Northern Devon Healthcare NHS Trust. Epilepsy Awareness. Presenter

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Bartholomew Payne
5 years ago
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1 Epilepsy Awareness Presenter

2 Housekeeping Northern Devon Healthcare NHS Trust

3 To respect confidentiality within the group unless it is necessary to address a current concern about the safety of an adult at risk

4 QUIZ Northern Devon Healthcare NHS Trust

5 Learning Outcomes Demonstrate an awareness of what Epilepsy is and recognise different seizure types. Understand appropriate First Aid Understand the risks associated with Epilepsy and the impact on a person s quality of life Demonstrate an understanding of the role of staff caring for a person with epilepsy.

6 What is Epilepsy Epilepsy is a common, chronic neurological disorder characterised by unprovoked seizures. A seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary disruption to the way the normal brain works. The disruption results in the brain s messages becoming halted or mixed up. What you experience during a seizure will depend on where in your brain the epileptic activity begins and how rapidly it spreads.

7 Epilepsy Facts There are many different types of seizures (approx.40 different types) and unique to the individual. It affects approx.112,000 young people under 25 in the UK. 1: 250 children and 1: 100 adults. It can affect anyone at any time. It is not contagious. There is no connection between epilepsy and intelligence Not all types of epilepsy are life long. Approx.75% of children either outgrow their epilepsy or have their epilepsy well controlled on medication

8 What Causes Epilepsy In 6 out of 10 cases there is no identifiable cause. Those epilepsies with a known cause are called symptomatic. There are two main categories: those caused by brain injury or disease e.g. Infections, brain tumours, trauma, malformations or degenerations, metabolic disorders. Hereditary factors: Epilepsy can be inherited, but in most people there is no family history of epilepsy. Genetic testing can help identify specific Gene defects, which may be useful for treatment, prognosis and genetic counselling.

9 Diagnosis There is no single test that will tell the consultant whether a person has epilepsy or not. A diagnosis is based on the medical history and eye witness account of the event. Various other tests such as an EEG, MRI, blood and genetic testing, may help to identify the type of epilepsy and possible cause.

10 Treatment The medicines used are called Antiepileptic drugs (AED). Epilepsy is usually controlled, but not cured by medication. Up to 70% of people can become seizure free if they are on the most appropriate medication for them. Taken on a regular basis Usually twice daily Common side effects include tiredness, dizziness and nausea. Other treatments options are ketogenic diet, VNS (Vagal Nerve Stimulator) or surgery.

11 Vagal Nerve Stimulator Northern Devon Healthcare NHS Trust

12 Potential Triggers Missed or late medication Lack of sleep/tiredness Stress /Excitement High Temperature Menstruation/ puberty Alcohol/drug Flickering lights/photosensitivity

13 Classification of Seizures Seizures can be divided into two main groups: Generalised Seizures or Focal (Partial) Seizures

15 Focal / Partial Seizures Affects just one part of the brain The person can be fully aware but may experience a strange sensation e.g.. Funny feeling in their tummy, strange taste, smell or fear. The person may also experience twitching of a finger/ face or have numbness. OR Consciousness may be altered and the person looks confused. May make strange movements e.g. Lip smacking, chewing, rubbing, plucking at their clothes Discharges can spread to the rest of the brain resulting in a generalised tonic-clonic seizure.

16 First Aid (Focal Seizures) DON T Restrain the person Act in a way that could frighten the person such as making abrupt movements or shouting at them Assume the person is aware of what is happening Attempt to bring the person around Give the person anything to eat or drink until fully recovered

17 Generalised Seizure In Generalised seizures the epileptic activity is in both halves of your brain. The main types of Generalised seizures are: Tonic Clonic Absence Myoclonic Tonic Atonic

18 Absence Seizures Absence seizures Generally a childhood disorder but can also occur in later life The person may look blank and stare, lasting a few seconds The person can appear to be day dreaming or dazed Eyelid fluttering/ blinking may occur May have minor facial movements or head drop Able to continue normal activity almost immediately afterwards

19 Generalised Seizures Myoclonic: - The person has shock like contractions of different muscles. These are brief but can happen in clusters and often occur shortly after wakening Atonic (drop attack): - Sudden loss of muscle tone and person falls to the ground. Lasts a few seconds and able to continue normal activity immediately afterwards Tonic:- The person s muscles contract resulting in a fall. These are all very brief and recover quickly but the person may injure themselves as a result of these.

20 Tonic / Clonic Seizures Most common and widely recognised of the generalised seizures. Resulting in loss of consciousness. Tonic Phase Muscles contract, body stiffens and person falls to the ground The person may become pale Their breathing may be irregular and lips may appear blue Saliva may dribble from their mouth and can be blood stained if tongue has been bitten Incontinence may occur

21 Tonic / Clonic Seizures Clonic Phase Consists of short sharp rhythmical jerks and gradually slows down Muscles relax and the body becomes limp The person will slowly regain consciousness but may be groggy and confused afterwards Post-ictal state After the seizure the person can be very tired and have memory loss. This can last from minutes to days.

22 Tonic / Clonic Seizure First Aid DO If there is no history of seizure activity then call the emergency services. Keep Calm and reassure the person Protect them from injury remove harmful objects Cushion their head Aid breathing by gently placing the person in the recovery position when the seizure has stopped Record time & duration of seizure Stay with the person until fully recovered DON T Put anything in the person s mouth Move unless in danger Restrain the person Give anything to eat or drink until fully recovered Attempt to bring the person around

23 Recovery Position Northern Devon Healthcare NHS Trust

25 Call ambulance if.. The patient has never experienced a seizure before and has no known Epilepsy diagnosis. The seizure continues for more than 5mins or longer than is normal for the person. One seizure follows another without the person regaining consciousness Person is injured during the seizure You believe the person needs urgent medical assistance

26 Rescue Medication (Buccal Midazolam, Rectal Diazepam or Paraldehyde) On rare occasions rescue medication is needed to stop continuous or repeated seizures. This is to help prevent status epilepticus which is a medical emergency. Rescue medication should only be given by someone who is trained in this procedure and where consent has been obtained. If required, a Rescue Medication Protocol (RMP) will be completed by the Consultant. In addition to this, an individualised care plan will also be completed by the identified Senior staff member. In the absence of an up to date RMP or appropriately trained staff, an ambulance must be called.

27 Rescue Medication Northern Devon Healthcare NHS Trust

28 Hypoglycaemic Seizure A hypoglycemic seizure may be triggered by injecting too much insulin, or failing to eat soon enough after using a fast acting insulin; excessive use of alcohol, skipping meals, or exercising vigorously without adjusting insulin dosages or eating properly. A seizure may also be triggered by oral diabetes medications that cause the pancreas to produce more insulin. Whatever the cause of the seizure, it needs to be treated as a medical emergency. To identify the onset of a hypoglycemic seizure, look for the following warning signs of seizures and symptoms:

29 Hypoglycaemic Seizure The signs Sweating Confusion Feeling faint or too sleepy Shakiness Feeling cold or clammy Hallucinations Unexplained emotional behaviours Uncontrollable crying Unaware of surroundings Changes in vision Loss of ability to speak clearly Loss of muscle control Muscle weakness Anxiety

30 Hypoglycaemic Seizure - Treatment It is best to treat severe hypoglycemia as an emergency. If you know how to administer glucagon via a glucagon injection kit this is a safe and effective way to raise blood glucose levels of someone suffering from a severe hypo. If you administer glucagon, ensure the person is in the recovery position as glucagon can lead to vomiting. If you do not have access to glucagon, call for emergency assistance and have a form of sugar (including fruit juice, a sugary drink, glucose tablets or sweets) available in case they recover. If someone experiencing hypoglycemia is having a seizure or is unconscious, do not attempt to feed them as this could present a risk of choking.

31 Epilepsy and Risk Assessment Risk involves balancing the health and safety of the individual with not wishing to restrict their quality of life by being over protective. It should be a multi disciplinary process Often a complex task and specific to each individual.

32 Risks with Epilepsy Stigma and quality of life- over protected versus informed choice and consent Risks of injury and fractures, increased admissions to hospital. Medication side effects. SUDEP- Sudden unexpected death in Epilepsy.

33 SUDEP 1 in every thousand people with epilepsy will die suddenly with no obvious cause. Risk is low but will vary from person to person. Not associated with all seizure types. Cause: don t really know. Possible link with seizures and heart rhythm abnormalities.

34 Who is at risk Tonic clonic /convulsive seizures. Nocturnal seizures. Young adults. Having seizures when no one is around to help. Medication compliance Lifestyle issues: alcohol, other recreational drugs, poor sleep pattern.

35 Practical Safety Tips Ensure family/ friends/ colleagues/ carers know about your Epilepsy and first aid care. Attend all Epilepsy appointments with Nurse or Doctor. Take prescribed medication as directed. Shower rather than bath. Inform people of your schedule/ routine. Wear Medic Alert bracelet / necklace. Most sporting activities are suitable with care

36 Role of staff Obtain information about the person s epilepsy from individual, family/ carer. Communicate with person and family about any concerns i.e. seizure pattern, change in ability, behaviour or mood. Report & record any seizure activity observed as per local policy. Communicate with appropriate staff/ carers. Ensure a risk assessment is carried out for the individual if required.

37 Information Required about a persons Epilepsy Emergency contact details Type of seizure/s Any warning or tell tale signs of a pending seizure What happens Before a seizure During a seizure After a seizure How long does the seizure last How person is following a seizure and what First Aid is appropriate. Details of emergency medication if required.

38 Description of Seizure Why? Informs care staff of what is normal for person Assists with establishing a diagnosis Observe changes in frequency and type of seizures Helps monitor effects of treatment Important to review recordings otherwise changes may go unnoticed.

39 Observation of Seizures Before - During - After Northern Devon Healthcare NHS Trust How did the person feel before the event? In what environment/activity? Time of day or night? Anything trigger the event? Was there a warning? What was the event like? Standing / Sitting / Lying? Was there a fall? Parts of body effected/movements? Eyes open/closed? Were they unconscious fully or vaguely? If unconscious How long? Behaviour? Incontinence / tongue bite /excess saliva? Any injury or bruising? Length of time in seizure? What were they like after the event? Recovery time? How did care staff cope with event anxious/debriefing?

40 Seizure Management Plan Seizure Management Plan should be in place & available agreed by: Parent/Next of Kin / Carer Updated yearly or more often if required Be aware of who is responsible for first aid Carer/ Parent / Next of Kin should be informed of seizure ASAP Record seizure

41 Seizure Management Plan WILL PROVIDE: Description of seizure Triggers Management of the seizures What to do in an emergency Any other relevant information

42 Emergency Seizure Management WILL PROVIDE: Plan Description of seizure/duration Indications for use of rescue medication Initial dose of rescue medication Usual response to rescue medication (if known)

43 Emergency Seizure Management Plan WILL PROVIDE Who is trained to administer Consent

44 Useful Contacts

45 Questions? Northern Devon Healthcare NHS Trust

46 References Epilepsy Action Epilepsy Seizures Explained. Epilepsy Society January Did you know? Factsheet. NICE Jan 2012 (Last Updated Feb 2016). Epilepsies: Diagnosis and Management. Epilepsy Action My Epilepsy Care Plan. JEC Joint epilepsy Council of the U.K and Ireland 2012 A guideline on training standards for the administration of buccal midazolam.

Seizures explained. What is a seizure? Triggers for seizures

Seizures explained. What is a seizure? Triggers for seizures Seizures explained What is a seizure? A seizure is a sign of a temporary disruption in the brain s electrical activity. Billions of brain cells pass messages to each other and these affect what we say