Epilepsy in Adults A Basic Introduction

Epilepsy in Adults:
A Basic Introduction
Shahin Nouri, MD
New York Methodist Hospital
Director, Comprehensive Epilepsy Center
What Is the Difference Between

Epilepsy & Seizures?
A seizure is a brief, temporary

disturbance in the electrical activity
of the brain
Epilepsy is a disorder characterized
by recurring seizures (also known as
seizure disorder)
A seizure is a symptom of epilepsy
Who Has Epilepsy?

About 2.3 million Americans have epilepsy
(0.5-1% of the population)
Roughly 181,000 new cases of seizures and
epilepsy occur each year
50% of people with epilepsy develop seizures by
the age of 25; however, anyone can get epilepsy at
any time
Now there are as many people with epilepsy who
are 60 or older as children aged 10 or younger
The Brain Is the Source of

Epilepsy
All brain functions -- including feeling, seeing,
thinking, and moving muscles -- depend on
electrical signals passed between nerve cells in the
brain
A seizure occurs when too many nerve cells in the
brain fire too quickly causing an electrical
storm
What Causes Epilepsy?

In about 70% of people with epilepsy, the
cause is not known
In 30%, most common causes are:
- Head trauma
- Infection of brain tissue
- Brain tumor and stroke
- Heredity
- Prenatal disturbance of brain development
What Happens During a Seizure

Generalized seizure
Involve the whole brain and loss of
consciousness
Absence: characterized by brief loss of consciousness
Tonic-clonic: characterized by rhythmic jerking of muscles
Partial seizure
Involve only part of the brain; may or may not
include loss of consciousness
Symptoms relate to the part of the brain affected
Classifying Epilepsy and

Seizures
Classifying epilepsy involves more than
just
seizure type
Seizure types:
Partial
Simple
Complex
Consciousness
is maintained
Consciousness
is lost or impaired
Generalized
Absence
Convulsive
Altered awareness
Characterized by
muscle contractions
with or without loss
of consciousness
Symptoms That May Indicate a

Seizure Disorder
Periods of blackout or confused memory

Occasional fainting spells
Episodes of blank staring
Sudden falls for no apparent reason
Episodes of blinking or chewing at inappropriate
times
A convulsion, with or without fever
Clusters of swift jerking movements in babies
Everything you do,

you do with your
brain!
Different parts have different functions, and

different seizures!
How Is Epilepsy Diagnosed?

Clinical Assessment
Patient history
Tests (blood, EEG, CT, MRI or PET scans)
Neurologic exam
ID of seizure type
Clinical evaluation
to look for causes
What to Tell Your Doctor About

Your Seizures
Symptoms
Seizure patterns
Pre-seizure activity (if any)
How you felt after the seizure
Consider keeping a seizure record
Tools to Confirm the

Diagnosis of Epilepsy
EEG
Imaging
Scans
(Abnormal electricity) (Lesions)
Seizure Triggers
Missed medication (#1 reason)

Stress, anxiety
Hormonal changes, Menses
Dehydration
Lack of sleep, extreme fatigue
Photosensitivity
Illicit Drug, alcohol use
Certain Medications
Fever in Some Children
Treatment Goals in Epilepsy

Help person with epilepsy lead full and productive life
Eliminate seizures without producing side effects
Tailor treatment to needs of individuals/special
populations :
Women, Children, Elderly, Hepatic or renal failure
and other diseases
What if not treated?

Seizures can be potentially life threatening with brain
failure, heart and lung failure, trauma, accidents
Sudden Unexpected Death in Epilepsy (SUDEP)
Even subtle seizures can cause small damage in brain
Long Term problems: fall in IQ, depression, suicide, Social
Problems, Quality of Life
Types of Treatment
Medication
Surgery
Nonpharmacologic treatment
Ketogenic diet
Vagus nerve stimulation
Lifestyle modifications
Considerations in
Epilepsy Management
Underlying
Pathology
Comorbidities
Age and
Gender
Syndrome
vs
Seizure Type
Medication
Side Effects
Seizure
Frequency
Factors That Affect the

Choice of Drug
Seizure type/
Epilepsy
syndrome
Side effects &
safety
Patient age
Ease of Use
Lifestyle
Age, Sex,
Childbearing
potential
Other
medications
Factors That Influence

Response to Medication
Consistent use
Inadequate dosage or
ineffective
medication
Drug factors
Disease
Seizures
eliminated
(50% of people)
Seizures do
not
respond
(20%)
Seizures markedly
reduced (30%)
Tolerating Medications
Most Common Side Effects
Rash
Clumsiness
Drowsiness
Irritability
Nausea
Warning Signs of
Possible
Serious Side Effects
Side effects may be related

to dose
Care must be taken in
discontinuing drug due to
risk of seizure recurrence
Prolonged fever
Rash, nausea/vomiting
Severe sore throat
Mouth ulcers
Easy bruising
Pinpoint bleeding
Weakness
Fatigue
Swollen glands
Lack of appetite
Abdominal pain
Positive Characteristics
of New Seizure Medications
Efficacy at least equal to older agents.

Many possess broad spectrum of activity.
Most also good as single agent.
Safer, better tolerated, improved quality of living.
Blood testing often not necessary.
Less live metabolism and protein binding.
Less drug interactions.
Epilepsy Surgery
Factors influencing decision
Likelihood seizures are due to epilepsy
Likelihood surgery will help
Ability to identify focus of seizures
Other treatments attempted, and seizures couldnt
be treated with 2-3 medications
Benefits vs risks
Vagus Nerve Stimulation
Device is implanted to control

seizures by delivering electrical
stimulation to the vagus nerve in
the neck, which relays impulses
to widespread areas of the brain
Used to treat partial seizures
when medication does not work
Courtesy of Cyberonics Inc.
Ketogenic Diet
Based on finding that starvation -- which burns fat

for energy -- has an antiepileptic effect
Used primarily to treat severe childhood epilepsy,
has been effective in some adults & adolescents
High fat, low carbohydrate
and protein intake
Usually started in hospital
Requires strong family commitment
First Aid for Seizures
Stay calm and track time

Protect head, remove glasses, loosen tight neckwear
Move anything hard or sharp out of the way
Turn person on one side, position mouth to ground
Check for epilepsy or seizure disorder ID
Understand that verbal instructions may not be obeyed
Stay until person is fully aware and help reorient them
Call ambulance if seizure lasts more than 5 minutes or if
it is unknown whether the person has had prior seizures
Potentially Dangerous Responses

to Seizure
Dont restrain person

Dont put anything in the persons mouth
Dont try to hold down or restrain the person
Dont attempt to give oral antiseizure
medication
Dont keep the person on their
back face up
When to Call 911 or Emergency

Medical Services
A convulsive seizure occurs in a person not known to
have seizures or lasts more than 5 minutes
A complex partial seizure lasts more than 5 minutes
BEYOND its usual duration for the individual
Another seizure begins before the person regains
consciousness
Also call if the person:
Is injured or pregnant
Has diabetes/other medical condition
Recovers slowly
Does not resume normal breathing
Safety Issues for Patients with

Epilepsy
Cant Drive for about a year after the last seizure
(NY State)
Climbing altitudes
Swimming/ Bathing alone
Operating heavy machinery or weapons that can be
dangerous
Cooking, hot water
Taking care of babies
Bone Health
Effect of Epilepsy on Family

I just need to remember that things
happen for a reason, and that we will cope
with whatever comes our way. It is okay
not to like it, as seizures arent fun and
can be scary.
Epilepsy doesnt have to
rule our lives -- as long as we
have people who will listen to us,
believe us, and give us honest
answers.
Epilepsy in Women
Hormonal effects
Sexuality & contraception
Hormonal changes during puberty,

menopause, and the monthly cycle may affect
seizure frequency
Polycystic ovary syndrome
Sexual dysfunction
Birth control pills may be less effective
Pregnancy & motherhood
Need to continue medication
Epilepsy in Older Adults
Epilepsy is common in the elderly,

and is often unrecognized or
misdiagnosed
Older people face increased
treatment risks
Maintaining independence is a
challenge after the diagnosis of
epilepsy
Groups at Increased Risk

for Epilepsy
About 1% of the general population

develops epilepsy
The risk is higher in people with
certain medical conditions:
Mental retardation
Cerebral palsy
Alzheimers disease
Stroke
Autism
Epilepsy in Infants &

Young Children
Balancing normal development and

the special concerns of epilepsy
Good parenting skills
Childcare
Effects on brothers and sisters
Early childhood intervention
services
Epilepsy in Children Aged

6-12
Handling feelings
Family relationships
Safety
School and childcare
Developmental stages
Epilepsy in Teens & Young

Adults
Assuming responsibility
Dealing with feelings
Friends and social pressures
School
Driving
Drinking
Dating
Employment
Other Treatment Approaches
Behavioral therapy
Biofeedback
Relaxation
Positive reinforcement
Cognitive therapy
Aromatherapy
National and Community

Resources
The Epilepsy Foundation
Local affiliates, NY Chapter

Website: www.epilepsyfoundation.org
MedicAlert Foundation
Social Security Administration
Accreditation Council on Services for People with
Disabilities
US Dept of Education
State Offices
Vocational Rehabilitation
Protection and Advocacy
Division of Developmental Disabilities
Services at
Epilepsy Centers
Routine-EEG
Ambulatory-EEG (up to 48 hours)
Video-EEG Epilepsy Monitoring (few days)
MRI/CT
PET-CT Scans
Vagal Nerve Stimulation
Pre-surgical Evaluation
Epilepsy Surgery
Neuro-psychology
Support Groups
Thank You for your Attention

Epilepsy in Adults A Basic Introduction

Uploaded by

Copyright:

Available Formats

Epilepsy in Adults A Basic Introduction

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Epilepsy in Adults A Basic Introduction

Uploaded by

Copyright:

Available Formats

Epilepsy in Adults:

What Is the Difference Between

A seizure is a brief, temporary

A seizure is a symptom of epilepsy

Who Has Epilepsy?

The Brain Is the Source of

What Causes Epilepsy?

What Happens During a Seizure

Classifying Epilepsy and

Symptoms That May Indicate a

Periods of blackout or confused memory

Everything you do,

Different parts have different functions, and

How Is Epilepsy Diagnosed?

What to Tell Your Doctor About

Consider keeping a seizure record

Tools to Confirm the

Missed medication (#1 reason)

Treatment Goals in Epilepsy

What if not treated?

Factors That Affect the

Factors That Influence

Side effects may be related

Efficacy at least equal to older agents.

Vagus Nerve Stimulation

Device is implanted to control

Courtesy of Cyberonics Inc.

Based on finding that starvation -- which burns fat

First Aid for Seizures

Stay calm and track time

Potentially Dangerous Responses

Dont restrain person

When to Call 911 or Emergency

Safety Issues for Patients with

Effect of Epilepsy on Family

Sexuality & contraception

Hormonal changes during puberty,

Pregnancy & motherhood

Need to continue medication

Epilepsy in Older Adults

Epilepsy is common in the elderly,

Groups at Increased Risk

About 1% of the general population

Epilepsy in Infants &

Balancing normal development and

Epilepsy in Children Aged

Epilepsy in Teens & Young

Other Treatment Approaches

National and Community

The Epilepsy Foundation

Local affiliates, NY Chapter

Thank You for your Attention

You might also like