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Friday, July 25, 2014

All About Epilepsy and Seizures

People who do not deal with Epilepsy and seizures normally just think of Grand Mal seizures. Many do not realize that Epilepsy and seizures are so much more than that. I know before I became a mom of a child with Epilepsy I never realized how much was involved and how many different types of seizures there are. 

First off what is Epilepsy? Epilepsy is a neurological disorder that can affect both sexes, and people of all ages and races. It is characterized by unpredictable seizures, but can involve other health problems. There are also different syndromes associated with Epilepsy. Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person. Having seizures and epilepsy also can also affect one's safety, relationships, work, driving and so much more. How epilepsy is perceived or how people are treated (stigma) often is a bigger problem than the seizures.  

How is Epilepsy diagnosed? A person is diagnosed with epilepsy if they have had at least two seizures that were not caused by some known and reversible medical condition. Usually an EEG, CT Scan, or an MRI is done. Blood tests may also be done to check for certain medical conditions. 

What are the different types of seizures? 
                           1. Absence seizures- Absence seizures are lapses of awareness, sometimes with staring. They begin and end abruptly, lasting only a few seconds. They can be so brief that they may go on for a while without being detected. They are most common in children ages 4-14. These seizures are also called petit mal seizures. There are two types of absence seizures:
Simple absence seizures in which a person usually just stares into space for less than 10 seconds. Because they happen so quickly, it’s very easy not to notice simple absence seizures — or to confuse them with daydreaming or not paying attention.There is also Complex absence seizures in which a person will make some kind of movement in addition to staring into space. Movements may include blinking, chewing, or hand gestures. A complex absence seizure can last up to 20 seconds. When an absence seizure ends, the person usually continues doing whatever they were doing before the seizure. They are almost always wide awake and able to think clearly. No first aid is needed because of the seizure.
                      2. Atypical Absence seizure- this type is similar to an absence seizure, but may last a bit longer and a person may be more responsive. Blinking or slight jerking movements of the lips may occur and may be difficult to tell the difference between this and there reguar behavior. They usually last 5-30 seconds. Many children also have Lennox-Gastaut Syndrome.Medicine can help prevent atypical absence seizures. When an atypical absence seizure ends, the person usually continues doing whatever they were doing before the seizure. They are awake. No first aid is needed during the seizure. Atypical absence seizures may cause someone to:Have trouble learning at school, Have social problems or Misbehave more than normal. 
                      3. Atonic seizures- These types of seizures are often called drop seizures. The person loses their muscle tone. Their head might just fall, or sometimes they may fall limply to the ground from standing. The person usually remains conscious. These seizures typically last less than 15 seconds. They often start in childhood yet last into adulthood. Many people with atonic seizures are injured when they fall, so they may choose to use protection such as a helmet. These types of seizures usually begin in childhood and continue on through adulthood. When an atonic seizure ends, the person may or may not be confused. Because these seizures often results in falls, first aid may be necessary especially if the seizure led to an injury or bruise. 
                     4. Clonic seizures- these are a rare type of seizure and JUST involve repeated jerking movements. More commonly they are combined with Tonic seizures into Tonic-Clonic seizures which I will be describing later. When a clonic seizure ends, the person may simply continue what they are doing. First aid is not a typical requirement for this seizure type. They can occur at any age, including newborns.
                     5.  Myoclonic seizures- Myoclonic seizures are brief shock-like jerks of a muscle or group of muscles.They occur in a variety of epilepsy syndromes that have different characteristics. During a myoclonic seizure, the person is usually awake and able to think clearly. Sometimes just one happens, or there may be a few together. Even people without Epilepsy can experience these types, such as that sudden jerk as you are falling asleep that might wake you up or a hiccup. In epilepsy, myoclonic seizures usually cause abnormal movements on both sides of the body at the same time. They occur in a variety of epilepsy syndromes that have different characteristics:
Juvenile myoclonic epilepsy: The seizures usually involve the neck, shoulders, and upper arms. In many patients the seizures most often occur soon after waking up. They usually begin around puberty or sometimes in early adulthood in people with a normal range of intelligence. In most cases, these seizures can be well controlled with medication but it must be continued throughout life.
Lennox-Gastaut syndrome: This is an uncommon syndrome that usually includes other types of seizures as well. It begins in early childhood. The myoclonic seizures usually involve the neck, shoulders, upper arms, and often the face. They may be quite strong and are difficult to control.
Progressive myoclonic epilepsy: The rare syndromes in this category feature a combination of myoclonic seizures and tonic-clonic seizures. Treatment is usually not successful for very long, as the patient deteriorates over time.
When a myoclonic seizure ends, the person usually continues doing whatever they were doing before and during the seizure. They are awake and able to think clearly. No first aid is needed because of this seizure.
                  6. Tonic seizures- In a tonic seizure, the body arms or legs make sudden stiffening movements. The person usually doesn't lose consciousness. Tonic seizures most often occur during sleep and usually involve all or most of the brain, affecting both sides of the body. They usually last at most 20 second. Most commonly these seizures occur in people with  Lennox-Gastaut syndrome. When a tonic seizure ends, the person may or may not be sleepy or confused. Typically no first aid is needed unless an injury has occurred as a result of the seizures.
                 7. Tonic-clonic seizures: This is the type of seizure most people think about. They are known as Grand Mal seizures. A person loses consciousness, muscles stiffen, and jerking movements are seen.These types of seizures usually last 1 to 3 minutes and take much longer for a person to recover. A tonic clonic seizure lasting more than 5 minutes is a medical emergency.A seizure that lasts more than 10 minutes, or three seizures without a normal period in between, indicates a dangerous condition called convulsive status epilepticus. This requires emergency treatment. DO NOT, I repeat DO NOT try to put anything in the mouth of a person having a seizure. They will not swallow their tongue and trying to put something in their mouth may cause injury to them. This type of seizure can occur in all ages. When people have tonic clonic seizures, they are not aware of what’s going on around them. These seizures may require first aid including making certain that the person is breathing and there are no injuries. After the seizure has occurred, the person may be sleepy or confused for several minutes or longer. They may have lost bowel or bladder function. They also may have bitten their tongue.
               8. Simple Partial Seizures: These types of seizures are divided into 4 categories. They are often the "aura" to a bigger seizure.  The first category is motor seizures. These cause a change in muscle activity. For example, a person may have abnormal movements such as jerking of a finger or stiffening of part of the body.
The movements may spread, either staying on one side of the body or extending to both sides. Other examples are weakness, which can even affect speech, and coordinated actions such as laughter or automatic hand movements. The second is sensory seizures. During these seizures people may hear, taste, or smell things that aren't really there. Some may even be painful to the person. They may even have visual hallucinations or distortions of senses. A third category is psychic seizures. These seizures change how people think, feel, or experience things.They may have problems with memory, garbled speech, an inability to find the right word, or trouble understanding spoken or written language. They may suddenly feel emotions like fear, depression, or happiness with no outside reason. Some may feel as though they are outside their body or may have feelings of déja vu ("I've been through this before") or jamais vu ("This is new to me"— even though the setting is really familiar). The last type is autonomic seizures. These cause changes in the part of the nervous system that automatically controls bodily functions.These common seizures may include strange or unpleasant sensations in the stomach, chest, or head; changes in the heart rate or breathing; sweating; or goose bumps.
When a simple partial seizure ends, the person more often than not simply continues doing whatever they were doing before it started. If the simple partial seizure is an aura (a warning) a stronger seizure with loss of consciousness may follow. No first aid is needed for a simple partial seizure.
                 9. Complex partial seizure: Complex partial seizures last 1 to 2 minutes.These seizures may have an aura (or warning). Partial seizures are called so because they only involve part of the brain. Complex Partial Seizures include automatisms (such as lip smacking, picking at clothes, fumbling), unaware of surroundings or may wander. In these types of seizures some people may think the person is just daydreaming. They might go through the motions but in reality "no one is home." Some people can have seizures of this kind without realizing anything has happened. The seizure can wipe out memories of events just before or after it. Some of these seizures (usually ones beginning in the temporal lobe) start with a simple partial seizure,then the person loses awareness and stares blankly. Most people move their mouth, pick at the air or their clothing, or perform other purposeless actions. These movements are called "automatisms" .Less often, people may repeat words or phrases, laugh, scream, or cry. Some people do things during these seizures that can be dangerous or embarrassing, such as walking into traffic or taking their clothes off. These people need to take precautions in advance. When a complex partial seizure ends, the person may be tired or confused for about 15 minutes and may not be fully normal for hours. First aid may be necessary if an injury has occurred.
                      10. Secondarily Generalized Seizures- These seizures are called secondary generalized because they start in one area and spread to both sides of the brain. They usually last 1 to 3 minutes, but it may take a lot longer for a person to recover. The seizure may begin with an aura or simple partial seizure or they begin with a complex partial that continues and changes into the secondary generalized seizure. The secondary generalized part begins usually with stiffening of the muscles. Air being forced past the vocal cords causes a cry or groan. The person loses consciousness and falls to the floor. The tongue or cheek may be bitten, so bloody saliva may come from the mouth. The person may turn a bit blue in the face.
After the tonic phase comes the clonic phase. The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips, and knees. After a few minutes, the jerking slows and stops. Bladder or bowel control sometimes is lost as the body relaxes. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed. They cna be hard to differentiate from a tonic-clonic seizure. Most convulsive seizures during sleep are secondarily generalized seizures that do begin as partial seizures. After the seizure, consciousness returns slowly and the person may be drowsy, confused, agitated or depressed immediately after the seizure. If the person does not return to normal, or if another seizure occurs before they return to normal, this may be a sign of an emergency situation known as status epilepticus that requires immediate attention in a hospital. Call 911. 
             11. Febrile Seizures: these seizures are ones that occur with a fever.  These occur in children ages 3 months -6 years and occur in 2-5% of all children. They are more likely to happen if there is a family history. Sometimes the seizure comes "out of the blue." A fever may begin silently in a previously healthy child and a seizure can be the first sign that alerts the family that the child is ill. Febrile seizures cannot be prevented by giving the child lukewarm baths, applying cool cloths to the child's head or body, or using fever-reducing medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Doing these things may make a feverish child feel better, but they do not prevent febrile seizures. During a seizure, place the child on his or her side on a protected surface and observe carefully. Keep track of the time, and if the seizure lasts longer than 5 minutes, call 911 or take the child to an emergency facility if you can do so safely.Most children who have febrile seizures do not require daily treatment with seizure medicines. Some children who have repeated episodes of multiple febrile seizures are treated with phenobarbital, Depakote (valproate) or another seizure medicine, which reduces the risk of having more seizures.Among children who have their first febrile seizure before their first birthday, half will have at least one more. Among children who are older than 1 year when the first seizure occurs, about 1 in 4 will have more.The long-term outlook is excellent, however. The vast majority of children with febrile seizures do not have seizures without fever after age 5.
         12. Non-epilepsy seizures: Non-epileptic events (also called non-epilepsy seizures) are not caused by electrical activity in the brain.Events that look like seizures but are not due to epilepsy are called "nonepileptic seizures." A common type is described as psychogenic , which means beginning in the mind. Psychogenic seizures are caused by subconscious thoughts, emotions or 'stress', not abnormal electrical activity in the brain. Doctors consider most of them psychological in nature, but not purposely produced. Usually the person is not aware that the spells are not "epileptic." The term "pseudoseizures" has also been used  to refer to these events.
        13. refractory seizures: refractory seizures are seizures that are uncontrolled. First it's important to make sure that the diagnosis of epilepsy is correct and that the proper medicines are being used in the best way for each person. The individual with epilepsy needs to look at things they can do to better control their seizures, such as remembering medicines, staying in good health, getting good sleep, minimizing stress and avoiding seizure-precipitating conditions.Non-drug therapies, such as epilepsy surgery, vagus nerve stimulation, responsive neurostimulation, dietary therapies, or experimental clinical trials, may be good options for some people. Only 5% of people (1 out of 20) with refractory epilepsy get better each year. The biggest hope is for new therapies to prevent and cure epilepsy! 
       14. Gelastic and Dacrystic seizures: Gelastic seizures are also called laughing seizures because they may look like bouts of uncontrolled laughter or giggling. However, the laughter-like sounds are often forced and combined with a facial contraction similar to a smile or smirk. In some children, the vocalization has a crying quality and the facial contraction resembles a grimace. These crying seizures are called dacrystic seizures.

There are many different Epilepsy syndromes. Check out this link that will tell you about the different types. 

What triggers seizures? Not all have known trigger, but some people may notice that something sets them off. This can help them to know when one is coming. Some known triggers are: 

  • Specific time of day or night
  • Sleep deprivation – overtired, not sleeping well, not getting enough sleep
  • At times of fevers or other illnesses
  • Flashing bright lights or patterns
  • Alcohol or drug use
  • Stress
  • Associated with menstrual cycle (women) or other hormonal changes
  • Not eating well, low blood sugar
  • Specific foods, excess caffeine or other products that may aggravate seizures
  • Use of certain medications

some Epilepsy Statistics:
The average incidence of epilepsy each year in the U. S is estimated at 150,000 or 48 for every 100,000 people.
The incidence of epilepsy is higher in young children and older adults. This means that epilepsy starts more often in these age groups.
When the incidence of epilepsy is looked at over a lifetime, 1 in 26 people will develop epilepsy at sometime in their life.

Know you know and I hope it helps you to spread awareness and not be so afraid or judgemental. Seizures impact their lives in many ways including creating barriers to employment and education and facing a sense of discrimination and isolation from their peers who donʼt understand what happens when they see a seizure occur. We would love to be able to break down these barriers. Please help us!!

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