RCS%206080%20Medical%20and%20Psychosocial%20Aspects%20of%20Rehabilitation%20Counseling

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RCS 6080 Medical and Psychosocial Aspects of
Rehabilitation Counseling

• Epilepsy

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Epilepsy

• The most common of the chronic neurological
  disorders 1100-200.
• Epilepsy is not contagious and people with
  epilepsy are NOT crazy
• Etymology of the word comes from a Greek word
  meaning to possess, seize or hold.
• Historical figures with Epilepsy
• Julius Ceaser
• George Fredrick Handel
• Fyodor Dostoevsky
• Peter the Great
• Napoleon Bonaparte
• Vincent Van Gogh
• Pope Pius IX

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Epilepsy

• Diagnosed with the occurrence of two or more
  seizures
• A seizure involves the disruption of the normal
  activity of the brain through neuronal
  instability
• Seizures prevent the brain from interpreting and
  processing incoming sensory signals controlling
  muscles.
• Sometimes people know when they are about to have
  a seizure because they see, hear or feel
  something different this is known as an aura.
  Auras can act as an early warning for a person
  that a seizure is about to happen.

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Seizures

• Provoked
• Metabolic disorders
• Hypoglycemia
• Electolyte imbalance
• Withdrawal from massive amounts of alcohol or
  sedatives
• Massive sleep deprivation
• High fever
• Hypoxia
• Substance abuse
• Excessive use of stimulants

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Seizures

• Unprovoked
• TBI
• Birth trauma
• Anoxia
• Brain tumors
• Infectious diseases in the mother
• Parasitic infections
• Genetic
• Vascular diseases affecting the brains blood
  vessels
• Neurotransmitter GABA (gamma-amino butyric acid)
  imbalance

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Epilepsy

• 1-2 of people with epilepsy will have a
  diagnosable genetic etiology for their seizure
  occurrence
• The general incidence of epilepsy is between 1
  and 4
• Two major type so seizures Generalized and
  Partial
• Generalized uncontolled discharge of neurons on
  BOTH sides of brain. Seizure starts in one area
  and spreads across the brain.
• Partial abnormal electrical activity involving
  only a small part of the brain - although
  sometimes a partial seizure can spread to the
  whole brain

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Generalized Seizures

• Tonic-clonic seizures
• grand mal massive discharge of neurons on
  both cerebral hemispheres. Body becomes rigid
  and jerks. Tonic-clonic means
  stiffness-violent grand mal means great
  sickness
• Absence seizures
• Non-convulsive. Person may be unaware of
  surroundings and stare off. Lasts only 5-30
  seconds
• Atonic seizures
• Loss of muscle tone causes person to fall down
• Myoclonic seizures
• Involves motor cortex and causes twitching or
  jerking of certain body parts.
• Status epilepticus
• Frequent, long-lasting electrical activity with
  no regaining of consciousness between attacks.
  Very dangerous and requires immediate medical
  attention.

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Partial seizures

• Simple partial seizures
• Jacksonian or focal seizures.
• Short seizures with no loss of consciousness
• People may see, hear or smell something odd
  their body may jerk.
• Complex partial seizures
• Psychomotor seizures
• A seizure with a change, but no loss, in
  consciousness.
• People may hear or see things or have a memory
  resurface. Déjà vu may occur.

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Conditions that may look like a seizure

• Syncope
• Psychogenic seizures
• Breath-holding spells
• Paroxysmal REM sleep behavior
• Panic attacks

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International classification of epilepsies

• Originally established in 1989 currently under
  revision
• Current system comprises two major categories
• Localization-related syndromes
• Idiopathic
• Symptomatic
• Generalized-onset syndromes
• Idiopathic with age-related onset
• Idiopathic /or symptomatic
• Symptomatic
• Nonspecific etiology
• Specific syndromes

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Evaluation of single seizure

• History of event
• Medical History
• Family History
• Social History
• Physical Examination
• Neurological Examination
• Laboratory Evaluation
• EEG
• MRI
• Routine lab work

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Treatment and Prognosis

• Antiepileptic (anticonvulsant) medications
• Carbamazepine (Tegretol)
• Clobazam (Frisium)
• Clonazepam (Rivotril)
• Diazepam (Valium)
• Divalproex sodium (Depakote)
• Ethosuximide (Zarontin)
• Phenobarbital (many different names)
• Phenytoin (Dilantin)
• Valproic Acid (Depakene)

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Surgery

• Temporal Lobe surgery
• removal of cortex of temporal lobe where the
  epileptic seizure starts. May also remove
  hippocampus and amygdala.
• Corpus Callostomy
• the corpus callosum is cut to separate the right
  and left cerebral hemispheres. This procedure is
  done to prevent the spread of the seizure from
  one side of the brain to the next.
• Hemispherectomy
• one cerebral hemisphere is removed. Not done
  very often. Children CAN function reasonably
  well, but often find using their arm on the
  opposite side of the body to be difficult. Some
  surgeries remove just a specific lobe of the
  brain.

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Other treatments

• Vagal nerve stimulation
• Electrical stimulator placed in the Vagus nerve
  (cranial nerve X)
• Vagus nerve function sensory, motor and
  autonomic functions of viscera (glands,
  digestion, heart rate)
• Ketogenic diet
• High fat, low protein/carbohydrate diet

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Vocational Implications

• For an individual client, the counselor must
  understand the following
• Specific type of seizure with a clear description
  of what happens
• What type of seizure control the person has
  achieved
• If the person has a specific warning or aura
• What is involved in the recovery period
• If the person has ever been injured as a result
• If the person has any other disabilities
• The type of medication and compliance

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Vocational Implications

• Driving Floridas Law
• Seizure-free for 6 months and under regular
  medical supervision with doctors recommendation
• No waiver provision for people with epilepsy in
  regards to a commercial license
• Can drive taxi if meet personal requirements
• Not eligible to drive school bus or buses
  designed to seat more than 15 people
• No provision to require doctors to report to a
  central state agency anyone may report

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Additional Resources and Information from the Web

• Epilepsy Foundation of America (www.epilepsyfounda
  tion.org)
• Epilepsy Foundation of Northeast Florida
  (www.efnef.org)
• Online resource of Epilepsy Project
• (www.epilepsy.com)
• JANs webpage (www.jan.wvu.edu/media/Epilepsy.htm)