Seizures and Epileptic Status
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Slide 1 :
Seizures and Epileptic Status Presented By: Fadel zein
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What is Epilepsy
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What Is Epilepsy? It's a strange word, isn't it? Epilepsy comes from a Greek word meaning "to hold or seize," and people who have epilepsy have seizures. Epilepsy is a disorder of the central nervous system; specifically the brain in which the patient have tendency of recurrent seizures.
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Seizure Massive electrical discharge in a group of nerve cells in the brain Causes change in mental behavior Range from trancelike periods of inattention to unresponsiveness and jerky muscle spasms known as convulsions Common cause is epilepsy Chronic brain disorder characterized by recurrent seizures
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WHEN DO SEIZURE OCCUR?? A seizure occurs when the normal electrical balance in the brain is lost. The brain's nerve cells MISFIRE: they either fire when they shouldn't or don't fire when they should. The result is a sudden, brief, uncontrolled burst of abnormal electrical activity in the brain. Firing neurons
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What is a seizure threshold? A seizure threshold is the level of stimulation at which your brain will have a seizure. A very high fever, for instance, can sufficiently excite anyone's brain to produce a seizure. People with epilepsy have a lower-than-normal seizure threshold, meaning that only slightly increased excitement will cause them to have a seizure. Your seizure threshold is mostly genetically inherited
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What causes epilepsy? . Common causes are head injury (eg. from a car accident); brain tumour, scar or lesion; brain injury during fetal development; birth trauma (eg. lack of oxygen during labour); infectious diseases (eg. meningitis, encephalitis, measles); poisoning from substance abuse, like alcohol; and stroke.
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Types of Seizures Generalized Tonic-Clonic Seizure (Grand Mal) Simple Partial Seizure Complex Partial Seizure Absence (Petit Mal ) Seizure Febrile Seizure
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Generalized Tonic-Clonic Seizure Called Grand Mal Seizure Most common type of Epileptic Seizure Usually occurs in 4 stages Aura Tonic phase Clonic phase Postictal state
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Aura Warning that seizure is going to begin Involves sensory perception Sound, abnormal twitch, anxiety, dizziness smell or odor, odd taste, visual disturbances, unpleasant feeling in the stomach Tell patient to let you know if he is going to seize Can have seizure without the Aura
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Tonic Phase Patient becomes unresponsive and falls to the ground Typically follows Aura Muscles become contracted and tense Extreme muscle rigidity and arching back
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Clonic Phase Convulsions Muscle spasms alternating with relaxation Produce violent and jerky seizure activity Loss of bladder and bowel control May bite tongue, lips, or mouth Breathing may be shallow or absent Usually last 1 to 3 minutes
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Postictal State Recovery phase Complete unresponsiveness to confusion and disorientation Mental status improves over time Exhaustion and embarrassment May have a headache and hemiparesis Usually lasts 10 to 30 minutes
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Emergency Care Maintain airway - Insert NPA if patient is unresponsive Never force anything into the patient’s mouth Big O’s With NR or begin positive pressure ventilation Position the patient Left lateral recumbent or supine and fully immobilized, but be ready for vomiting Suction as needed Assist breathing if seizure lasts longer than 5 minutes Protect the patient from hurting themselves Transport
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Simple Partial Seizure Known as focal motor or Jacksonian motor seizure Jerky muscle activity in one area, arm, leg, or face Patient remains awake and aware of activity Can spread and become generalized tonic-clonic seizure Document where activity began and spread
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Emergency Care Recurring problem transport may not be necessary First time seizure transport for further evaluation Contact medical control or follow protocol
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Complex Partial Seizure Also known as psychomotor or temporal lobe seizure Usually starts with blank stare, followed by random activity such as lip smacking, chewing, or rolling the fingers Appears dazed, unaware of surroundings Mumbles or repeats certain word phrases Clumsy movements picks at or removes clothing Patient may struggle with you or show abrupt personality changes
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Emergency Care Speak calm and reassuringly to the patient Guide patient away from hazards Stay with patient until he is aware of surroundings Will most likely refuse transport Contact medical control or follow protocol
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Absence (Petit Mal) Seizure Most common in children Blank stare beginning and ending abruptly, only lasting a few seconds Rapid blinking, some chewing movements, lack of attention Unaware during seizure, awareness returns after seizure stops No emergency may be needed, but first time activity, medical evaluation should be recommended
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Febrile Seizure Common in children between 6 months to 6 years Caused by high fever Affects approximately 5% Generalized seizure, short duration No emergency may be needed, but first time activity, medical evaluation should be recommended If seizure last longer than 15 minutes or recurs without recovery period, transport immediately Status epilepticus, true medical emergency
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Scene Size-Up Assess scene for clues Look for any head injury Most commonly in postictal state upon arrival Do not hold patient down, guide movements Move objects away from patient Never place anything in mouth Be prepared to use AED if no pulse is found
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Initial Assessment Assess A,B,C’s Status epilepticus - seizures that last longer than 10 minutes with no period of responsiveness between them (true emergency)
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Categories for Priority Transport Patient remains unresponsive after seizure Any inadequacy of A,B,C’s Second seizure occurs without a period of responsiveness Seizure last longer than 5 minutes Pregnant, history of diabetes, or trauma Seizure occurred in water Evidence of head trauma
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Focused History/Physical Exam Postictal or altered mental status rapid assessment Assess head, pupils, look for medical alert tags Assess for fractures SAMPLE History Ongoing assessment Prepare for other seizures
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How is epilepsy diagnosed? There is no diagnostic test for a seizure or for epilepsy. The doctor's diagnosis is based on: a thorough investigation of a first seizure(including any witness observations), a physical examination, family history, and supportive tests such as 1) the EEG, 2) CT Scan, 3) MRI.
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What is an EEG? The electroencephalograph or EEG directly measures electrical activity in the brain--brain waves— through the skin. In this harmless test, small sensors called electrodes are attached to the patient's scalp. The electrical activity picked up by each sensor is graphed onto an EEG printout. Tests done on people with epilepsy commonly show uneven activity or large changes in the voltage of brain waves (spikes).
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How is epilepsy treated? Treatment for seizures is normally anti-epileptic medication, which does not cure epilepsy or the tendency to have seizures but usually does help control the seizure activity.
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What medications are used in the treatment of epilepsy? New Anti-Epileptics Gabapentin (Neurontin), lamotrigine (Lamictal), topiramate (Topamax) and Diazepam Rectal Gel (Diastat). Traditional Anti-Epileptics phenobarbital, primidone (Mysoline), phenytoin (Dilantin), carbamazepine (Tegretol), valproic acid (Depakene), divalproex sodium (Epival), clonazepam(Rivotril), ethosuximide (Zarontin
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What are the most common SE for Anti Epileptic Medication All anti-epileptic drugs can have side effects. These vary from drug to drug and only affect some people. In general, however, it is common for people on anti-epileptic medication to experience, drowsiness fatigue, weight change, upset stomach and difficulties with concentration and memory.
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Is there any Surgeries to treat Epilepsy Yes, brain surgery for epilepsy is performed, but only in a small percentage of cases. The vagus nerve stimulator ; small, pacemaker-like generator which is surgically implanted near the collarbone
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Is diet used to treat epilepsy? It is more useful in children than in adults and it is said to be KETOGENIC DIET which is a high caloric diet that achieve significant reduction in intensity and frequency of seizures
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Is there any Alternative Therapy Unconventional or non-medical therapies that focus on the integration of the body, mind and spirit have not yet been well researched for epilepsy. Some people who have tried 1)Relaxation, 2)Yoga, 3)Acupuncture, 4)Aromatherapy,
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What new medical treatments for epilepsy does the future hold? In the future, epilepsy may be treated by new forms of electronic stimulation of the brain, implanted devices to deliver medication directly to areas of the brain from which seizures arise, gene therapy, and transplants of immature brain cells to replace damaged or missing neurons.
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