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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

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seizure recognition seizure types first aid and safety

Seizure recognition, seizure types, First Aid and Safety

Charuta Joshi MBBS, FRCPC

Director of pediatric epilepsy

UIHC

objectives
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 s eizure recognition
What is a seizureSeizure recognition
  • A clinical manifestation of :
  • Abnormal
  • Excessive
  • Paroxysmal
  • Electrical discharge in neurons
seizure recognition
Seizure recognition
  • Stereotyped
  • Repetitive
  • If unsure video tape events
  • Ask pediatrician to see
seizure recognition1
Seizure recognition
  • Spectrum of findings

Generalized seizures

Complex partial seizures

Simple partial seizures

seizure recognition generalized
Seizure recognitionGeneralized
  • Absence
  • Myoclonic
  • Tonic
  • Generalized tonic clonic
first seizure clinic results
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
what is epilepsy
What is epilepsy
  • Tendency to have recurrent, unprovoked seizures
  • 2 or more unprovoked seizures separated by 24 hours
questions parents have after seizures
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 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
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
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
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
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 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
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
Seizure safety
  • Maximize quality of life
  • Water safety
  • Safety on roads
  • High structures
  • Medic alert, seizure beds, seizure dogs, baby monitors
seizure precautions
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
Prehospital treatment of seizures

Operational definition of status

Time definition of convulsive status epilepticus

Most seizures stop

Optimum time to start therapy

0

30

5

15

lorazepam
Lorazepam
  • 2mg/ml Intensol
  • Indicated for anxiety
ketogenic diet
Ketogenic diet
  • UIHC= The only center in the state
  • 30-40 active patients
  • Dedicated dietician

Karla Mracek

  • Dedicated ARNP

Tiffany Rickertsen

historical anecdotes
Historical anecdotes

History

Mr MacFadden

Physical culture

  • 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
historical anecdotes1
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 anecdotes2
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

Charlie Foundation

Movie

  • Mr Jim Abrahams
  • Sought help from Johns Hopkins for his son Charlie
  • Seizure free today after several medications and neurologists
mechanisms of action not exactly known
Mechanisms of actionNot exactly known
  • Ketone bodies= antiepilepsy properties
  • PUFAs= membrane stabilization
  • Antioxidative/ antiinflammatory
  • Uncoupling of oxidative phosphorylation( better energy utilization)
types of ketogenic diet
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 diet1
Ketogenic diet

Most kids not fat…

Results

50-60% improve

Almost 100% improve – Doose , GLUT1

Contraindicated

Fatty acid oxidation defect