A comprehensive guide to help

care givers and patients in epilepsy

EPILEPSY IS

A TABOO

Overview of Epilepsy

HISTORY/

 Hippocrates
recognized that
epilepsy was a
brain disorder,
and he refuted
the ideas that
seizures were a
curse

Image is for understanding and is taken from Google not copyrighted



/ ,

/
.

Image is for understanding and is taken from Google not copyrighted

Epilepsy

A seizure is a brief, excessive

discharge of brain electrical activity
that changes how a person feels,
senses, thinks, or behaves
Epilepsy is a disorder in which a
person has two or more seizures
without a clear cause

, ,
,
, / .

Do not fear the word epilepsy!

People see you
through your eyes, if
you are comfortable
in talking about it,
then almost
everyone else will
be.

Image is for understanding and is taken from Google not copyrighted

 !

,

What causes epilepsy?

Anything that injures nerve cells in
the brain can cause epilepsy

But in many cases we dont know the

cause
Some patients have brain injuries
from head trauma, infection, or other
causes, such as an abnormal brain
architecture found on MRI

In some people, genetic factors

 !

/ ,
.

.

, , ,

( ),

.

I had one seizure, will I get

epilepsy?
After a single seizure, the
chances of another are
about 50%.
People with a known brain
injury and those with
abnormalities on their
neurological examination,
(MRI) or (EEG) are more
likely to have another
seizure, whereas those
with normal findings are
much less likely to have a
second seizure
Image is for understanding and is taken from Google not copyrighted


,

?


% .

(MRI EEG) ,


.

Is epilepsy a lifelong
problem?
Most people with epilepsy
require medication for only a
small portion of their lives.
For many forms of epilepsy in
children and adults, when the
person has been free of
seizures for 24 years,
medications can often be slowly
withdrawn and discontinued
under a doctors supervision

.

, 2-4

,

Does epilepsy affect the life span

?

Average person with epilepsy has a

normal life span

Will epilepsy effect my life

style?
If treated well and
controlled then it is as
amazing as ever!!!

Image is for understanding and is taken from Google not copyrighted


?



.

If I have epilepsy, will my

child have it?
The vast majority of
cases are not inherited,
although some types
are genetically
transmitted. Most of
these types are easily
controlled with
medication
Image is for understanding and is taken from Google not copyrighted


,
?

,


.


.

If My better half has it will my

child have it?
The vast majority of cases
are not inherited, although
some types are genetically
transmitted. Most of these
types are easily controlled
with medication

Image is for understanding and is taken from Google not copyrighted

 / ,

?

,

.

My first seizure /

I woke up in the ambulance with an

oxygen mask on my face and had
no idea what had happened. I tried
to get up, to get away. People
were asking me if I knew my name,
but my head felt so heavy and I
was really confused. The side of
my tongue was throbbing in pain.
Slowly I understood more, they
said you had a seizure? I am 40
years old and theres never been
anything wrong with me. Why did
this happen? What does this
mean?

. .
,
,
.

.
.

.
? ?

But the real fear comes after

the seizure ends
Will the medicines need to be taken?

Is this the start of terrible affliction

What is the underlying cause

Will there be another?

Are drugs needed

?

?

?

?

Remember
The vast majority of people who have a single seizure do
extremely well!

,

.

Can epilepsy be controlled?

Some patients remain seizurefree on AEDs, but when they
attempt to come off their
medications, seizures recur. In
many cases, the recurrence is
due to sleep deprivation,
alcohol intake, or emotional
stress.


?
AEDs

,
,

,
, ,

Simple partial seizure

I almost enjoy them. The

feeling like I have lived
through this moment,
Everything seems brighter
and more alive.

Image is for understanding and is taken from Google not copyrighted

Simple partial seizure

( )

.

,

Simple partial seizure

Image is for understanding and is taken from Google not copyrighted

Complex Partial Seizures

Impairment of consciousness:
cognitive, affective symptoms

Formed auditory
hallucinations.
Hears music, etc

FRONTAL
LOBE

Dreamy state; blank, vacant

expression; dj vu;
jamais vu; or fear
d

PARIETAL
LOBE
POSTERIOR
TEMPORAL
GYRUS
OCCIPITAL
LOBE

Formed visual
hallucinations.
Sees house, trees
that are not there

Bad or unusual smell

Superior
temporal
gyrus

Dysphasia

Psychomotor phenomena.
Chewing movements, wetting lips,
automatisms (picking at clothes)

Complex Partial Seizures

:
, ,

: ,

FRONTAL
LOBE

:
, .
d

PARIETAL
LOBE
POSTERIOR
TEMPORAL
GYRUS
OCCIPITAL
LOBE

:
, -
,
.

Superior
temporal
gyrus

:
, ,
( )

Tonic-Clonic Seizures
A. Tonic phase
Incontinence

B. Clonic phase

C. Post-ictal
confusion fatigue

Cyanosis

Epileptic cry

Cyanosis

Generalised stiffening
of body and limbs,
back arched

Eyes
blinking
Salivary
frothing

Clonic jerks of
limbs, body
and head

Limbs and body limp

-
B. /

A. /

( )

C. -

( )

Febrile seizure
Ananda was just 14
months old. He caught a
bad cold from a child in his
playgroup. He had a fever
and runny nose. He was
taking a nap when I heard
this strange banging
sound. I ran into his room,
and his whole body was
stiff and shaking. Those 5
minutes were the longest 5
minutes of my life.


(Febrile seizure)
14 .

.

.

.


. 5
5 .

Secondary Generalization
They start with a tingling in the
right thumb.
Then the thumb starts jerking.
In a few seconds, the whole right
hand is jerking, and I learned to
start rubbing and scratching my
forearm.
Sometimes I can stop the
seizure this way. Other times the
jerking spreads up the arm.
When it reaches the shoulder, I
pass out and people tell me that
my whole body shakes


(Secondary Generalization)

.


,
,
(rubbing) (scratching)
.
.
.
,

Absence seizure
Ajay, a 7-year-old boy, often blanks
out for a few seconds, and
sometimes for 1020 seconds. His
teacher calls his name, but he
doesnt seem to hear her. He
usually blinks repetitively, and his
eyes may roll up a bit, but with the
short seizures he just stares. Then
he is right back where he left off.
Some days he has more than 50
spells

Image is for understanding and is taken from Google not copyrighted

 (Absence seizure)

, 7 ,
"
(Blanks out)", 10-20
.
,
.


.

.

.

Absence Seizure
Between seizures
patient normal

Seizure:
Vacant stare, eyes roll
upward, eyelids flutter
(3/sec), cessation
of activity, lack of
response

Absence Seizure

:
,
,
(3/sec),
,

Myoclonic seizure
In the morning I get these jumps. My arms just go
flying up for a second. I may spill my coffee or drop a
book. Occasionally my mouth shuts for a split second.
Sometimes I get a few of these jumps in a row. Once I
have been up for a few hours I never get any more of
these jumps.

 (Myoclonic
seizure)

.
.
. -

. -

.


.

Atonic seizure
Ravis drop seizures are his
biggest problem. He falls to
the ground and often hits his
head and bruises his body.
Even if Im right next to him
and prepared, I may not catch
him. The helmet is great, but
he often forgets to put it on
before he gets out of bed

Image is for understanding and is taken from Google not copyrighted

 (Atonic seizure)
""

,
.
,

Tonic seizure
Raja just stiffens up. Both arms are raised
over his head, and he grimaces, as if
someone is pulling on his cheeks. The
episodes last less than a minute, but if he
is standing he may lose his balance and
fall. These seizures dont knock him out
like the grandmals, but if he has a few
close together, he is often tired

 (Tonic seizure)
.
,
. 1

. (Grandmal)

, - .

Unexpected Death in Epilepsy

Many deaths occur in bed; about a third show
evidence of a seizure near the time of death.
They are often found lying on their stomach.
Available evidence suggests that problems
with breathing or the heart are most often
responsible

( ).
.
(evidences)

.

Safety precautions may reduce the

chances of SUDEP
Seizures, especially tonic-clonic seizures, should
be well controlled.
Patients should take their medications as
prescribed and avoid provocative factors such
as sleep deprivation and excess alcohol.
Adult patients with a high likelihood of tonicclonic seizures in sleep should be watched
Basic first aid should be provided, including
rolling the person onto one side

 SUDEP

, -

.

; -
.
( -

) .

,

Seizure

Provoking

Factors
/

excessive alcohol use

premenstrual period

sleep deprivation

missed medication
emotional stress

flashing lights

startling noises

premenstrual period
( )

Missed Medication
Missed medication is the most
common cause of both
breakthrough seizures and
prolonged seizures (status
epilepticus) that require
emergency medical treatment
The most common and least
harmful instance is
occasionally missing a single
dose.

Image is for understanding and is taken from Google not copyrighted

(Staus Epilepticus)

How to overcome missing

medication? /

?

A seizure

calendar

A seizure calendar can help identify the type or frequency of

seizures overtime, the effect of different medications on seizure
control, adverse effects of medications, and seizure-provoking
factors.
The most basic seizure calendar includes the date and time of
the seizure, as well as the type of seizure.
If a precipitating factor is suspected (e.g., lack of sleep, missed
medication, stress, menstrual period), it should be noted.
Try to record the medication, dosage, and blood levels of the
drug.
For women, it may be useful to track the relationship between
seizures and the menstrual cycles (record the days of
menstruation; ovulation occurs 14 days before menstruation).


, , -

,
.
, .
.
( ,

, .) .


, .

menstrual cycle
.

Refilling the Prescription

If the number of pills starts to
get low and there are refills on
the last prescription, get
another supply from the
pharmacy well before.
Dont run out of medications!

 (Prescription)


prescription

pharmacy
.

Sleep Deprivation/

 Sleep deprivation, or lack of

restorative sleep, can trigger a
seizure

The sleepwake cycle is

associated with prominent
changes in brain
electrical,chemical, and
hormonal activities



.
- (The sleep
wake cycle)

, ,

How to get good sleep

1 The sleeping environment should be
quiet and dark
2 Should avoid caffeinated beverages
or foods within 6 hours of going to
sleep
3 Avoid alcohol

4 Exercise daily

Image is for understanding and is taken from Google not copyrighted


1.

-
.

2.

caffeinated

3.

4.

Alcohol consumption is
never recommended for
persons with epilepsy

.

Image is for understanding and is taken from Google not copyrighted

Drug Abuse

Menstrual Cycle/

 Seizures may occur

shortly before
menstruation, during and
immediately after it, or at
the time of
ovulation(midcycle).
The premenstrual and
ovulatory phases are
associated with the
highest seizure
frequencies

ovulatory

.

What helps then?

Controlling cycle seizures
remains a difficult problem.
For women who have regular
menstrual cycles, a slight
increase in the dosage of their
usual AEDs may help.

Image is for understanding and is taken from Google not copyrighted

.

,
.

Stress/

Image is for understanding and is taken from Google not copyrighted

(Emotions of
worry)

(Fear)

(Depression)

(Frustration)
(Anger)

 ?
How to manage that?

.
Simple
Relax and dont take
stress.

Making a diagnosis

 What time of day did it

occur?
Did it occur around the
transition into or out of
sleep?
How did it begin?
Was there a warning?
Were there abnormal
movements of the eyes,
mouth, face, head,
arms, or legs?
Was the person able to
talk and respond
appropriately?
Was there loss of urine or
feces?
Was the tongue or inside
of the cheeks bitten?

During the attack

Image is for understanding and is taken from Google not copyrighted

 ?
?

,
, , ,
,
?

?
?

After the attack:

Was the person confused or

tired?
Was speech normal?
Was there a headache?
Was any part of the body
weak?

?
?

?

 Stay calm.
Help the person lie down, and place something soft
under the head and neck. Keep the person (especially
the head) away from sharp or hard objects such as the
corner of a table.
Time the duration of convulsive movements, if possible.
Roll the person onto one side with the head and mouth
angled toward the ground so that any excessive saliva or
fluids will not accidentally be swallowed or inhaled. This
position will also prevent the tongue from falling back
and blocking the airway.
Loosen all tight clothing by unfastening top shirt buttons,
belts, and skirt or pant buttons. Remove any eyeglasses
or tight neck chains.
Do not put anything in the persons mouth. The tongue
cannot be swallowed during a seizure.


.

.

.

,
, ,

.

 After the seizure is over, do not try to restrain the person.

He or she may be confused and disoriented. Restraint
may provoke agitation and a violent reaction. Use a calm
voice.
Try to keep the person in a safe environment.
Walking around is permissible, except near a street,
stairs, or other potentially dangerous place.
Do not give pills, beverages, or food until the person is
fully alert.
Stay with the person until he or she is fully alert and
oriented. Be careful. The person may claim to be fine but
still be quite confused.

 -

.

.

.
,

,

.

Medication/

I felt like I might have a seizure,

so I took an extra pill
Since most medicines take
more than 1015 minutes to
begin reaching the brain, oral
medications will rarely stop an
imminent seizure. However, if
the person feels vulnerable to
a seizure over the coming
hours, this approach could
reduce the risk of a seizure


,
.

10-15
,

. ,

I vomited after I took my pill,

should I take another?


,

?

,

.

45
,

.

I wasnt sure so I didnt

mention it
Patients should report any
unusual symptoms to their
doctor, especially during
the first 8 weeks after starting
a new AED.






,

8 .

Can I become addicted to my

medication?

Missed dose what to do?

As a general rule, if a single
dose is missed, it must be
taken as soon as possible.
Avoid doubling up on the
next dose, as this may lead
to side effects; instead, take
the missed dose as soon as
possible and then take the
next scheduled dose after
an interval of at least 2
hours, often with some food
to delay the second doses
absorption

Image is for understanding and is taken from Google not copyrighted


?


.

.

,

.

AED and birth pills

Most women with epilepsy can take birth control pills
without affecting their seizure control. Usually there is no
change when the pills are started, though some women
have slightly improved or worsened seizure control.

AED

How does my medication

work?
AEDs help restore balance to the brains
electrical activity.

How do you know if they are

safe to take for a long time?
Doctors have much more
long-term safety
information about drugs
There are also many
studies and data available
to define the safety limits


?

.

.

Living with
and out growing epilepsy/

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 Decisions about driving,

employment, household
responsibilities,
swimming, and other
activities must consider
the individual situation

, ,

, ,

Prevention of Seizure-Related
Injuries

 When cooking, persons with

frequent seizures may be
safer using a microwave oven
or putting guards around an
open flame. Whenever
possible, they should bring
individual dishes to the
source of hot food rather than
carrying kettles or saucepans.

Other safeguards in the

home include
carpeting the bathroom,
putting a temperature
monitor showerheads,
lowering the temperature
of the water heater,
putting guards around
radiators,
using a laundry for
clothes that have to be
ironed, avoiding electric
carving knives and slicing
machines,

showerheads ,

, radiators
,
, ,
, .

Image is for understanding and is taken from Google not copyrighted