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Parent Education on Pediatric Epilepsy(PEPE)

Learn about pediatric epilepsy, its causes, symptoms, and how to manage seizures in children. Gain knowledge about triggers, seizure mimics, and available treatment options.

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Parent Education on Pediatric Epilepsy(PEPE)

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  1. Parent Education on Pediatric Epilepsy(PEPE) Dr.T.M. Ananda Kesavan MD,MNAMS, FRCP National President, IAP Neurology Chapter-2017 Addl. Professor of Pediatrics, GMC Thrissur

  2. Epilepsy Day Observation-2017 November 17

  3. 1 General

  4. What is seizures?

  5. What is epilepsy? Epilepsy is described as the tendency to have repeated seizures that start in the brain Epilepsy is usually only diagnosed after the person has had more than one seizure

  6. Seizures can manifest as:

  7. Epilepsy Classification by ILAE( International League Against Epilepsy ) Generalised Partial Absence Tonic-Clonic Myoclonic Clonic Tonic Atonic Simple Complex Secondarily Generalised Unclassified Status epilepticus

  8. Difference between Partial (focal) Secondarily generalized (spread) and Primary generalized (absence) seizures

  9. Age • Anyone can develop epilepsy, at any time of life. • It happens in people of all ages, races and social classes. • Epilepsy is most commonly diagnosed in children and in people over 65. • There are over half a million people with epilepsy in the UK, so around 1 in 100 people.

  10. Epidemiological aspects • 5.5 M in India • 3.6 M rural • 3% popn has 2 or more seizures in their lives • Prevalence higher in developing countries • Incidence highest in childhood and old age Age-specific incidence of new-onset epilepsy and unprovoked seizures by sex in Rochester, Minnesota, from 1935 to 1984 Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia. 1993; 34: 453–468

  11. Epilepsy –a common disease • Around 87 people are diagnosed with epilepsy every day • Over 500,000 people in the UK have epilepsy. That’s about one in every 100 people. There are around 60 million people with epilepsy in the world.

  12. Celebrities with Epilepsy

  13. Famous people with Epilepsy

  14. Febrile Seizure-only in Children(below 5years) • Most common seizure (3- 4 %)in young children • Age : 3 mo – 5 yrs(6mo-18mo) • No h/o afebrile seizure OR NS infection • C/f : Rapidly rising temp – roseola , shigella ,etc • Generalized – tonic clonic(no absence or myoclonic)

  15. Treatment • Antipyretics • Hydrotherapy • Rx infection • IV /PR diazepam 0.2 – 0.3 mg / kg / dose --Correction of anemia

  16. Correct Method

  17. Wrong method

  18. Seizure History • What was the child doing? • When & where did the seizures occur? • Who observed the child at the time of seizure onset? • What happened just before the seizure started? • Was the child angry? Hurt? Frightened? • Any precipitating factors? • Detailed description of the episode-

  19. Seizure History • ‘Aura’ - highly localizing -describe “what they felt” at that time • Patiently - get the witness to “enact the event” • Video film the event-in recurrent seizures • Generalized or a focal onset • Determine whether acute symptomatic/ provoked/ unprovoked

  20. An Aura is one Symptom of a Seizure

  21. What causes Epilepsy 60 - 70% of cases the cause is unknown Some known causes include Birth injury Head injury Stroke Brain haemorrhage Brain Tumour Meningitis/encephalitis Drugs Alcohol

  22. Seizure triggers • Triggers are situations that can bring on a seizure in some people with epilepsy If one knows what triggers their seizures, they may be able to avoid these triggers and so lessen the chances of having a seizure

  23. Potential Triggers Flickering lights/photosensitivity Lack of sleep/tiredness Stress Excitement Missed meals High Temperature Menstrual Missed or late medication

  24. What's the difference between triggers and causes? • Triggers for seizures are not the same as causes for epilepsy. • A trigger for someone to have their first seizure may be a stressful situation, but the underlying cause for that person to start having seizures may be quite different. • Causes can be genetic or as a result of structural damage to the brain

  25. TV and Epilepsy One of the most common forms of photosensitive epilepsy • Age at onset: 10 to 12 years. • Sex: 2-fold female preponderance. • Choosing a screen • If you have photosensitive epilepsy, the current advice is to use an LCD screen. This is the type that carries the least risk of triggering a seizure. The content you look at on a computer or television could trigger seizures if it has any of the following. • Flashing or flickering lights • Rapidly changing images • Contrasting or moving patterns In the UK, there are guidelines for TV broadcasters to restrict the use of images that may cause a problem for people with photosensitive epilepsy. They should also give a warning if a programme has images that could trigger a seizure.

  26. Seizure Mimics Various types of non-epileptic attacks continue to be over diagnosed as epilepsy 25-30% of non-epileptic conditions are diagnosed as epilepsy

  27. Some Common Non-epileptic Events • Breath holding spells • Syncopal attacks • Benign paroxysmal vertigo • Complicated migraine • Shuddering attack • Tics • Night terrors • Somnambulism • Narcolepsy • GER with laryngospasm and apnea • Transient ischemic attacks • Peudoseizures/psychogenic

  28. Gratification Phenomenon (Masturbation) Self-stimulatory behavior in girls between the ages of 2 mo and 3yr. Stereotyped movements of tonic posturing associated with copulatory movements followed by flushing, grunting with no loss of consciousness.

  29. 2 Myths and Facts

  30. Myths and Facts MYTH : You shake and jerk when you have epilepsy FACT : Not every seizure means a person jerks convulsively, nor is a person always unconscious during a seizure. Type of jerk also vary from seizure to seizure MYTH : You can restrain someone during a convulsive seizure and put your finger in their mouth FACT : During a convulsive seizure you should never hold the person down or put anything in their mouth

  31. Seizure-First Aid

  32. Call for an  help/ambulance if: • It is the person’s first seizure • They have injured themselves badly • They have trouble breathing after the seizure • One seizure immediately follows another with no recovery in between • The seizure lasts 2 minutes longer than is usual for them • The seizure lasts for more than 5 minutes and you don’t know how long their seizures usually last.

  33. MYTH : Epilepsy is rare • FACT : Epilepsy is not rare, over 500,000 people in the UK have epilepsy. That’s about one in every 100 people. • There are also around 60 million people with epilepsy in the world. •  Anyone can develop epilepsy, it happens in all ages, races and social classes.

  34. MYTH : The only side effects of a seizure are tiredness and being confused • FACT : Epilepsy can affect people in different ways. Knowing that a person ‘has epilepsy’ does not tell you very much about what happens for them or how epilepsy affects them • Some people may have problems with sleep or memory and for some people epilepsy may affect their mental health

  35. Any one can develop epilepsy at any time • The myth: You are born with epilepsy. The cause is genetic. • The truth: Anyone can develop epilepsy at any time. Some people are born with it, whereas others have their very first seizure in middle age. While genetics can play a factor, there are other more common causes of epilepsy, such as head trauma, brain tumour or lesion and stroke. • In most cases about 65 to 70 % the cause of epilepsy is not known.

  36. Epilepsy and intelligence • The myth: Epilepsy affects intelligence. • The truth: People with epilepsy on average have the same level of intelligence as those without epilepsy. Learning can be made more difficult if seizures are frequent, or if medication has very pronounced side effects, such as causing drowsiness and excessive fatigue • Epilepsy typically does not cause lower intelligence. In fact, some very talented and brilliant people have epilepsy, including some pretty influential historical figures such as Sir Isaac Newton, Vincent Van Gogh, Ludwig van Beethoven, Agatha Christie and Napoleon.

  37. Famous people with Epilepsy

  38. Epilepsy and schooling.. • The myth: People with epilepsy can’t work, excel at school, have children or lead normal lives. • The truth: Having epilepsy doesn’t preclude someone from doing well at school, excelling in the workplace, having a family and leading a busy life. Epilepsy is a medical condition that can be managed and therefore people with epilepsy can often lead normal lives. • The myth: There is one type of “seizure” convulsion. • The truth: In fact, there are more than 40 different types of seizures, and a convulsion is not the most common kind. Seizures can take many forms including a blank stare, involuntary movement, altered consciousness, a change in sensation or a convulsion.

  39. First Aid • You can swallow your tongue during a seizure.It is physically impossible to swallow your tongue. • You should force something into the mouth of someone having a seizure.Absolutely not! That’s a good way to chip teeth, puncture gums, be bit or even break someone’s jaw. The correct first aid is simple. Gently roll the person on one side and put something soft under his or head for protection from injury. • You should restrain someone having a seizure.Never use restraint! The seizure will run its course, and you cannot stop it. Simple first aid to prevent injury is best.

  40. Not contagious • The myth: Epilepsy is a form of spiritual possession. • The truth: Although most people have long recognized that epilepsy is not a form of possession, some cultures still believe this. Epilepsy is a medical condition, a disorder of the brain that causes sufferers to have recurrent seizures • The myth: Epilepsy is contagious. • The truth: Epilepsy is not contagious and cannot be ‘caught’ by coming into contact with someone who has seizures, just as diabetes or high blood pressure are not contagious.

  41. Epilepsy and Job • Only kids get epilepsy.Epilepsy happens to people over age 65 almost as often as it does to children age 10 and under. Seizures in the elderly are often the after effect of other health problems like stroke and heart disease • People with epilepsy are disabled and can’t work.People with epilepsy have the same range of abilities and intelligence as the rest of us. Some have severe seizures and cannot work; others are successful and productive in challenging careers • People with epilepsy shouldn’t be in jobs of responsibility and stress.People with seizure disorders are found in all walks of life and at all levels in business, government, the arts and other professions. We aren’t always aware of them because many people, even today, do not talk about having epilepsy for fear of what others might think.

  42. Marriage will cure epilepsy??!!

  43. 3 Diagnosis and Treatment

  44. Diagnosis • History • Watching an episode-teacher/caretaker • Recording • Blood investigations in special situations • EEG • MRI • Newer investigations

  45. EEG

  46. Overcoming EEG’s drawbacks

  47. MRI

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