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S EIZURE RECOGNITION, SEIZURE TYPES, F IRST A ID AND S AFETY Charuta Joshi MBBS, FRCPC Director of pediatric epilepsy UIHC.

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Presentation on theme: "S EIZURE RECOGNITION, SEIZURE TYPES, F IRST A ID AND S AFETY Charuta Joshi MBBS, FRCPC Director of pediatric epilepsy UIHC."— Presentation transcript:

1 S EIZURE RECOGNITION, SEIZURE TYPES, F IRST A ID AND S AFETY Charuta Joshi MBBS, FRCPC Director of pediatric epilepsy UIHC

2 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

3 What is a seizure Seizure recognition A clinical manifestation of : Abnormal Excessive Paroxysmal Electrical discharge in neurons

4 Seizure recognition Stereotyped Repetitive If unsure video tape events Ask pediatrician to see

5 Seizure recognition Spectrum of findings Generalized seizures Simple partial seizures Complex partial seizures

6 Seizure recognition simple partial seizures Localization

7 Seizure recognition Generalized Absence Myoclonic Tonic Generalized tonic clonic

8 How important is it to be sure about a seizure

9 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

10 Differential diagnosis

11 Investigations after a first unprovoked seizure

12 Investigations

13 Yield of neuroimaging (Shinnar et al 2001)

14 What is epilepsy Tendency to have recurrent, unprovoked seizures 2 or more unprovoked seizures separated by 24 hours

15 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?

16 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

17 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%

18 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

19 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

20 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

21 When does immediate treatment matter When risks of recurrent seizures outweigh benefits of withholding treatment ( adults) Cyanotic congenital heart disease in a child

22 Seizure first aid ABCs Stay calm Don’t leave patient alone Lateral position if possible Don’t restrain Nothing in mouth Call 911

23 Seizure safety Maximize quality of life Water safety Safety on roads High structures Medic alert, seizure beds, seizure dogs, baby monitors

24 Seizure precautions Regular sleep Alcohol Infections Photic stimulation Substances of abuse Sports participation has not been shown to increase risk of seizures

25 Prehospital treatment of seizures Time definition of convulsive status epilepticus Most seizures stop Operational definition of status Optimum time to start therapy

26 Medications used for prehospital treatment Diazepam Midazolam Lorazepam

27 Prehospital treatment

28 midazolam

29 Lorazepam 2mg/ml Intensol Indicated for anxiety

30 Faves…

31 Moving on to a different discussion now…

32 Ketogenic diet UIHC= The only center in the state active patients Dedicated dietician Karla Mracek Dedicated ARNP Tiffany Rickertsen

33 Historical anecdotes History Mac Fadden 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

34 Historical anecdotes Conklin’s work( intestinal epilepsy- toxin release from glands= seizures) Conklin’s fast days ( or as long as they could stand it)

35 Historical anecdotes Dr Geyelin worked at Johns Hopkins= confirmed Conklin's findings Dr BJ Wilder= fat can be used to break fast= no seizures

36 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

37

38 Since then…

39 Indications

40 Mechanisms of action Not exactly known Ketone bodies= antiepilepsy properties PUFAs= membrane stabilization Antioxidative/ antiinflammatory Uncoupling of oxidative phosphorylation( better energy utilization)

41 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

42 Ketogenic diet Most kids not fat…Results 50-60% improve Almost 100% improve – Doose, GLUT1 Contraindicated Fatty acid oxidation defect

43 Thank You !!


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