT TIPS (1)

1.Take your medication regularly (through

reminders), dont run of medication

(especially on vacation)

2.Learn about your medication (side effects,

strength, dosage, if you miss a dose, etc)

3.Dont ever stop medication abruptly

4.Dont try other peoples pills


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TREATMENT TIPS (2)

5.Never mix alcohol with medication

6.Keep medication out of reach of children

7.Keep medication away from direct sunlight,dampness & high humidity

8.Tell doctors, dentists, pharmacists that youare taking antiepileptic medication

9. Tell your doctor about your seizure control& unpleasant side effects


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THE RIGHT ANTIEPILEPTIC DRUG

(AED) DEPEND ON :

Type of epilepsy

Age, gender, other health issues

How the AED work & side effects Other medicine youre taking

Are the side effects acceptable

In a female, pregnancy side effects


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FIRST AID FOR SEIZURE

Gently roll person on 1 side & put some-thing

soft under head, loosen neckwear

Dont put fingers / something else in mouth

Dont try to stop his movements & clear away

dangerous objects

Stay until the seizure ends naturally Try to bring him to emergency


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STATUS EPILEPTICUS

Seizure more than 5 minuteslife-threatening

Prolonged seizure, without regaining con-

sciousness between seizures Convulsive or nonconvulsive seizure

(confusion or agitation state)

Cause : trauma, tumor etc Medical emergency


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13-Aug-14 21

STATUS EPILEPTICUS TH/ (1)

Gen. tonic-clonic st.epilepticus = medical

emergencystop seizures within 1 hour

Maintain vital signs, airway, O2

50 cc blood for glucose, Ca, Mg, electro-

lytes,Bun, LFT,antiepsy drug level, CBC,

Toxicology, monitor EKG, bl press, EEG

Normal saline IV + 50 cc glucose 50 % +

100 mg thiamine


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13-Aug-14 22

STATUS EPILEPTICUS TH/ (2)

Diazepam IV (5 mg in 2 minutes), repeatevery 510 min up to 30 mg

Give phenytoin 18 mg / kg IV at rate of 50

mg/min or less, slow infusion rate ifcardiac arrhytmia occur

If seizure persist, intubate & give pheno-

barb 50100 mg/min IV Arrange for inhalation anesthesia, neuro-

musc blockade & EEG monitoring


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SURGERY

3 broad categories of epsy for successful surgery :

1. Focal seizures

2. Focal & spreading

3. Unilateral multifocal epsy with infantile hemiparesis

(Rasmussens encephalitis)

* After unsuccessful trying of 23 medication

First WADA test areas for speech & memory

Postoperative 2 yrs with anticonvulsant therapy

.


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VAGUS NERVE STIMULATOR

For patients not well-controlled by meds

Device is surgically implanted under the chestskin & attached to vagus nerve like pace

maker, delivers short bursts & can reduce 2040 % seizures

Do not stop medication

Side-effect device minimal (sore throat,nausea)


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KETOGENIC DIET FOR CHILDREN

Ketogenic diet (rich in fats & low in carbo-

hydrates)break down of fats instead of

carbohydratesketosisreduce seizures

Side-effect : retarded growth - nutritional

def, dehydration, constipation, kidney stone

Taking large doses of vitamins harmful

Only folic acid as supplement is justified


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How does epilepsy affect daily life ?

Children often develop behavioral &emotional problems

Do not reward negative behavior with unusual

amount of attention Most people with epsy lead a normal life

Poor self-esteem, depression & suicide are the

result of lack of understanding & avoidance bythe community


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DOCTORS QUESTIONS

When did you first begin experiencing seizures

?

Do the seizures seem be triggered by cer-tain

events or conditions ?

How frequent is your seizure ?

What symptoms do you have during the attack

and is there anything which appear to improve

of worsen the seizures ?

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PREPARING FOR APPOINTMENT -

1

Keep a detailed seizure calender :type of

seizure & how long it lastedtrigger fac-tors :

missed medications, sleep deprivation, stress,

menstruation etc & input from people whomay observe the seizure activity

Personal information (stress or recent life

changes)

List all medications incl vit & supplements

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13-Aug-14 30

DRIVING & RECREATION

Seizure related accident is 93 % less in

people who wait 1 yr after last attack

Sport : avoid head trauma (boxing, racing)

Jogging, football (except heading)OK

Swimming, sailing under supervision

Regular exercise improve seizure control


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13-Aug-14 31

EDUCATION

Antiepileptic drugs side effects interfere

with concentration & memory

Temporal lobe epilepsy cause memory

problems

Parents & teachers should accommodate

the special needs

Survey : 56 % finish high school & 15 %

finish college


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LIFESTYLE, COPING & SUPPORT -

1

Take medication correctly

Get enough sleep

Wear a medical alert bracelethow to treatyou correctly

Manage stress, avoid alcohol & smoking

Educate yourself, family & friends aboutepilepsy

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LIFESTYLE, COPING & SUPPORT -

3

Work from home by developing a special skill

like computer programming

Develop or participate in hobbies

Work to develop friends

Become a volunteer, helping others is the best

way to help yourself

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SUPIR PENDERITA EPILEPSI

A, supir angkot adalah seorang penderitaepilepsi yg jarang mengalami serangan

Pada umumnya serangannya timbul bila

kurang tidur atau stres atau terlalu letih Serangannya berupa kejang seluruh tubuh

sebentar yg disertai kesadaran menurun

Sudah bbp kali timbul serangan, untung taktabrakan, waktu sadar penumpangnya sdhtidak ada lagi


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EPILEPSI - SIM

Calvin, penderita epilepsi, mendapatserangan sewaktu mengendarai Toyota

Avanza, sehingga oleng dan menyerem-

pet 43 peserta gerak jalan santai PDIPdalam rangka peringatan bulan BungKarno (20/6-10), dimana Atin telahmeninggal dunia akibat perdarahan otak

Di US, penderita epilepsi tidak bolehdiberikan SIM


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No longer afraid to talk about epsy1

CNN 10 OCT 2012

Paul R found out he had epsy when he was 22

Now 50, hes had 7 grand mal seizures, heoften went yrs without having a S at all

He kept it private, as he was ashamed of it *While sitting in the waiting room to see his

neurologist, he stumbled across a CNN story

on his iPad, about US commerce secretaryJohn B, who had a S while driving and talkedabout the impact Epsy had on his life.


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No longer afraid to talk about epsy3

CNN 10 OCT 2012

He became a team captain for the founda-

tionswalk to End Epilepsy on Oct 28 at Rose

Bowl.

Last mo, days before his 50thbirthday, he

climbed Mt Whitney, the highest point in con-

tigous US, in a 15 hour hike and dedicated the

hike and his birhtday to raising money fo thewalk


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END-EPILEPSY

epilepsy - part ii

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