Epilepsy and Modern life

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Epilepsy and Modern life
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• We will discuss
• Epilepsy awareness and knowledge
• Modern technology and epilepsy
• Exercise and epilepsy
• Stress and epilepsy
• Diet and epilepsy
• Others

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• Epilepsy in modern life gained much benefit from
  new technology regarding diagnostic procedures
  and therapeutic modalities including epilepsy
  surgery, vagus nerve stimulation, gene therapy
  and alternative medicine approaches like yoga,
  relaxation techniques, biofeedback, nutritional
  herbal supplements , dietary measures and
  acupuncture.
• On the other hand, modern life is still adding
  risk factors for epilepsy which presents multiple
  challenges to the clinicians.

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Attitude, Awareness and Knowledge

• Paradigm Shift ???

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• Although a revolution has been done in epilepsy
  research, recent technologies didnt make this
  paradigm shift in perception and understanding of
  epilepsy in general population.
• Epilepsy has frequently been portrayed in
  literary works, films and television (TV) series,
  often relating it with madness, evil, violent
  behaviors or possession by the divine or ghosts.
  This marks the awareness and knowledge people
  have about epilepsy and epileptic patients.

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• -
• Epilepsy has been always stigmatized (and still).
• - History declared that much discrimination
  measures were taken against epileptics even in
  20th century.
• - In old civilizations and beliefs
  misunderstanding about epilepsy and epileptic
  patients was the base, one of exceptions which
  was done by the pure sunnah in Islam.

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Narrated 'Ata bin Abi Rabah Ibn 'Abbas said to
me, "Shall I show you a woman of the people of
Paradise?" I said, "Yes." He said, "This black
lady came to the Prophet and said, 'I get attacks
of epilepsy and my body becomes uncovered please
invoke Allah for me.' The Prophet said (to her),
'If you wish, be patient and you will have
(enter) Paradise and if you wish, I will invoke
Allah to cure you.' She said, 'I will remain
patient,' and added, 'but I become uncovered, so
please invoke Allah for me that I may not become
uncovered.' So he invoked Allah for her.SAHIH
BUKHARI" Volume 7, Book 70, Number 555
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• Modern Technology and Epilepsy

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Photosensitive Epilepsy (PSE)

• It is a good example for effect of technology,
  its a form of reflex epilepsy in which seizures
  can be triggered by flickering or intermittent
  light stimulation, occurring in 1/4000 of the
  population, common in childhood and more in
  girls. With age, it can disappear but 75 stay
  photosensitive for life.
• Seizures vary from brief absence seizures to
  tonicclonic seizures, May preceded by aura and
  this can serve as a warning. Flashing lights or
  rapidly changing or alternating images (as in
  clubs, around emergency vehicles, in action
  movies or television programs, cinema,
  theatre.. etc.) are examples especially in
  luminance contrast. Red color is a good trigger.
  The photoparoxysmal response in EEG helps in
  diagnosis. Treatment remains the removal of the
  offending stimulus with drug therapy (as sodium
  valproate).

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Television
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• Television is the most common source of seizures
  in PSE especially in a dark room, at close range
  and with flickering. Some patients self-induce
  seizures by waving their fingers in front of
  their eyes with TV watching.
• For protection
• The room should be well-lit.
• light source is placed on top of or behind the TV
  to balance the screen brightness.
• Flat screen or LCD (liquid crystal display) units
  dont flicker at all.
• Sitting away (2.5 meters).
• Use a remote control or cover one eye to reduce
  flickering.
• Take a five-minute break every 30 minutes.

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Video Games
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• Seizures triggered by VGs were reported, not only
  in photosensitive, but also in nonphotosensitive
  epileptic children.....Preventive measures
  concerning the characteristics of images VGs
  (flash rate, choice of colours, patterns, and
  contrast).
• Playing video games on a LCD TV screen
• No playing with the feeling of tiredness
• Taking a 5-minute break away every 15 minutes
• Switching off immediately with dizziness ,
  blurring of vision, muscle twitching and being
  uncomfortable in any way .

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Computers
Computers
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• It is recommended that computer screens have a
  refresher frequency of at least 73 Hz or use LCD
  screen, the computer screen should not show any
  glare, which can result in a flickering.
• The risk of a seizure depends on the material
  being viewed. Some software, especially games,
  cartoons and web designs contain flickering
  images.
• Use an anti-glare screen to reduce fatigue and
  discomfort
• Take regular breaks away (5 minutes every 15
  minutes).

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Cinema and Theatre
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• Going to cinema and theatre is safe with
  epilepsy. Films with special effects (including
  laser and flashing lights) could potentially
  trigger seizures in people with photosensitive
  epilepsy. Think carefully about where is the
  seat.

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Fluorescent Lighting
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• It is more beneficial to use natural light or
  old-fashioned light bulbs. Energy-saving bulbs
  are small fluorescent tubes. Older strip
  fluorescent light tubes flicker more and should
  be exchanged regularly.

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Mobile
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• Electromagnetic fields (EMFs) emitted by mobile
  phones had been shown to increase cortical
  excitability and modulate inter-hemispheric
  synchronization of temporal and frontal resting
  EEG rhythms.
• Inhabitants living nearby mobile base stations
  are at risk for developing neuropsychiatric
  problems and some changes in the performance of
  neurobehavioral functions either by facilitation
  or inhibition.

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• Although that exposure wasnt above accepted
  international guidelines, studies had reported
  increased prevalence of adverse neurobehavioral
  symptoms , such as headache, memory changes,
  dizziness, tremors, depression, sleep
  disturbances and more significant increases in
  the frequency of seizures in epileptic patients
  if living at distances lt500 m from base stations
  which suggesting that current guidelines may be
  inadequate in protecting health. Other studies
  added the dose response relationship, duration
  exposure and other variables, such as
  sociodemographic data.
• Future research should address critical and
  neglected issues such as investigation of
  repeated, intensive and chronic exposures,
  especially in in highly sensitive populations
  such as epileptic children to provide safe rules
  for the use of mobile

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• Finally, research related to the effects on
  health of using mobile phones is inconclusive. So
  until there is more evidence, it is sensible for
  everyone, whether they have epilepsy or not, to
  restrict their mobile phone use to short and
  essential calls only.
• -People with epilepsy who use mobile phones often
  should carefully monitor their seizure frequency.
  
• -Mobile phones should be kept away from vagus
  nerve stimulation devices.
• -Children with epilepsy should be discouraged
  from using mobile phones.

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Microwave Ovens
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• Although microwave ovens are recommended as a
  safe cooking alternative for epileptic patients
  but hand burns in complex partial seizures are
  reported. The use of gloves and heating foods
  (not boiling liquids) is recommended.

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Stress
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• Both physical (work related) and mental stress
  are commonly believed to precipitate seizures in
  some patients with epilepsy. Stress itself may
  also be associated with other seizure-provoking
  factors such as sleep deprivation.
• Stressful life events as wars can be provocative
  factors for the occurrence of seizures. Typical
  absence seizures are more likely to be provoked
  by stress then other types of seizures.

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Sports
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• Epileptic patients have previously been
  discouraged from participation in sports dx- for
  fear of inducing seizures or increasing its
  frequency. Although there are rare cases of
  exercise-induced seizures, studies have shown
  that it improves both physical and psychosocial
  outcomes.
• The majority of sports are safe provided
  adequate seizure control and preparation of
  family and trainers. Contact sports including
  football dont induce seizures.
• Water sports and swimming are safe if seizures
  are well controlled and direct supervision is
  present with exception for those who have bathing
  epilepsy or hot-water epilepsy.
• Additional care must be taken in sports
  involving heights such as gymnastics, or
  horseback riding. Sports such as hang-gliding,
  diving are not recommended, given the risk of
  severe injury or death, if a seizure were to
  occur during the activity.

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• Generally, most sports are safe as long as
  patients avoid overexertion, dehydration and
  hypoglycemia. If a seizure occurs, it is most
  likely to be after the exercise (15 minutes to
  three hours later) and can occur suddenly without
  warning.

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Travelling
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• Travelling by cars and trains Patients should
  sit away from watching fast moving or jerking
  shapes on roads, also light reflection on rapidly
  moving vehicles which can trigger seizures in
  PSE.
• Air travel increases seizures frequency. Provided
  that seizures are controlled with medication,
  epileptic Patients can travel by air.
• Epilepsy is thought to be one of the essential
  contraindication for driving a motor vehicle on
  public roads. There is a tendency toward a
  greater liberalization of driving standards for
  people with epilepsy.

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• Foods that thought to be seizure triggers in
  some patients include artificial colors,
  preservatives especially Propionate in addition
  towheat, cows milk and cheese (but not sheep
  cheese), tomatoes, tea, grapes and other
  salicylate-containing foods chocolate, pork,
  banana, amine-containing foods and other
  glutamate containing foods (Egger et al,
  1989). ).

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Others

• Pollution
• Noise
• Smoking
• Radiation

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Thank you
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• Warning