Seizures & Epilepsy
Beth Blakeley, M.S.
Director of Education
Epilepsy Foundation of Kentuckiana
National Epilepsy Facts:
 Over 3 million Americans have epilepsy.
 Roughly 181,000 new cases of seizures and
epilepsy occur each year.
 50% of people with epilepsy develop seizures by the
age of 25; however, anyone can get epilepsy at any
time.
 Now there are as many people with epilepsy who are
60 or older as children aged 10 or younger.
Kentucky Epilepsy Facts:
 Over 90,000 of Kentucky’s residents have epilepsy.
 This was discovered using the Centers for Disease
Control & Prevention’s (CDC) Behavioral Risk Factor
Surveillance System (BRFSS).
 BRFSS interviewed young – middle age adults via
the telephone.
 Because the very young nor very old were
interviewed, experts at UK and UofL believe this
number is actually closer to 180,000.
It is not getting better soon….
 Studies suggest that traumatic brain injury (TBI) leads to posttraumatic epilepsy (PTE) in approximately 20 – 25% of civilians
with closed head injuries.
 Approximately 1.4 million soldiers were recently deployed to and
are now returning from missions in Afghanistan and Iraq, and
many have sustained TBI’s because of improvised explosive
devices (IEDs).
 Approximately 50% of military head injuries lead to PTE.
 Kentucky is home to two military bases (Forts Knox and
Campbell), therefore epilepsy experts are expecting a wave of
epilepsy diagnoses in the very near future.
Epilepsy & Employment Facts:
 Workers with epilepsy have a job performance record that
compares favorably with the job performance record of
workers who do not have epilepsy.
 Most people with epilepsy do not need accommodations to do
their jobs.
 For those that do need accommodations, most are less than
$500.
What causes epilepsy?
 In about 70% of people with epilepsy, the cause is not
known.
 In the remaining 30%, the most common causes are:
Head trauma
Brain tumor and stroke
Lead poisoning
Infection of brain tissue
Heredity
Prenatal disturbance of brain development
Dispelling Misconceptions about Epilepsy
 Most seizures are NOT medical emergencies.
 Epilepsy is NOT contagious.
 Epilepsy is NOT a form of mental illness, it is a
medical condition.
 People rarely die or have brain damage from a
seizure.
 A person can NOT swallow his/her tongue during a
seizure
Who is at a risk for developing epilepsy?
 Approximately 1% of the general population will develop epilepsy.
 The risk is higher in people with certain medical conditions:
Mental retardation
Cerebral palsy
Alzheimer’s disease
Stroke
Autism
What is a Seizure?
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Your brain cells (neurons) constantly send tiny electrical impulses
(signals) that direct the functions of your body.
All brain functions – including feeling, seeing, thinking and moving in
the brain – depend on these electrical impulses passed between the
neurons.
A seizure occurs when too many neurons in the brain “fire” too
quickly, causing an “electrical storm”.
These uncontrolled electrical impulses can cause a change in
awareness or movement.
Symptoms that may indicate a seizure disorder:
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Periods of blackout or confused memory
Occasional “fainting spells”
Episodes of blank staring in children
Sudden falls for no apparent reason
Episodes of blinking or chewing at inappropriate
times
 A convulsion, with or without fever
 Clusters of swift jerking movements in babies
What is the difference between Epilepsy and
Seizures?
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Seizure – a brief, temporary disturbance in the
electrical activity of the brain
Epilepsy – a disorder characterized by recurring
seizures
A seizure is a symptom of epilepsy
Seizure Facts:
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There are over 20 different types of seizures.
Some seizures cause people to shake, fall or have
convulsions.
Other seizures involve staring, confusion, muscle
spasms, aimless wandering.
Many seizure types do not cause loss of
consciousness.
What can trigger a seizure?
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Missed medication (#1 reason)
Stress/anxiety
Hormonal changes
Dehydration
Lack of sleep/extreme fatigue
Photosensitivity
Drug/alcohol use; drug interactions
Seizure Types
 Generalized seizures
Involve the whole brain and loss of consciousness
• Absence
• Generalized Tonic -Clonic
 Partial seizures
Involve only one part of the brain; may or may not include loss of
consciousness
Symptoms relate to the part of the brain affected
• Simple partial
• Complex partial
Partial Seizures
Type
Duration
Seizures Symptoms
Postictal
Symptoms
Simple
Partial
10-90
seconds
No loss of consciousness
Sudden jerking
Sensory phenomenon
Possible transient
weakness or loss
of sensation
Complex
Partial
1-10
minutes
May have aura
Staring
Automatisms (such as lip
smacking, picking at clothes,
fumbling.)
Unaware of environment
May wander
Amnesia of
seizure events
Mild to moderate
confusion
Sleepy
Each part of the brain is responsible for controlling
various activities
Frontal lobe –
controls decisionmaking,
problem solving
and planning
Parietal lobe –
controls the reception
and processing of
sensory information
from the body
Temporal lobe –
controls memory,
emotion, hearing
and language
Occipital lobe –
controls vision
Possible Affects of Partial Seizures
Parietal lobe –
Frontal lobe –
seizures here
may cause
disruptive
behavior, running,
screaming, fear,
anger, undirected
aggression or
swearing
seizures here can cause
strange physical
sensations, such as a
tingling or warmth down
one side of the body
Temporal lobe –
seizures here
produces illusions
of sounds such as
ringing sounds or
music. Seizures in
this area can also
alter mood or
consciousness
Occipital lobe –
seizures here
create visual
distortions and
images of people
or things that
are not actually
there
First Aid for Complex Partial Seizures
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Stay calm and track the time.
Do not restrain the person.
Remove dangerous objects from the person’s path.
Calmly direct the person to sit down and guide him or her from
dangerous situations.
Use force only in an emergency to protect the person from
immediate harm, such as walking out in front of an oncoming car.
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Observe, but do not approach a person who appears angry or
combative.
Remain with the person until he or she is fully alert.
No first aid is necessary for simple partial seizures.
Generalized Seizures
Type
Myoclonic
Duration
1 – 15 seconds
may occur in clusters
Atonic
1 – 15 seconds
(or Drop Attacks)
may occur in clusters
Absence
(petit mal)
Generalized
Tonic-Clonic
(grand mal)
Seizure Symptoms
Postictal Symptoms
Brief rapid muscle contractions
Usually affects both sides of body
Similar to leg jerks while sleeping
--
Abrupt loss of muscle tone
Head drops
Loss of posture, or sudden collapse
Injuries – head gear
--
2 – 15 seconds
Staring
Eyes fluttering
Automatisms if prolonged
Amnesia for seizure
events
No confusion
Promptly resumes
activity
1 – 10 minutes
Sudden cry
Fall
Rigidity
Convulsions
Amnesia for seizure
events
Confusion
Deep sleep
First Aid for Generalized Tonic-Clonic Seizures
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Stay calm and track the time.
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Do not restrain the person, but help them avoid hazards.
Protect head, remove glasses, loosen tight neckwear.
Move anything hard or sharp out of the way.
Turn person on one side.
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Check for epilepsy or seizure disorder identification.
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Stay until person is fully aware and help re-orient them.
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Call ambulance if seizure lasts longer than 5 minutes, or if it is
unknown whether the person has had prior seizures.
First Aid for Generalized Tonic-Clonic
Seizures on School Bus
• Safely pull over and stop bus
• Place student on his/her side across the seat facing
away from the seat back (or in aisle if necessary)
• Follow standard seizure first aid protocol until
seizure abates and child regains consciousness
• Continue to destination or follow school policy
NEVER
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Put anything in the person’s mouth.
Try to hold down or restrain the person.
Attempt to give oral antiseizure medication.
Keep the person on their back face up throughout
convulsion.
When to call an ambulance
 A convulsive seizure occurs in a person not known to
have seizures or lasts more than 5 minutes.
 A complex partial seizure lasts more than 5 minutes
BEYOND its usual duration for the individual.
 Another seizure begins before the person regains
consciousness.
 Also call if the person:
Is injured or pregnant
Has diabetes/other medical condition
Recovers slowly
Does not resume normal breathing
Treatment Goals
 Help person with epilepsy lead full and
productive life.
 Eliminate seizures without producing side
effects.
Treatment Options
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Medication
Surgery
Nonpharmacologic treatment
Vagus nerve stimulation (VNS)
Ketogenic diet
Lifestyle modifications
Factors that Determine Response
to Medication
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Consistent use
Inadequate dosage or
ineffective medication
Drug factors
Disease
Seizures
markedly
reduced
(30%)
Seizures
do not
respond
(20%)
Seizures
eliminated
(50%)
Surgery
Factors influencing decision:
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Likelihood seizures are due to
epilepsy
Likelihood surgery will help
Ability to identify focus of seizures
Other treatments attempted
Benefits vs risks
Vagus Nerve Stimulation
(VNS)
Used to treat partial seizures when medication does not work.
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Vagus nerve serves many organs and structures, including:
Larynx (voice box)
Lungs
Heart
Gastrointestinal tract
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Vagus nerve has connections to areas of the brain that are
instrumental in producing seizures.
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Pacemaker-like device is implanted in the left side of the
chest with electrodes wrapped around the vagus nerve.
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Controls seizures by delivering electrical stimulation at
pre-set time intervals to the left vagus nerve in the neck,
which relays impulses to widespread areas of the brain.
How does VNS work?
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The electrical stimulation produced by the VNS device can
significantly decrease the brain’s ability to generate seizure
activity in most patients.
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VNS therapy does not eliminate the occurrence of seizures
in most cases.
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However, the VNS device can stop or decrease the time and
severity of seizures when activated right before or during a
seizure.
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Most patients will continue to take their anti-seizure
medications.
Stimulating the Vagus Nerve to
Stop a Seizure
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If a person has a seizure warning sign (aura), he/she or a
trained observer may swipe the magnet over the VNS device
to activate it and help abort the seizure.
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The magnet may be swiped during an actual seizure to
shorten the length of the seizure.
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Once activated, the device will send an additional electrical
impulse to the vagus nerve.
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The magnet may be swiped over the VNS device as often as
needed with at least one minute between swipes.
VNS magnets are usually worn on a belt or on the wrist.
Ketogenic Diet
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Based on finding that starvation – which burns fat for
energy – has an antiepileptic affect.
Used primarily to treat severe childhood epilepsy, has been
effective in some adults and adolescents.
High fat, low carbohydrate and protein intake.
Usually started in the hospital.
Requires a strong family commitment.
Beth Blakeley, M.S.
Director of Education
502-637-4440 x14
bblakeley@efky.org
Phone: 502-637-4440
Toll Free: 1-866-275-1078
Website: www.efky.org