RCS 6080
Medical and Psychosocial
Aspects of Rehabilitation
Counseling
Epilepsy
Epilepsy
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The most common of the chronic neurological disorders –
1:100-200.
Epilepsy is not contagious and people with epilepsy are NOT
“crazy”
Etymology of the word comes from a Greek word meaning
“to possess, seize or hold.”
Historical figures with Epilepsy
 Julius Ceaser
 George Fredrick Handel
 Fyodor Dostoevsky
 Peter the Great
 Napoleon Bonaparte
 Vincent Van Gogh
 Pope Pius IX
Epilepsy
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Diagnosed with the occurrence of two or more
seizures
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A seizure involves the disruption of the normal activity of
the brain through neuronal instability
Seizures prevent the brain from interpreting and
processing incoming sensory signals & controlling muscles.
Sometimes people know when they are about to
have a seizure because they see, hear or feel
something different – this is known as an “aura.”
Auras can act as an early warning for a person that
a seizure is about to happen.
Seizures
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“Provoked”
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Metabolic disorders
 Hypoglycemia
Electolyte imbalance
Withdrawal from massive amounts of alcohol or
sedatives
Massive sleep deprivation
High fever
Hypoxia
Substance abuse
Excessive use of stimulants
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Seizures
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“Unprovoked”
 TBI
 Birth trauma
 Anoxia
 Brain tumors
 Infectious diseases in the mother
 Parasitic infections
 Genetic
 Vascular diseases affecting the brain’s blood vessels
 Neurotransmitter GABA (gamma-amino butyric acid) imbalance
Epilepsy
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1-2% of people with epilepsy will have a
diagnosable genetic etiology for their seizure
occurrence
The general incidence of epilepsy is between 1%
and 4%
Two major type so seizures: Generalized and
Partial
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Generalized – uncontolled discharge of neurons on
BOTH sides of brain. Seizure starts in one area and
spreads across the brain.
Partial – abnormal electrical activity involving only a
small part of the brain - although sometimes a partial
seizure can spread to the whole brain
Generalized Seizures
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Tonic-clonic seizures
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Absence seizures
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Loss of muscle tone – causes person to fall down
Myoclonic seizures
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Non-convulsive. Person may be unaware of surroundings and stare off.
Lasts only 5-30 seconds
Atonic seizures
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“grand mal” – massive discharge of neurons on both cerebral hemispheres.
Body becomes rigid and jerks. “Tonic-clonic” means “stiffness-violent” “grand
mal” means “great sickness”
Involves motor cortex and causes twitching or jerking of certain body parts.
Status epilepticus
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Frequent, long-lasting electrical activity with no regaining of consciousness
between attacks. Very dangerous and requires immediate medical attention.
Partial seizures
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Simple partial seizures
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“Jacksonian” or “focal” seizures.
Short seizures with no loss of consciousness
People may see, hear or smell something odd & their body
may jerk.
Complex partial seizures
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“Psychomotor” seizures
A seizure with a change, but no loss, in consciousness.
People may hear or see things or have a memory
resurface. Déjà vu may occur.
Conditions that may look like a
seizure
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Syncope
“Psychogenic” seizures
Breath-holding spells
Paroxysmal REM sleep behavior
Panic attacks
International classification of
epilepsies
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Originally established in 1989 – currently under
revision
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Current system comprises two major categories:
 Localization-related syndromes
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Idiopathic
Symptomatic
Generalized-onset syndromes
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Idiopathic with age-related onset
Idiopathic &/or symptomatic
Symptomatic
Nonspecific etiology
Specific syndromes
Evaluation of single seizure
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History of event
Medical History
Family History
Social History
Physical Examination
Neurological Examination
Laboratory Evaluation
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EEG
MRI
Routine lab work
Treatment and Prognosis
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Antiepileptic (anticonvulsant) medications
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Carbamazepine (Tegretol)
Clobazam (Frisium)
Clonazepam (Rivotril)
Diazepam (Valium)
Divalproex sodium (Depakote)
Ethosuximide (Zarontin)
Phenobarbital (many different names)
Phenytoin (Dilantin)
Valproic Acid (Depakene)
Surgery
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Temporal Lobe surgery
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Corpus Callostomy
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removal of cortex of temporal lobe where the epileptic
seizure starts. May also remove hippocampus and
amygdala.
the corpus callosum is cut to separate the right and left
cerebral hemispheres. This procedure is done to prevent
the spread of the seizure from one side of the brain to the
next.
Hemispherectomy
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one cerebral hemisphere is removed. Not done very often.
Children CAN function reasonably well, but often find using
their arm on the opposite side of the body to be difficult.
Some surgeries remove just a specific lobe of the brain.
Other treatments
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Vagal nerve stimulation
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Electrical stimulator placed
in the Vagus nerve (cranial
nerve X)
Vagus nerve function:
sensory, motor and
autonomic functions of
viscera (glands, digestion,
heart rate)
Ketogenic diet
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High fat, low
protein/carbohydrate diet
Vocational Implications
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For an individual client, the counselor must
understand the following:
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Specific type of seizure with a clear description of what
happens
What type of seizure control the person has achieved
If the person has a specific warning or aura
What is involved in the recovery period
If the person has ever been injured as a result
If the person has any other disabilities
The type of medication and compliance
Vocational Implications
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Driving – Florida’s Law
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Seizure-free for 6 months and under regular medical
supervision with doctor’s recommendation
No waiver provision for people with epilepsy in regards to a
commercial license
Can drive taxi if meet personal requirements
Not eligible to drive school bus or buses designed to seat
more than 15 people
No provision to require doctors to report to a central state
agency – anyone may report
Additional Resources and
Information from the Web
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Epilepsy Foundation of America
(www.epilepsyfoundation.org)
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Epilepsy Foundation of Northeast Florida
(www.efnef.org)
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Online resource of Epilepsy Project
(www.epilepsy.com)
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JAN’s webpage
(www.jan.wvu.edu/media/Epilepsy.htm)