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Base Course Epilepsy/Seizures

Field test version-1.00May 2012 DO NOT UPLOAD ON THE INTERNET. Base Course Epilepsy/Seizures. Contents (Epilepsy/Seizures). Introduction Learning objectives Emergency management of seizures Key actions Establish communication and build trust Conduct assessment

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Base Course Epilepsy/Seizures

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  1. Field test version-1.00May 2012 DO NOT UPLOAD ON THE INTERNET Base CourseEpilepsy/Seizures mhGAP-IG base course - field test version 1.00 – May 2012

  2. Contents (Epilepsy/Seizures) • Introduction • Learning objectives • Emergency management of seizures • Key actions • Establish communication and build trust • Conduct assessment • Plan and start management • Link with other services and supports • Follow up mhGAP-IG base course - field test version 1.00 – May 2012

  3. Share your experience Has anyone of you witnessed a seizure? What did you see? This course will only cover (generalized) convulsive seizures Generalized seizures account for 70% of all seizures mhGAP-IG base course - field test version 1.00 – May 2012

  4. TRUE or FALSE • Seizures are contagious • FALSE • Epilepsy is caused by witchcraft, possession, or evil spirits • FALSE • Seizures areabnormal electrical discharges from neurons • TRUE • People with epilepsy should be restrained • FALSE • Children of people with epilepsy will develop epilepsy as well • FALSE • People with epilepsy can be treated by primary health care doctors and nurses • TRUE • With antiepileptic medicines 70% can be seizure-free when treated in primary health care mhGAP-IG base course - field test version 1.00 – May 2012

  5. What do local people believe? What causes seizures or epilepsy? What is the treatment for seizures or epilepsy? mhGAP-IG base course - field test version 1.00 – May 2012

  6. What are seizures? mhGAP-IG base course - field test version 1.00 – May 2012 • Seizures are episodes of brain malfunction due to abnormal electrical discharges • Seizures can be classified as generalized or partial according to the clinical presentation • Seizures can cause • Loss of consciousness • Convulsive movements (i.e. involuntary shaking of body) • Incontinence of urine or stool • Tongue biting

  7. What is epilepsy? mhGAP-IG base course - field test version 1.00 – May 2012 • The condition in which people experience recurrent (at least twice), unprovoked seizures • Recurrent = usually separated by days, weeks or months • Unprovoked = there is no evidence of an acute cause of the seizure (e.g. febrile seizure in a young child)

  8. What causes epilepsy? mhGAP-IG base course - field test version 1.00 – May 2012 • Complications during childbirth • Head injury • Brain infections • Meningitis, encephalitis, cerebral malaria • Neurocysticercosis (tape worm) • Genetic, only in some cases • Some epilepsy has no known cause • Stroke • It is important to note that most epilepsy is not inherited! People with epilepsy only rarely have children with epilepsy

  9. Contents (Epilepsy/Seizures) 9 • Introduction • Learning objectives • Emergency management of seizures • Key actions • Establish communication and build trust • Conduct assessment • Plan and start management • Link with other services and supports • Follow up mhGAP-IG base course - field test version 1.00 – May 2012

  10. Learning objectives 10 To be able to assess and manage an acute seizure To be able to assess a person with epilepsy To be able to prescribe and monitor antiepileptic medication To be able to educate people about their condition and its treatment To be able to follow up appropriately To be able to understand when it is necessary to refer to a specialist mhGAP-IG base course - field test version 1.00 – May 2012

  11. Contents (Epilepsy/Seizures) 11 • Introduction • Learning objectives • Emergency management of seizures • Key actions • Establish communication and build trust • Conduct assessment • Plan and start management • Link with other services and supports • Follow up mhGAP-IG base course - field test version 1.00 – May 2012

  12. What do you need for management of an acute seizure? mhGAP-IG base course - field test version 1.00 – May 2012

  13. Why is management of seizures an emergency? Prolonged or repeated seizures can result in brain injury Prolonged or repeated seizures can result in death if not treated immediately Seizures can be a symptom of a life-threatening problem, like meningitis Treatment can end seizures or shorten seizure duration mhGAP-IG base course - field test version 1.00 – May 2012

  14. Group discussion: Case study • A person is brought into the clinic, and is unconscious after a reported seizure… • How will you assess and manage this person? mhGAP-IG base course - field test version 1.00 – May 2012

  15. Using the mhGAP Version 2.0 for acute seizures We will now use the mhGAP version2.0 to assess and manage our case study mhGAP version 2.0 pg 53-57 mhGAP-IG base course - field test version 1.00 – May 2012

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  21. Key messages from acute seizure management • Seizures are symptoms not a cause, you need to look for a cause. • If the person presents convulsing it is an emergency and needs to be treated urgently a) seizures can be a sign of a life-threatening problem b) seizures can result in brain injury or death! • In persons who are having seizures, assessment and management should be done at the same time. mhGAP-IG base course - field test version 1.00 – May 2012

  22. Contents (Epilepsy/Seizures) 22 • Introduction • Learning objectives • Emergency management of seizures • Key actions • Establish communication and build trust • Conduct assessment • Plan and start management • Link with other services and supports • Follow up mhGAP-IG base course - field test version 1.00 – May 2012

  23. Establish communication and build trust 23 • Try to understand how the person perceives the problem • Ask "What do you think is the cause" • Communicate your understanding of what the person says • Find out how the condition has affected the person's life • Have there been experiences of discrimination? • Is the condition affecting the person's daily life? • Explain what epilepsy is in simple language • Explain that there are medicines to control seizures mhGAP-IG base course - field test version 1.00 – May 2012

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  29. Convulsive Seizures? mhGAP-IG base course - field test version 1.00 – May 2012 • Convulsive seizures are possible if there are convulsive movements lasting longer than 1-2 minutes plus 2 or more of the criteria below during the episode

  30. If there are convulsive seizures, is there an acute cause? • Ask about and look for acute causes for the seizures • Ask about • Fever (especially relevant in young children) • Headache • Meningeal irritation (e.g. stiff neck) due to meningitis • Loss of consciousness, abnormal muscle tone and posture (?cerebral malaria) • Was there a head injury? • Metabolic abnormality (hypoglycemia, hyponatraemia) • Alcohol or substance use/withdrawal mhGAP-IG base course - field test version 1.00 – May 2012

  31. If you suspect epilepsy, what do you do? mhGAP-IG base course - field test version 1.00 – May 2012 Take a full history and do a physical examination Assess for underlying cause -any history of trauma, birth asphyxia head injury brain infection or family history of seizures? Ask for further information from carer/family Refer to specialist for further evaluation of cause.

  32. What if there is not an acute cause? mhGAP-IG base course - field test version 1.00 – May 2012 • Has the person had at least 2 convulsive seizures in the last year that occurred on 2 different days? • Ask • "How many seizures have you had in the last year?" • "Were these seizures on different days?" • If the answer to all is yes then the person is likely to have epilepsy

  33. Contents (Epilepsy/Seizures) 33 • Introduction • Learning objectives • Emergency management of seizures • Key actions • Establish communication and build trust • Conduct assessment • Plan and start management • Link with other services and supports • Follow up mhGAP-IG base course - field test version 1.00 – May 2012

  34. Management of epilepsy involves mhGAP-IG base course - field test version 1.00 – May 2012 • Medication • Prescribing and monitoring antiepileptic drugs • The vast majority of seizures can be controlled by antiepileptic drugs. • The person and carers should be informed on the following: • The details of the condition • Lifestyle and safety issues • The importance of treatment adherence • followed up care

  35. Medication: Choice of drug mhGAP-IG base course - field test version 1.00 – May 2012 • Try to prescribe a drug that is always available in your area • Avoid prescribing expensive drugs • Good choices include phenobarbital, carbamazepine, phenytoin, or valproate (valproic acid) • Which antiepileptic drugs are available in your area?

  36. Starting Antiepileptic Drug Therapy mhGAP-IG base course - field test version 1.00 – May 2012 • Start with one drug only • “Start low, go slow:" start at a low dose and slowly increase • Ask the person and family to keep a seizure diary • If the person is on other long-term medications, consult the national or WHO formulary for possible drug interactions

  37. Example of a seizure diary mhGAP-IG base course - field test version 1.00 – May 2012 Ask the person (and carer) to keep a record of seizure history

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  39. Education: medication mhGAP-IG base course - field test version 1.00 – May 2012 Explain to the person and family • The need for prompt medical treatment • The time to onset and duration of treatment • Potential side effects and what to do if they occur • The risk of further seizures if missing doses • The plan for follow up

  40. Information about the medication 40 Please refer to mhGAP version 2 page 65-66 on Pharmacological Interventions: mhGAP-IG base course - field test version 1.00 – May 2012

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  43. Common side-effects of antiepileptic Drugs mhGAP-IG base course - field test version 1.00 – May 2012

  44. Dangerous side effects and drug reactions Phenobarbital • Excessive drowsiness • Bone marrow suppression (rare) • Low white blood count • Low red blood cell count • Low platelets count • Hepatic failure (rare) Carbamazepine • Stevens-Johnson syndrome • Rash involving the eye or mouth membranes associated with a fever • STOP DRUG AND REFER! mhGAP-IG base course - field test version 1.00 – May 2012

  45. Dangerous side effects and drug reactions 45 Phenytoin • Skin rash: consider Stevens-Johnson Syndrome • Anemia or other blood problem • Hepatitis Sodium Valproate (Valproic acid) • Hepatitis or impaired hepatic function • Pancreatitis • In all cases, STOP DRUG AND REFER! mhGAP-IG base course - field test version 1.00 – May 2012

  46. How to manage a child with epilepsy and a developmental or behavioural disorder? mhGAP-IG base course - field test version 1.00 – May 2012 • Always assess children with epilepsy for developmental and behavioral disorders • Avoid Phenobarbital if possible for children with behavioral disorders • If there is a developmental and behavioural disorder • Consult with a specialist for management of epilepsy

  47. Special management for women with epilepsy mhGAP-IG base course - field test version 1.00 – May 2012 • Always give folate (5 mg/day) to prevent birth defects • Avoid valproate which can cause birth defects • If pregnant -Consult with a specialist for management -Avoid using more than one antiepileptic drug -Advise hospital delivery. -At delivery, give 1mg vitamin K IM to the newborn to prevent hemorrhagic disease • Carbamazepine is preferred to other medication if breastfeeding.

  48. FAQs about anti-epileptic drugs 48 • What should I do if I miss a dose? • My prescription is 250mg twice a day but I only have a 500mg. Can I break it in half? Can I take 500mg once daily? • Do I take the drug every day when I'm not having seizures? • How long should I take the medication? • What should I do if I am planning a pregnancy? • Should I keep on breastfeeding my baby? mhGAP-IG base course - field test version 1.00 – May 2012

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  50. When to get help • A person with epilepsy must be taken to a health care facility should any of the following occur at home: - Patient have trouble breathing during a convulsion - experiences convulsion lasting longer than 5 minutes - when the person with epilepsy is not waking up after a convulsion. mhGAP-IG base course - field test version 1.00 – May 2012

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