Epilepsy and Seizures

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Epilepsy and Seizures

• Nicholas G. Avgeropoulos, M.D.
• January 2009

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Epilepsy - Scientific Background

• When the brain functions normally, millions of
  fluctuating, simultaneous, tiny electrical
  charges go from the nerve cells to all parts of
  the body.
• People who have seizures / epilepsy have these
  normal electrical patterns interrupted by
  sudden and relatively intense bursts of
  electrical energy that may affect consciousness,
  body movements, and sensation.

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• Signals are electrochemical
• Neurotransmitters can be excitatory or inhibitory

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Epilepsy -Scientific Background

• Nerve cells normally transmit electrochemical
  signals and maintain a balance of excitatory and
  inhibitory neurotransmitters as well as sodium,
  potassium, and other factors critical to energy
  stability.
• When this balance is changed, a seizure may
  result.

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POLL QUESTION 1

• Do you know the difference between seizures and
  epilepsy?

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Epilepsy vs. Seizures

• A seizure is defined by release of excessive and
  uncontrolled electrical activity in the brain.
  Seizures themselves are not a disease, they are
  an event.
• Epilepsy (seizure disorder) is a neurological
  condition, that in different times produce brief
  disturbances in the electrical functions of the
  brain. Seizures are a symptom of epilepsy.

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Seizures

• Seizures can cause different symptoms based on
  the location of the source of and where the
  abnormal electrical activity spreads.
• Seizures can range from tingling in a finger to
  grand mal (generalized) seizures, during which
  people lose consciousness, become stiff, and
  jerk.
• Not everything that looks like a seizure is a
  seizure. And not every seizure is an epileptic
  seizure. Fainting, collapsing, and confusion can
  also result from other disorders or even from
  emotional stress. Withdrawal from alcohol or
  addicting drugs can also cause seizures.

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EEG Montage
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EEG Depicting Seizure
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Poll Question 2

• T or F Epilepsy is a relatively uncommon event

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Facts About Epilepsy

• There are over 2.5 million people diagnosed with
  epilepsy in the United States.
• Epilepsy affects more people than other serious
  conditions such as cerebral palsy, cancer,
  tuberculosis, muscular dystrophy, and multiple
  sclerosis combined.
• The leading cause of epilepsy in adults is
  automobile accidents

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Facts About Epilepsy

• All other things even, people who have epilepsy
  have the same abilities and intelligence as
  everyone else
• The leading cause in children is birth trauma
• The leading cause for the elderly (people over
  65) is strokes

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Causes of Seizures by Age(Brain Tumor trends
indicated in BLUE)
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Epilepsy and Brain Tumors

• Any type of brain tumor can cause seizures
• Slowly or quickly growing primary tumors
• Multiple metastases
• Tumors near the Rolandic fissure, temporal lobes
  / insular cortex more seizure prone. Tumors in
  the cerebellum and brainstem are not.
• Seizures are the second most common presenting
  symptom reported in brain tumor patients, with
  33 of patients reporting a seizure before the dx
  was made.

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Classification of Seizures

• Seizures are classified into partial and
  generalized
• Partial seizures are divided into
• Simple partial - Consciousness is not impaired
• Complex partial - Consciousness is impaired
• About 2/3 of people with epilepsy have complex
  partial seizures

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Different Types of Seizures

• Generalized seizures - Can be convulsive or
  non-convulsive
• Absence seizures - Typical vs. Atypical
• Typical absence seizures - Non-convulsive with
  muscle tone preserved. The seizure usually lasts
  less than 10 seconds.
• Atypical absence seizures - Convulsive, longer in
  duration, loss in muscle tone, and tonic/clonic
  movements are observed.

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Different Types of Seizures

• Tonic-clonic seizures (grand mal) - Generalized
  convulsion occurring in the tonic phase and the
  clonic phase. Often this is preceded by an aura.
• Tonic phase - Muscles stiffen up, person loses
  consciousness, body grows rigid.
• Clonic phase- Body extremities jerk and twitch.
• Secondary generalized tonic-clonic seizures
  begins locally with partial seizures

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Tonic and Clonic(Most often, these alternate)
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Different Types of Seizures

• Photosensitive seizures - These are very rare,
  even for people with epilepsy (related stimulus may trigger this seizure, hence
  the warning labels on electronic devices, theme
  park rides, and even video games.
• Atonic seizures - Sudden lack of muscle tone,
  causing the inability to sit and stand. They are
  also called akinetic seizures. These are very
  rare in adults.

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Poll Question 3

• True or False Status epilepticus can be a life
  threatening event

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Status Epilepticus

• Status Epilepticus - A state of recurring
  seizures when consciousness does not return
  between seizure events.
• Can be very serious and at times fatal. This is a
  seizure that lasts for about 20 minutes, and can
  cause serious brain damage, if not aborted.
• Benzodiazepines like diazepam or lorazepam may be
  given to patients in the hospital for treatment.

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Treatments

• Keppra - Binds to the surface of the vesicles
  which contains neurotransmitters, and may inhibit
  some of the release of neurotransmitters to the
  neuron. May also stop hypersynchronized
  electrical releases.
• Dilantin - Is mainly used for treatment of
  tonic-clonic seizures and complex partial
  seizures. It works in part by reducing
  electrical conductance between brain cells and by
  stabilizing the inactive state of voltage gated
  sodium channels. Sodium channels are
  co-transporters, which offer facilitation of
  neurotransmitter movement.

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Treatments

• Valproic acid - Include drugs such as Depakote,
  Depakene, and Valrelease. Valproate affects the
  sodium channels in the brain, helping prevent the
  release of abnormal brain signals. Valproic acid
  increases gamma-aminobutyric acid (GABA), which
  is a natural brain chemical that stops or slows
  down other brain signals. Valproate is usually
  prescribed for complex partial or complex absence
  seizures but has many other utilities.

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Treatments

• Lamictal - Many of these medicines are similar in
  how they work, and Lamictal works by blocking
  sodium channels. However, lamotrigine also
  lessens the flow of glutamate (an excitatory
  neurotransmitter).
• Topamax - Works very similar to valproic acid
  with respect to GABA stimulation. Mainly
  prescribed for tonic-clonic and partial
  seizures.
• Tegretol - The generic name is Carbamazepine.
  Helps block sodium channels like the others. Has
  many uses.

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Common Side Effects

• Nausea, drowsiness, confusion, dizziness, skin
  rash / severe allergy, weight gain, liver damage,
  altered white blood cell and platelet counts and
  function amongst many others.
• Consult with a doctor to make sure other drugs do
  not interact negatively as different medicines
  work for different people. Make sure there is no
  allergic reaction history to a related compound.

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Poll Question 4

• True or False Once a person has had a seizure,
  they can never drive again

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How do Seizures/Epilepsy Affect You?

• Seizures may restrict driving, working, and
  social opportunities and also affect self-esteem.
  But remember, you can influence how epilepsy
  will affect you.
• Most peoples epileptic seizures can be
  controlled. Some people end their seizures with
  the first medication they try. Others will need
  to partner with their Neuro-Oncologist or
  epileptologist to find the right dosage and
  combination of medications, especially as brain
  tumors can change geometry and location.

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Take Control of Managing Seizures

• Understand your epilepsy, including your seizure
  type
• Make sure to talk to your Neuro-Oncologist or
  epileptologist about all available treatment
  options
• Fill out a medical history and seizure calendar,
  so you can become involved in your medical care
• Learn how to communicate well with your
  neurologist and his or her staff

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Take Control of Managing Seizures

• Bring your epilepsy medications or a detailed
  printed list to each Neuro-Oncology visit Take
  your medication regularly.
• Linking this to a routine may be helpful (when
  you brush your teeth, prepare for bed, etc.).
• There are also devices that can help like a
  watch that beeps when your dose is due or special
  blister packaging that is pre-dosed Get enough
  sleep- lack of it can bring on epileptic seizures

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Download

• Questionnaire and informational handout regarding
  seizure control.

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Common Myths

• Epilepsy is contagious
• People may swallow their tongue during a seizure
• Putting things in peoples mouths (like wallets
  or a stick) while seizing is a good idea
• Ambulance should be called immediately
• If the seizure lasts longer than 5 minutes, it
  is their first seizure, they request an
  ambulance, or have multiple seizures in a row

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Summary

• In most instances, there is a zero-tolerance
  policy for seizure control but there are
  exceptions
• Most commonly, we have to strike a balance
  between seizure control and toxicity of
  medications
• Seizures are often a frightening experience which
  in turn can make them tricky to discern from
  emotional repercussions such as panic, abnormal
  movements such as from spasticity, etc. As
  usual, knowledge gives us power to gain control
  over even the toughest situations

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Work Cited

• http//www.epilepsyfoundation.org/about/faq/index.
  cfm
• http//www.umm.edu/ency/article/003200.htm
• http//www.epilepsy.com/101/ep101_epilepsy
• http//healthlink.mcw.edu/article/921725959.html
• http//professionals.epilepsy.com/page/seizures_cl
  assified.html

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Work Cited

• http//www.epilepsy.ca/eng/content/types.htmlanch
  or126332
• http//www.keppra.com/pc/about_keppra/how_keppra_w
  orks.asp
• http//www.vhi.ie/hfiles/hf-066.jsp
• http//ca.geocities.com/epilepsy911/epilepsyfacts.
  html

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Work Cited

• http//epilepsy.emedtv.com/valproic-acid/valproic-
  acid.html
• http//www.tiscali.co.uk/lifestyle/healthfitness/h
  ealth_advice/netdoctor/archive/100001450.html
• http//www.netdoctor.co.uk/medicines/100002607.htm
  l
• http//www.bellaireneurology.com/seizure/epil_trt_
  tegretol.html