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Brain Injury and Seizures

Brain Injury and Seizures. www.efmn.org | 1600 University Avenue West, Suite 300, St. Paul, MN 55104 | 1.800.779.0777. A little bit about your presenters. Amanda Pike- Epilepsy Foundation of MN Jeannine Conway- University of MN, EFMN PAB. Today’s Objectives.

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Brain Injury and Seizures

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  1. Brain Injury and Seizures www.efmn.org | 1600 University Avenue West, Suite 300, St. Paul, MN 55104 | 1.800.779.0777

  2. A little bit about your presenters • Amanda Pike- Epilepsy Foundation of MN • Jeannine Conway- University of MN, EFMN PAB

  3. Today’s Objectives • Define epilepsy and discuss the correlation between brain injuries and strokes with seizures • Identify the most common types of seizures and describe appropriate response • Discuss available treatment options

  4. Epilepsy is… • A neurological disorder of the brain characterized by the tendency to have recurring seizures • May also be called a Seizure Disorder

  5. Epilepsy Facts… • Approximately 2.2 million Americans have epilepsy • Epilepsy is the most common neurological condition in children and the fourth most common in adults after Alzheimer’s, stroke and migraines • Approximately 1 in 26 people will develop epilepsy at some point in their lives • Over 60,000 people in MN & ND have epilepsy

  6. Epilepsy and stroke • Number 1 cause of epilepsy in people older than 50. • Side effects of medicine can make the effects of the stroke a little worse. • Make sure you know about any other medications and if it is safe to mix with any epilepsy medications.

  7. What happens to the brain during a seizure? • Sudden electrical activity in the brain • Most seizures are either partial or generalized • Where the activity occurs in the brain will determine how the seizure will look

  8. Possible Causes of Epilepsy • Head Trauma • Brain tumor and stroke • Infection and maternal injury • Some forms are genetic

  9. In 70% of the epilepsy cases – there is no known cause

  10. Possible Seizure Triggers • Assess the environment • Failure to take medications • Lack of sleep • Stress / Anxiety • Dehydration • Photosensitivity – strobe lights • Menstrual cycle / hormonal changes

  11. Seizure Classification Partial Seizures (focal) • Involves only part of brain • Simple & complex forms • Symptoms relate to the part of brain effected Generalized Seizures • Involves whole brain • Convulsions, staring, muscle spasms, and falls • Most common are absence & tonic-clonic

  12. Simple Partial Seizures • Uncontrollable shaking movements of hand, arm or legs • Sensory Seizures – may see flashing lights in peripheral vision, hear bells ringing, etc. • Seizure usually lasts between 1 and 2 minutes – no impairment of consciousness • May be considered an aura • No immediate action is needed other than reassurance and emotional support • A medical evaluation is recommended

  13. Complex Partial Seizures • Most common seizure type • Unaware of surroundings and unable to respond • Repetitive, purposeless movements such as lip smacking, hand wringing, or wandering - actions seem unusual • Seizure usually lasts approximately three minutes

  14. Complex Partial Seizures

  15. Appropriate Response – Complex Partial • Stay calm • Track time • Do not restrain • Gently direct away from hazards • Remain with the individual until they have gained full awareness

  16. Absence Seizures (formerly petit mal) • Usual onset between 4 and 12 years of age • Characterized by brief staring – can be confused with “daydreaming” • Starts and ends abruptly - can happen several times a day • Quickly returns to complete awareness • Appropriate response includes documentation

  17. Absence Seizures (formerly petit mal)

  18. Generalized Tonic Clonic (formerly grand mal) • NOT the most common type • Completely unconscious – loss of control • Characterized by a sudden fall • May cry out or make some types of noise • Onset of uncontrolled jerking or shaking of muscles • May have irregular breathing • Lasts 5 minutes or less

  19. Generalized Tonic Clonic (formerly grand mal)

  20. Appropriate Response – Generalized Tonic Clonic • Stay calm • Protect their head • Turn on side to prevent choking * • Track time • Check for Seizure Disorder ID • Move objects out of the way * Do NOT put anything in the person’s mouth.

  21. Appropriate Response – Generalized Tonic Clonic • Remain with them until they have gained full awareness • If seizure lasts more than 5 minutes, call EMS • Recovery period– post ictal state

  22. Call 911 if the person… • Is injured • Has diabetes • Is pregnant • Does not resume normal breathing • Has a 1st time seizure • Has a seizure in water

  23. Treatment Options • Medication • Brain Surgery • Diet • VNS

  24. Medications Medications are most often the first line of treatment: • Approximately 60% of people achieve seizure control after the 1st year • 15% achieve control at a later date • 25% continue to have seizures despite treatment

  25. Common Side Effects of Medication • Lethargy • Weight gain / weight loss • Cognitive, concentration, memory difficulties • Hyperactivity • Emotional and/or behavioral changes

  26. Brain Surgery Options • Lobectomy • Partial Seizures • Hope for result of seizure free • Corpus Callosotomy • Generalized Seizures • Never seizure free, less frequent/ intense seizures

  27. Medical Device Options

  28. Special Diets • Ketogenic Diet • Burns fat instead of glucose (fasting induced) • Gets 80% of calories from fat • Gets 20% from carbohydrates and proteins • Must be strictly managed and maintained daily • 1/3 become seizure free or almost seizure free • 1/3 improve but still have some seizures • 1/3 do not respond or find it too hard to comply

  29. Special Diets • Modified Atkins Diet • No fluid or calorie restriction, no protein restriction • Foods not weighed and measured, carbohydrates monitored • Not fast induced • Low Glycemic Index Treatment • Glycemic Index: how high that food raises your blood glucose • Easier to maintain - based more on portion control • Increase of carbohydrates with a low Glycemic Index

  30. Possible Impact of Epilepsy • Depression, Anger, Anxiety, Fear • Cognitive Problems • Developmental Delays • Relationships • Financial Costs • School/Employment • Driving • Recreational Activities

  31. The Epilepsy Foundation of Minnesota leads the fight to stop seizures, find a cure and overcome the challenges created by epilepsy. 1.800.779.0777 www.efmn.org www.efmn.org | 1600 University Avenue West, Suite 300, St. Paul, MN 55104 | 1.800.779.0777

  32. ABOUT US We serve Minnesota and Eastern North Dakota Offices in St. Paul, Rochester, Duluth, St. Cloud, and Fargo Funding Sources: used clothing, individual/corporate donations, special events and grants The Epilepsy Foundation is the only organization in MN or ND that works exclusively with people affected by seizures. www.efmn.org | 1600 University Avenue West, Suite 300, St. Paul, MN 55104 | 1.800.779.0777

  33. PROGRAMS THAT EDUCATE Seizure Smart Communities Seizure Recognition & Response Training Seizure Smart Schools Conferences & Workshops www.efmn.org | 1600 University Avenue West, Suite 300, St. Paul, MN 55104 | 1.800.779.0777

  34. PROGRAMS THAT CONNECT Camp Oz Regional Events Shining Star Program Information & Referral Program Peer Groups & Online Communities www.efmn.org | 1600 University Avenue West, Suite 300, St. Paul, MN 55104 | 1.800.779.0777

  35. PROGRAMS THAT EMPOWER Stroll for Epilepsy Creative Arts Advocacy Volunteering Youth Advisory Council Winning Kid www.efmn.org | 1600 University Avenue West, Suite 300, St. Paul, MN 55104 | 1.800.779.0777

  36. Make A Difference! Help us educate, connect and empower those impacted by epilepsy! - Visit us online at www.efmn.org/giving - Participate in your employee giving campaign (United Way, Community Health Charities or Combined Federal Campaign) - Attend EFMN events - Donate your used clothing

  37. Anticonvulsants and Brain Injury

  38. Objectives • Describe the elements of epilepsy treatment including: • Available treatments • Desired outcomes • Describe medication choices

  39. Indications for AEDs • Epilepsy • Headache • Psychiatric disorders • Neuropathic pain • Behavior • Weight loss • Movement disorders • Spasticity

  40. Goals of Epilepsy Care • Eliminate seizures with no side effects; alternatively • Reduce the number • Decrease the severity • Minimize side effects • Optimize quality of life

  41. Chronology of AED Development 2nd generation AEDs YearDrug 1993 Felbamate 1994 Gabapentin 1994 Lamotrigine 1996 Topiramate 1997 Tiagabine 1999 Oxcarbazepine 1999 Levetiracetam 2000 Zonisamide 2005 Pregabalin 2009 Rufinamide 2009 Vigabatrin 2011 Clobazam 1st generation AEDs Year Drug 1912 Phenobarbital 1938 Phenytoin 1947 Mephenytoin (no longer available) 1954 Primidone 1960 Ethosuximide 1968 Diazepam 1974 Carbamazepine 1975 Clonazepam 1978 Valproate • 3rd generation AEDs • YearDrug • 2009 Lacosamide • 2011 Ezogabine • 2012 Perampanel

  42. Normal CNS Function Inhibition Excitation Glutamate Aspartate GABA

  43. Glutamate Aspartate Abnormal Excitation Inhibition GABA Excitation Furthermore, membrane depolarization leads to enhanced excitatory receptor function and reduced GABA-receptor function. This pattern of ‘voltage-dependence’ leads to an even greater level of excitation.

  44. AEDs Act By Restoring Balance Inhibition Excitation Increase inhibition Phenobarbital (PB) Benzodiazepines (BDZ) VPA FBM TPM ZNS Tiagabine Vigabatrin Reduce excitation Phenytoin (PHT) Carbamazepine (CBZ) Valproic acid (VPA) Felbamate (FBM) Lamotrigine (LTG) Topiramate (TPM) Oxcarbazepine (OXC) Zonisamide (ZNS) Levetiracetam (LEV)

  45. Drug Choices for the Treatment of New Onset Seizures

  46. Medication Selection • Seizure type • Co-medications • Medical conditions • Age of the patient • Insurance coverage • Allergies • Adherence challenges

  47. Optimize Therapy • Titrate dose or serum concentration to response • Increase dose until seizure control is attained or until unacceptable side effects occur • Consider adding 2nd AED if first is not effective

  48. Monitoring AED Treatment • Efficacy • Seizure control • Toxicity • Side effects • Serum concentrations

  49. Toxicity • Acute side effects • Concentration dependent • Common, bothersome, generally not life threatening • Reversible by decreasing the serum concentration • Examples: dizziness, ataxia, headache • Idiosyncratic • Rare, may be serious and life threatening • Generally involve organ hypersensitivity • Examples: hepatic failure, rash, aplastic anemia

  50. Toxicity • Chronic Side Effects • Due to long term exposure to the medication • Occur regardless of serum concentration levels • Examples: Alopecia, weight gain, behavior change, cognitive impairment

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