Epilepsy

Kelly Smith, EDU 214

Epilepsy is a brain disorder that causes people to have repeated seizures over a period of time.  Epilepsy is typically diagnosed when a person has more than one seizure.  About 2 million Americans have epilepsy, and about 1% of people worldwide.  There are approximately 125,000 new cases of epilepsy diagnosed each year, and up to 50% are children or adolescents.  There is no cure for epilepsy, but steps can be taken to prevent and reduce the occurrence of seizures.

Possible Causes of Epilepsy

  • Permanent changes in the brain cause it to become excited or irritable; the brain then sends out abnormal signals, leading to a seizure
  • Brain injury near or during birth
  • Brain defects at birth
  • Traumatic brain injuries
  • Infections (brain abscess, meningitis, encephalitis, and HIV/AIDS)
  • Dementia (such as Alzheimer disease)
  • Metabolism disorders present at birth
  • Abnormal blood vessels in the brain
  • Stroke
  • The cause may also be unknown, or idiopathic.

Symptoms and Behaviors of Epilepsy

Symptoms and behaviors of epilepsy can vary from person to person.  The type of seizure depends on which part of the brain is affected and/or the cause of epilepsy.  In most cases, the seizure is similar to the ones before it.  Seizures may be brought on by lack of sleep, stress, or flickering lights.  The amount of stimulus that is necessary to bring about a seizure is the seizure threshold.  This is lowered in epilepsy.  Some people with epilepsy could have a strange sensation before the seizure.  Sensations may be tingling, smelling an odor that is non-existent, or emotional changes.  This is called an aura.

Possible symptoms/behaviors fall into groups by the type of seizure.

  • Absence (petit mal) seizure- simple staring spells or unresponsive
  • Generalized Tonic-Clonic (grand mal) seizure- entire body is involved, including the aura, violent shaking or jerking, muscles twitching, loss of alertness
  • Partial (focal) seizure- can include any symptoms from the Absence seizure or the Generalized Tonic-Clonic seizure, depending on where the seizure begins in the brain

Testing

Doctors will complete a physical exam, having a detailed look at the brain and nervous system.  Doctors will also conduct an EEG (electroencephalogram) to check the electrical activity in the brain.  Many people with epilepsy will have abnormal electrical activity, and this can be seen from the EEG.  This test could also help doctors see where the seizures begin in the brain.  People may be asked to wear an EEG recorder for days or weeks to help diagnose or plan for surgery.  Another option would be a stay in a special hospital where brain activity could be monitored by a video EEG.  Other tests to help with a diagnosis or surgery plan could be:  complete blood count, blood sugar, blood chemistry, kidney or liver function tests, lumbar puncture (spinal tap), test for infectious diseases.

An EEG being conducted on a patient.

Treatment

As with many diseases, medication, life-style changes, and surgery may be necessary.  Even mild seizures may need treatment for people with epilepsy because of activities like driving or swimming.  Both could be dangerous if a seizure occurred.  Medication, called anticonvulsants, can be given to prevent and reduce the number of seizures.  The dosage may need to be altered from time to time.  Patients would need to always take their medication because a missed dose could lead to a seizure.  Also with these medications, vitamins or other supplements may be needed.

Medically refractory epilepsy occurs when the use of two or three anti-seizure drugs have been tried and have not been successful.  Doctors may then recommend surgery.  One surgery is to remove the abnormal brain cells that are causing the seizures.  A second is to place a vagus nerve stimulator (VNS) under the skin on the chest wall.  A wire will then run from the device to the vagus nerve in the neck.  It is sometimes considered similar to a heart pacemaker.  The VNS will send pulses of electrical energy to the brain, in hopes of preventing future seizures.

At times, a special diet is recommended for people with epilepsy.  A popular one is the ketogenic diet, which is low in carbohydrates. 

How the VNS is used in the body.

Teaching Strategies

Teachers and staff need to find out as much as possible about each and every child's epilepsy because it varies so much.  The Equality Act 2010 covers epilepsy.  It is against the law for educators or trainers to discriminate against people with epilepsy.  Children may have problems with motor skills, cognitive functions, or difficulty acquiring new skills or knowledge due to a deficit with their working memory.

Strategies to Use in the Classroom

  • Adapting the curriculum- focus less on retrieval and more on recognition
  • Expose the students to new information as often as possible
  • Individual/one-on-one instruction
  • Be cautious with flickering lights in the classroom, or on a video or computer program
  • Discussions with parents concerning causes of stress (ex. test-taking)
  • What steps need to be taken if a seizure occurs

Family and Community Resources

  • American Epilepsy Society   https://www.aesnet.org/                                                       
  • University of Maryland Medical Center Epilepsy Center                                               22 S. Greene St. Baltimore, MD 21201                                                                       1-800-492-5538                                                             https://umm.edu/programs/epilepsy
  • Kennedy Krieger Institute                                                                                                        707 North Broadway, Baltimore, MD 21205                                                              (443) 923-9200                                                                                    http://www.kennedykrieger.org/patient-care/diagnoses-disorders/epilepsy-seizure-disorder  
  • Epilepsy Foundation                                                                                                                                http://epilepsyfoundation.ning.com/group/speakupma...          
  • Patients Like Me                                                                    http://www.patientslikeme.com/

                                                                                       

References

Epilepsy. (2014).  In Dystonia & Functional Movement Disorder Sufferer.  Retrieved from http://www.dystoniasufferer.com/2013/11/

Epilepsy.  (2015).  In U.S. National Library of Medicine National Institutes of Health MedLine Plus website.  Retrieved from http://www.nlm.nih.gov/medlineplus/epilepsy.html

Epilepsy.  (2015).  In Wikipedia, The Free Encyclopedia.  Retrieved from http://en.wikipedia.org/wiki/Epilepsy

Epilepsy Overview.  (2012).  On Kennedy Krieger Institute website.  Retrieved from http://www.kennedykrieger.org/patient-care/diagnoses-disorders/epilepsy-seizure-disorder

Epilepsy Overview.  (2014).  In U.S. National Library of Medicine - The World's Largest Medical Library PubMed Health website.  Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00017...

Rodriguez, D.  (2012, May 23). Seizures and other epilepsy symptoms. Retrieved from everyday Health website http://www.everydayhealth.com/epilepsy/understanding/symptoms.aspx

Vagus Nerve Stimulation. (n.d.). Retrieved from Pixgood.com website:  http://pixgood.com/vagus-nerve-stimulation.html

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