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INTRODUCTION TO EPILEPSY Aims of the session

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. INTRODUCTION TO EPILEPSY Aims of the session.

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INTRODUCTION TO EPILEPSY Aims of the session

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  1. Berkshire West Primary Care TrustsEPILEPSY INTRODUCTION TRAINING PROGRAMMEBerkshire West Primary Care Trusts is a collaboration between Newbury and Community, Reading and Wokingham PCTs

  2. 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

  3. 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

  4. WHAT IS EPILEPSY? The tendency to recurrent seizures

  5. WHAT IS A SEIZURE? The result of intermittent and abnormal bursts of electrical activity within the brain

  6. INVESTIGATIONS AND DIAGNOSIS • Referral to doctor • History • EEG (electroencephalogram) • MRI Scan (Magnetic Resonance Imaging) • Videotelementry

  7. CAUSES OF EPILEPSY In 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

  8. TYPES OF EPILEPSY • IDIOPATHIC • SYMPTOMATIC • CRYPTOGENIC

  9. 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

  10. SEIZURE Partial Generalised Seizure activity Seizure activitystarts in one part involves the of the brain whole brain

  11. PARTIAL SEIZURE Simple Complex With secondary Generalisation Seizure activity Seizure activity Seizure activity while the person with change in begins in one is alert awareness of area and surroundings spreads to whole brain

  12. GENERALIZED SEIZURE Absence Myoclonic Tonic-clonic Tonic Atonic Staring and blinking without falling Jerking movements of the body Stiffening, tends to fall backwards if standing Falling heavily to the ground Stiffening, falling and jerking of the body

  13. SEIZURE MONITORING OBSERVATION – BEFORE • Aura/unusual sensation • Automatisms • Change in sleep pattern • Behaviour change • Lethargy • Scream/cry out

  14. SEIZURE MONITORING OBSERVATION – 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

  15. SEIZURE MONITORING OBSERVATION – AFTER • Confusion • Aggression • Drowsy • Headache • Tearful • Alteration in appetite • Thirsty • Hyperactive • Partial seizures • Automatisms

  16. SEIZURE MONITORINGOBSERVATIONSSheet 3Client Name ……………………………………………………………………………DoB ……………………………………

  17. INJURYPlease record any injury sustained during a seizure

  18. POSSIBLE SEIZURE TRIGGERS • Hungry • Missed medication • Tired • Lack of sleep • Hormonal • Photosensitivity • Excitement • Alcohol • Boredom • Illness • Stress

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. THE RECOVERY POSITION

  26. 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

  27. SEIZURES THAT MAY REQUIRE MEDICAL INTERVENTION • Status Epilepticus • Serial Seizures

  28. 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.

  29. SERIAL SEIZURES Serial seizures are defined as seizures recurring at frequent intervals with full recovery between attacks

  30. EMERGENCY PROCEDURES 999 CPR

  31. 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

  32. GENERAL LIFESTYLE IMPLICATIONS • Leisure Activities • Sport • Alcohol and Drugs • Education • Work • Driving and Travel • General Safety Measures

  33. DEATH IN EPILEPSY • accidents • status epilepticus • SUDEP– sudden unexpected death in epilepsy

  34. 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

  35. 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

  36. 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

  37. THE HUMAN CEREBRAL HEMISPHERE SHOWING THE DIFFERENT LOBES

  38. CONTACT DETAILS READING LOCALITYFiona Simpson/Barbara Chandler, Reading Community 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

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