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Download seizure recognition, seizure types, first aid and safety
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SEIZURE RECOGNITION, SEIZURE TYPES, FIRST AID AND SAFETY Charuta Joshi MBBS, FRCPC Director of pediatric epilepsy UIHC Objectives At the end of this lecture the participants will be able to: Define a seizure Recognize different types of seizures Define epilepsy Know basic steps involved in seizure first aid Name 2 different medications used on the site to treat seizures in the prehospital setting Be familiar with ketogenic diet as therapy for seizures What is a seizure Seizure recognition • • • • • A clinical manifestation of : Abnormal Excessive Paroxysmal Electrical discharge in neurons Seizure recognition • • • • Stereotyped Repetitive If unsure video tape events Ask pediatrician to see Seizure recognition • Spectrum of findings Generalized seizures Complex partial seizures Simple partial seizures Seizure recognition simple partial seizures • Localization Seizure recognition Generalized • • • • Absence Myoclonic Tonic Generalized tonic clonic How important is it to be sure about a seizure First seizure clinic results • 127 children • 94 were given diagnosis of epilepsy in first seizure clinic • 36 had suffered at least one previous seizure ( 15 unrecognized by family as a seizure) • 31 – non epileptic events • Unclassified in 2 Differential diagnosis Investigations after a first unprovoked seizure Investigations Yield of neuroimaging (Shinnar et al 2001) What is epilepsy • Tendency to have recurrent, unprovoked seizures • 2 or more unprovoked seizures separated by 24 hours Questions parents have after seizures • • • • Will it happen again? How long do I have to wait for a recurrence? Could my child die during a recurrence? Could there be brain damage due to recurrence • If medication treatment is delayed will there be change in long-term chance of permanent remission? Recurrence risks • Recurrence rate at 2 years 40-50% • Half the recurrences are within 6 months of initial seizure • 80% of 5 year recurrence risk stabilizes by 2 years out Risk factors for recurrence • Remote symptomatic etiology • Abnormal EEG ( any spikes, generalized spike wave, focal or generalized slowing) • Occurrence of seizure during sleep state (increases chance of recurrence)= lower morbidity than during daytime seizure • Risk of recurrence after 2 seizures is 80% Do you treat a first seizure • Treatment reduces the risk of a second seizure by 50% at 2 years • Immediate treatment DOES NOT reduce risk of long term seizures • Treated and untreated groups have a 64% chance of 5 year remission at 10 years (MESS study) • Risk of toxicity, allergic reaction, cognitive side effects Risks of morbidity/ mortality due to seizures- could my child die?? • • • • • 692 children in Nova Scotia ( Camfield 2002) Followed =20 years 26 deaths 1 from status 1 from SUDEP as an adult at age 22 years Could my child die • • • • • • • • • Dutch study of childhood epilepsy ( Callenbach 2001) 472 children followed for 5 years 9 deaths None from epilepsy Connecticut study ( Berg 2004) 613 children followed for 7.8 years 13 deaths 1=status 1=SUDEP When does immediate treatment matter • When risks of recurrent seizures outweigh benefits of withholding treatment ( adults) • Cyanotic congenital heart disease in a child Seizure first aid • • • • • • • ABCs Stay calm Don’t leave patient alone Lateral position if possible Don’t restrain Nothing in mouth Call 911 Seizure safety • • • • • Maximize quality of life Water safety Safety on roads High structures Medic alert, seizure beds, seizure dogs, baby monitors Seizure precautions • Regular sleep • Alcohol • Infections • Photic stimulation • Substances of abuse Sports participation has not been shown to increase risk of seizures Prehospital treatment of seizures Operational definition of status Most seizures stop 0 Time definition of convulsive status epilepticus Optimum time to start therapy 5 15 30 Medications used for prehospital treatment • Diazepam • Midazolam • Lorazepam Prehospital treatment midazolam Lorazepam • 2mg/ml Intensol • Indicated for anxiety Faves… Moving on to a different discussion now… Ketogenic diet • UIHC= The only center in the state • 30-40 active patients • Dedicated dietician Karla Mracek • Dedicated ARNP Tiffany Rickertsen Historical anecdotes History • Mac Fadden 1899- magazine Physical Culture • Medical profession= Organized fraud • People who follow MacFadden’s rules would live to 120 years • Since much of the body’s energy is wasted in digesting food, if no food is provided, more energy can be applied to recovering health • Dr Conklin-osteopath in Battlecreek , Mi • Used diet in epilepsy Mr MacFadden • Physical culture Historical anecdotes • Conklin’s work( intestinal epilepsy- toxin release from glands= seizures) • Conklin’s fast 18-21 days ( or as long as they could stand it) Historical anecdotes • Dr Geyelin worked at Johns Hopkins= confirmed Conklin's findings • Dr BJ Wilder= fat can be used to break fast= no seizures Charlie foundation Charlie Foundation • Mr Jim Abrahams • Sought help from Johns Hopkins for his son Charlie • Seizure free today after several medications and neurologists Movie Since then… Indications Mechanisms of action Not exactly known • • • • Ketone bodies= antiepilepsy properties PUFAs= membrane stabilization Antioxidative/ antiinflammatory Uncoupling of oxidative phosphorylation( better energy utilization) Types of ketogenic diet • • • • Classic ketogenic diet= 4:1 ratio MCT oil diet ( less restrictive) Modified Atkins diet=15-20 gm carbs/day Low Glycemic index diet=60 gm carbs/day Ketogenic diet Most kids not fat… Results • 50-60% improve • Almost 100% improve – Doose , GLUT1 Contraindicated Fatty acid oxidation defect Thank You !!
