Living with Epilepsy and first aid

Epilepsy is a common chronic neurological disorder characterized by seizures.

In a large majority of patients it is NOT hereditary – a big myth. Only in certain types of epilepsies the ability to develop epilepsy is inherited to an extent of 2-4%,which, means a great majority do not have hereditary factor. This is one of the greatest myths in epilepsy

 When Are Seizures not Epilepsy?

First seizures, febrile seizures, nonepileptic events, and eclampsia are examples of seizures that may not be associated with epilepsy.

About 50,000,000 million people worldwide have epilepsy, and nearly two out of every three new cases are discovered in developing countries.

Onset of new cases occurs most frequently in infants and the elderly and it increases with age.

About 3% of people will be diagnosed with epilepsy at some time in their lives.

The prevalence of active epilepsy is roughly in the range 5–10 per 1000 people. Up to 5% of people experience non febrile seizures at some point in life; epilepsy's lifetime prevalence is relatively high because most patients either stop having seizures or (less commonly) die of it. Epilepsy's approximate annual incidence rate is 40–70 per 100,000 in industrialized countries and 100–190 per 100,000 in resource-poor countries; socioeconomically deprived people are at higher risk.

Seizure First Aid

During a seizure, we first ask that everyone involved stay calm and keep the child safe. Time the seizure with a watch or clock, as most seizures seem to be a lot longer than they really are. If the seizure lasts longer than five minutes, EMS needs to be called. Notice what the seizure looks like so you can give a good description to the paramedics and the child's doctor. Please DO NOT places anything in the child's mouth. They cannot swallow their tongue. If possible, gently lay the child on his side. Lastly, let the seizure run its course. Do not try to restrain the child. After the seizure is over, allow them to rest and completely recover from the seizure. Again, if the seizure does not stop after five minutes, 911 should be called. If there are any other unusual or concerning circumstances surrounding the seizure, also consider consulting medical personnel.

Seizure Precautions

These are some general precautions for children with a history of seizures or epilepsy. Discourage your child from climbing higher than 10 feet. Do not let your child take a tub bath alone, as some children have drowned in the bath during a seizure. If they are too old for supervision, they should take a shower and leave the door unlocked. There should be no unsupervised swimming; they should swim with other swimmers who are strong enough to rescue them. As with all children, children with epilepsy should wear a helmet when riding a bike or rollerblades. If your child is old enough to drive, they should not drive unless they have been seizure free for six months and you have contacted the physician. While there can't be a universal rule applicable to every possible situation and person, older children and adults also need to take reasonable precautions or restrictions with more dangerous activities, such as operating heavy machinery and playing contact sports.

Despite the above precautions, children with epilepsy should be encouraged to lead as normal a life as possible. Using common sense, there is no reason that people with epilepsy cannot participate fully in the vast majority of activities that life offer

First Seizures

Many people have a single seizure at some point in their lives. Often these seizures occur in reaction to anesthesia or a strong drug, but they also may be unprovoked, meaning that they occur without any obvious triggering factor. Unless the person has suffered brain damage or there is a family history of epilepsy or other neurological abnormalities, these single seizures usually are not followed by additional seizures. One recent study that followed patients for an average of 8 years found that only 33 percent of people have a second seizure within 4 years after an initial seizure. People who did not have a second seizure within that time remained seizure-free for the rest of the study. For people who did have a second seizure, the risk of a third seizure was about 73 percent on average by the end of 4 years.

Sudden unexpected death in epilepsy

Beyond symptoms of the underlying diseases that can be a part of certain epilepsies, people with epilepsy are at risk for death from four main problems: status epilepticus (most often associated with anticonvulsant noncompliance), suicide associated with depression, trauma from seizures, and sudden unexpected death in epilepsy (SUDEP).

Status epilepticus affects about 195,000 people each year in the United States and results in about 42,000 deaths. In UK epilepsy kills 1000 every year. While people with epilepsy are at an increased risk for status epilepticus, about 60 percent of people who develop this condition have no previous seizure history.

People with epilepsy who are otherwise healthy are known to have a risk of unexplained sudden death that is more than 20 times higher than the general population. Doctors call it sudden unexpected death in epilepsy or SUDEP.

However, that risk may be reduced by a variety of precautions, a new review of research finds.

The review, published online in The Lancet, should be understood properly by those with epilepsy, says researcher Simon Shorvon, MD, professor of neurology at University College London. "Life is full of risks," he says, ''and [it's] important to keep in perspective. "

For the review, Shorvon searched for published medical studies focusing on the seizure disorder epilepsy and sudden death from 1950 to 2010, finding 580 articles. He focused on those published in the past five years.

About 3 million Americans have epilepsy and seizures, according to the Epilepsy Foundation.

How to Reduce Risk of Sudden Death

Shorvon pooled the data from his analysis of risk factors. He found:

·         The more often a seizure known as tonic-clonic occurs, the higher the risk. These are a type of generalized seizure that affects the entire brain.

·         Men were at higher risk than women.

·         Those who had epilepsy long term were at higher risk than those who had it for a shorter time.

·         Those on many epilepsy medicines were at higher risk than those not taking many medicines.

Shorvon also found SUDEP usually occurs when people with epilepsy are not observed by others and often at night.

To reduce risk, ''reducing the number of convulsions is probably the single most important way of prevention [of SUDEP],'' Shorvon tells WebMD.

Other ways to reduce risk:

·         Take medication as prescribed.

·         If drugs are changed, the doctor should change them in a gradual manner.

·         Patients at high risk should be supervised at night. A person can supervise the patient or the patient can use alarms that are set off by seizures.

·         Epilepsy drugs that have potential cardiac and respiratory effects should be prescribed with care.

·         Doctors should discuss risks of sudden death with people with epilepsy.

The measures suggested to reduce SUDEP risk are only speculative suggestions, Shorvon writes, based on data about what leads to SUDEP. If medications don't help, Shorvon writes, epilepsy surgery can help make a patient seizure-free and probably reduces the risk of SUDEP.

What to Do if You See Someone Having a Seizure

If you see someone having a seizure with convulsions and/or loss of consciousness, here's how you can help:

1.     Roll the person on his or her side to prevent choking on any fluids or vomit.

2.     Cushion the person's head.

3.     Loosen any tight clothing around the neck.

4.     Keep the person's airway open. If necessary, grip the person's jaw gently and tilt his or her head back.

5.     Do NOT restrict the person from moving unless he or she is in danger.

6.     Do NOT put anything into the person's mouth, not even medicine or liquid. These can cause choking or damage to the person's jaw, tongue, or teeth. Contrary to widespread belief, people cannot swallow their tongues during a seizure or any other time.

7.     Remove any sharp or solid objects that the person might hit during the seizure.

8.     Note how long the seizure lasts and what symptoms occurred so you can tell a doctor or emergency personnel if necessary.

9.     Stay with the person until the seizure ends.

Call emergency services if:

1.     The person is pregnant or has diabetes.

2.     The seizure happened in water.

3.     The seizure lasts longer than 5 minutes.

4.     The person does not begin breathing again or does not return to consciousness after the seizure stops.

5.     Another seizure starts before the person regains consciousness – status epilepticus.

6.     The person injures himself or herself during the seizure.

7.     This is a first seizure or you think it might be. If in doubt, check to see if the person has a medical identification card or jewelry stating that they have epilepsy or a seizure disorder.

8.     After the seizure ends, the person will probably be groggy and tired. He or she also may have a headache and be confused or embarrassed. Be patient with the person and try to help him or her find a place to rest if he or she is tired or doesn't feel well. If necessary, offer to call a taxi, a friend, or a relative to help the person get home safely.

9.     If you see someone having a non-convulsive seizure – complex partial seizure (he may take away your belongings  . . . ), remember that the person's behavior is not intentional. The person may wander aimlessly or make alarming or unusual gestures. You can help by following these guidelines:

10.                        Remove any dangerous objects from the area around the person or in his or her path.

11.                        Don't try to stop the person from wandering unless he or she is in danger.

12.                        Don't shake the person or shout.

13.                        Stay with the person until he or she is completely alert.

Safeguard your kitchen

• Use oven mitts and cook only on rear burners
• If possible, use an electric stove, so there is no open flame
• Cooking in a microwave is the safest option
• Ask your plumber to install a heat-control device in your faucet so the water doesn't become too hot
• Carpet the kitchen floor. This can provide cushioning if you fall
• Use plastic containers rather than glass when possible
• If possible, cook when someone else is nearby.
• Use the back burners of the stove to prevent accidental burns.
• Use shatterproof containers as much as possible. For instance, sauces can be transferred from glass bottles to plastic containers for use.
• Limit time that is required using knives or other sharp objects. If possible, buy foods that are already cut, or ask someone to help in meal preparation.
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General Safety at Home

• Do not smoke or light fires in the fireplace unless someone else is present.
• Do not use space heaters that can be accidentally overturned.
• When alone, avoid using step stools or ladders, and do not clean rooftop gutters.
• Purchase power tools and motorized lawn equipment which have a safety switch that will stop the machine if you release the handle (a 'dead man's' switch).

Safeguard your bathroom

• Install a device in your tub and showerhead that controls temperature. This keeps you from burning yourself if a seizure occurs
• Carpet the floor—it's softer and less slippery than tile
• Do not put a lock on the bathroom door. If you have one, never use it. Someone should always be able to get in if you need help
• Learn to bathe with only a few inches of water in the tub, or use a handheld showerhead

A person with seizures may want to shower instead of bathe to avoid accidental drowning. If falls occur during the patient's typical seizure, a person should use a shower seat, preferably one with a safety strap.

• Use nonskid strips in your shower or tub.
• Never use electrical equipment near water. This prevents accidental electrocution.
• Consider changing glass in shower doors to shatterproof glass.
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Planning ahead for safety outside the home

Driving. For many people with epilepsy, the risk of seizures restricts their independence, in particular the ability to drive. The Epilepsy Foundation offers a state-by-state database of driving restrictions and regulations on its website. Find out more about driving and epilepsy.

Participating in activities. You can play sports with epilepsy, but it's a good idea to have someone with you who knows how to manage a seizure. Wearing head protection is also recommended when you participate in a contact sport that might cause you to fall or hit your head.

Here are some tips for picking the right physical activities when you are living with epilepsy:

• If seizures usually occur at a certain time, plan activities when seizures are less likely to happen
• Avoid extreme heat when exercising and keep hydrated with plenty of water to reduce seizure risks
• Check with your neurologist before starting any new exercise program

Some activities may be restricted if you have uncontrolled seizures, including:

• Swimming alone
• Climbing to unsafe heights
• Riding a bike in traffic

Driving and Transportation
Avoid driving unless your seizures are well controlled and/or you have permission to drive from your state's Department of Motor Vehicles

(DMV). Each state has different laws.

• If you ride a bicycle, wear a helmet and any other necessary protective gear.
• When taking public transportation like the bus or subway, stay clear of the platform edge.

Outdoor and Sports Safe

• Swimming is okay, but does present certain risks. Never swim alone, and tell friends what to do if you have a seizure while swimming.
• Wear appropriate protective equipment.
• Ski with a friend. If a seizure occurs, your friend can seek help, if needed. He or she can also help to get you out of the cold. Consider using a safety hook or belt while riding the ski lift.

Safety Issues for Parent

• Feed, nurse, dress, and change your infant while sitting on the floor, in a well-protected area.
• Childproof your house as much as possible. If you are home alone with your child, consider using a safe play area or playpen. Use child safety gates to prevent a child from falling down stairs or to prevent your child from wandering in the event that you have a seizure.
• As your child grows, explain what seizures are in terms that he or she can understand. Some people perform 'seizure drills.' Many people teach their children how to call 911 in an emergency.

For senior citizens –

• Seniors may react to medicines differently than younger people
• Seniors may need to take different doses than other patients
• Seniors may not easily detect side effects
• Some medicines may cause seizures in seniors with epilepsy
• Kidney problems may complicate treatment in some seniors
• Bone density may be an additional concern in treatment planning

Epilepsy at workplace –

Use carpeting or rubber matting on the floor of your workspace If you use a desk chair, choose one with armrests to prevent falls Have a buddy at work who knows how to help you if you have a seizure Take breaks when you need them Use the elevator instead of the stairs Avoid shift work or get plenty of rest. Lack of sleep can cause seizures

Prevention

If the seizures are related to another medical condition, identification and treatment of that medical condition is the key to prevention. If anticonvulsant medication is prescribed, taking the medication on the recommended schedule and not missing medication is important.

Some people with epilepsy are quite sensitive to alcohol. If this pattern develops, avoid alcohol. Others may have seizures only after ceasing heavy alcohol intake. The key to prevention is avoidance of alcohol.

Sleep deprivation and stress certainly may increase the frequency of seizures in some eople with epilepsy.

Does seizures cause brain damage ? Yes in long run

relationship of epilepsy & sleep? a) Sleep deprivation can precipitate seizures; b) Some seizures are more frequent during sleep state eg. Frontal lobe epilepsy, primary generalized epilepsy of genetic origin.

                                                     MYTHS      

DEVIL

MENTAL ILLNESS

CONTAGIOUS

LOW MENTAL ABILITY – NOT ALWAYS . . .

HEREDITARY – ONLY 2 TO 4%

MARRIAGE CURES

LIFE LONG DISORDER

RARE

GIVING KEY/SHOE!

CHILDHOOD DISEASE

SPOON IN MOUTH

As per the Motor vehicle Act in India - driving is not permitted once a person declares that he had / has epilepsy or even if he is free from epilepsy and off medication. In the western countries driving is allowed to drive personal vehicle if a person is free from seizures for 6 months - 2 years even while taking antiepileptic drugs (AEDs).

http://www.youtube.com/watch?v=5hVYA6JrVUA