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EMSWorld EXPO November 13, 2014 – Nashville Aldith Steer, M.A., Program Manager, Epilepsy Foundation Gary McLean, RN, Paramedic – Sandy, OR Funded by CDC.

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Presentation on theme: "EMSWorld EXPO November 13, 2014 – Nashville Aldith Steer, M.A., Program Manager, Epilepsy Foundation Gary McLean, RN, Paramedic – Sandy, OR Funded by CDC."— Presentation transcript:

1 EMSWorld EXPO November 13, 2014 – Nashville Aldith Steer, M.A., Program Manager, Epilepsy Foundation Gary McLean, RN, Paramedic – Sandy, OR Funded by CDC grant #1U58DP Seizures and the EMS Response: “Treating the Cause”

2 EMS World Expo ‘Print’ Presentation To reduce the size and for ease of printing and ing, many of the photos, video clips and logos used during the presentation have been removed from this print version. A URL address for each video clip (unedited) has been provided in exchange for the actual video. Many of the photos have also been removed and may be found online through various sources. To reduce the size and for ease of printing and ing, many of the photos, video clips and logos used during the presentation have been removed from this print version. A URL address for each video clip (unedited) has been provided in exchange for the actual video. Many of the photos have also been removed and may be found online through various sources. Videos, Photos and Drawings All found online, not used for profit, and we thank the creators for their availability and use for this educational purposes. Epilepsy Foundation Logo

3 Informational Resources Epilepsy Foundation Epilepsy Therapy Project Robert Fisher, MD, PhD Epilepsy.ComEpilepsyProject.Com The American Epilepsy Society National Institutes of Health Epilepsy Foundation Logo

4 Why this topic? Why this topic?

5 EMS responders unsure regarding what they were seeing, how to treat, and when transport necessary

6 Topic Objectives Topic Objectives - A&P Basics: What are you actually witnessing - Treatment: When and How - Transport: Is it always necessary? - New approaches: Treatments you may see - Quality of Life: The personal impact of Epilepsy

7 It involves the Cerebral Cortex, Neurons, Action Potentials and Neurotransmitters What is going on inside the skull? Add video, photo or drawing to help student cognitively understand above listed items.

8 Cerebral Cortex: What is going on inside the skull?

9 Neuron (Dendrites, Nucleus, Axon & Synaptic Terminals):

10 What is going on inside the skull? Neuron (Dendrites, Nucleus, Axon & Synaptic Terminals):

11 What is going on inside the skull? Action Potentials: Neurons send messages, called nerve impulses or action potentials, around the body, one neuron to another.

12 What is going on inside the skull? Action Potentials: Sodium, Potassium and Calcium shifts

13 What is going on inside the skull? Action Potentials: Sodium, Potassium and Calcium shifts

14 What is going on inside the skull? Neurotransmitters: Sound See the YouTube Video at: The Brain—Lesson 2—How Neurotransmission Works - - By: The Professor Ted https://www.youtube.com/watch?v=p5zF gT4aofA

15 What is going on inside the skull? Neurotransmitters: DopamineAdenosine Epinephrine Norepinephrine Oxytocin Histamine Serotonin Acetylcholine …… over 150 known

16 GLUTAMATE and GABA (gamma-aminobutyric acid): the brain's major "workhorse" neurotransmitters that regulate action potential traffic. GABA = inhibitory = stops / slows action potentials. GLUTAMATE = excitatory = starts action potentials or keeps them going. Both work together to control many processes, including the brain's overall level of excitation. What is going on inside the skull?

17 Maintaining a Balance Add video, photo or drawing showing how GABA and Glutamate are affected by caffeine, alcohol, PCP, etc.

18 An unpredictable, uncontrolled, abnormal and excessive synchronization imbalance of the excitatory and inhibitory forces within the CNS network of cortical neurons in the cerebral cortex. So then, what is a SEIZURE? Add video, photo or drawing showing how GABA and Glutamate are affected by caffeine, alcohol, PCP, etc.

19 Imbalance Causes  Fever: especially in infants or from heatstroke  Infection: Meningitis  Drug ingestion/withdrawal: including alcohol and poisoning  Acute neurological insult:  Acute neurological insult: stroke, trauma  Brain tumor, degenerative diseases: Alzheimer's

20  Pregnancy: Complication  Metabolic disturbances: Hypoxia, Hypoglycemia, Hypocalcemia, Hyponatremia, Thyrotoxicosis  Congenital conditions: Down syndrome; Angelman's syndrome; tuberous sclerosis and neurofibromatosis  Unknown… Imbalance Causes

21 Seizure Threshold: We all have one! Add video, photo or drawing showing how certain substances can lower a person ’ s seizure threshold.

22 Increased permeability of neuronal cell membranes = increase in neuronal cell excitability. What’s the Common Denominator? Neurons discharge action potentials irregularly without adequate suppression and attenuation of the abnormal activity...

23 … leading to a temporary change in the electrical functioning of the brain. What’s the Common Denominator?

24 General Treatment Hypoxia = Open airway, Ventilate, Oxygen Fever = Lower temperature, Treat the cause Metabolic = Fix it (Hypoglycemia = Glucose) Eclampsia = Magnesium, Give Birth Structural = Surgery, Decrease pressure Epilepsy = Several Ways Treat the Cause!

25 ... If that’s a Seizure... Convulsion? …what is a Convulsion? The visual - clinical manifestation of a seizure. It’s what you see the person doing. Our “Objective” (SOAP)

26 General Treatment Treat the Cause......NOT the convulsions! CauseSeizureConvulsion

27 Epilepsy Epilepsy Foundation Logo

28 - Epilepsy - Chronic, recurrent Chronic, recurrent seizures not otherwise provoked by an acute injury or health emergency. (1)At least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome.

29 Epilepsydisorder Epilepsy is a disorder Seizuressymptoms Seizures are symptoms Seizure Disorder Epilepsy - aka ‘Seizure Disorder’ - Epilepsy -

30 Epidemiology of Epilepsy Most common functional neurological disorder in the world Most common functional neurological disorder in the world An estimated 3 million in U.S. suffer from epilepsy- related seizures An estimated 3 million in U.S. suffer from epilepsy- related seizures About 200,000 new cases occur each year About 200,000 new cases occur each year 10% of population will experience a seizure 10% of population will experience a seizure 3% will develop epilepsy by 75 3% will develop epilepsy by 75 ~$17.6 billion in healthcare costs ~$17.6 billion in healthcare costs

31 What Causes Epilepsy? 30% - Most common causes are: - Head trauma - Infection of brain tissue - Brain tumor and stroke - Heredity - Prenatal disturbance of brain development 70% - Cause is not known (idiopathic)

32 Breakdown by Age: Children: Children: birth traumas, infections, such as meningitis, congenital abnormalities or high fevers Epidemiology of Epilepsy Middle years Traumatic Brain Injury (Veterans) Middle years: infections, alcohol, stimulant drugs or medication side effects, Traumatic Brain Injury (Veterans) Elderly: Elderly: brain tumors and strokes cause a higher proportion of seizures

33 Epilepsy may also occur with:  Cerebral palsy  Cognitive impairments  ADD/ADHD  Developmental disabilities  Autism  Traumatic Brain Injury

34 Epileptics may also have seizures triggered by:  Failure to take medication correctly  Brand to generic switching  Sleep deprivation/fatigue  Stress/illness  Stress/ illness  Hypoglycemia/dehydration

35 What if there is no cause or acute insult? General Treatment Treat the Cause! ? Slow the Action Potential!

36 Sodium Channel Blockers General Treatment

37 Sodium Channel Blockers Calcium Current Inhibitors General Treatment

38 Sodium Channel Blockers Calcium Current Inhibitors GABA Enhancers and/or Glutamate Blockers General Treatment

39 Sodium Channel Blockers Calcium Current Inhibitors GABA Enhancers and/or Glutamate Blockers Other drugs with unknown mechanisms of action General Treatment

40 PhenobarbitolPhenobarbitol Dilantin (phenytoin)Dilantin (phenytoin) Depakote (Valproic acid)Depakote (Valproic acid) Gabatril (tiagabine)Gabatril (tiagabine) Keppra (levetiracetam)Keppra (levetiracetam) Lamictal (lamotrigine)Lamictal (lamotrigine) Topamax (topiramate)Topamax (topiramate) Neurontin (gabapentin)Neurontin (gabapentin) Tegretol (carbamezepine)Tegretol (carbamezepine) Trileptal (oxcarbazepine)Trileptal (oxcarbazepine) Felbatol (felbamate)Felbatol (felbamate) Zonegran (zonisamide)Zonegran (zonisamide) Lyrica (pregabalin)Lyrica (pregabalin) Anti-Epileptic Drugs (AEDs)

41 Phenobarbitol Phenobarbitol Increases GABA, Decreases Glutamate Dilantin (phenytoin)Dilantin (phenytoin) Depakote (Valproic acid)Depakote (Valproic acid) Gabatril (tiagabine)Gabatril (tiagabine) Keppra (levetiracetam)Keppra (levetiracetam) Lamictal (lamotrigine)Lamictal (lamotrigine) Topamax (topiramate)Topamax (topiramate) Neurontin (gabapentin)Neurontin (gabapentin) Tegretol (carbamezepine)Tegretol (carbamezepine) Trileptal (oxcarbazepine)Trileptal (oxcarbazepine) Felbatol (felbamate)Felbatol (felbamate) Zonegran (zonisamide)Zonegran (zonisamide) Lyrica (pregabalin)Lyrica (pregabalin) Anti-Epileptic Drugs (AEDs)

42 PhenobarbitolPhenobarbitol Dilantin (phenytoin) Sodium ChannelsDilantin (phenytoin) Sodium Channels Depakote (Valproic acid)Depakote (Valproic acid) Gabatril (tiagabine)Gabatril (tiagabine) Keppra (levetiracetam)Keppra (levetiracetam) Lamictal (lamotrigine)Lamictal (lamotrigine) Topamax (topiramate)Topamax (topiramate) Neurontin (gabapentin)Neurontin (gabapentin) Tegretol (carbamezepine)Tegretol (carbamezepine) Trileptal (oxcarbazepine)Trileptal (oxcarbazepine) Felbatol (felbamate)Felbatol (felbamate) Zonegran (zonisamide)Zonegran (zonisamide) Lyrica (pregabalin)Lyrica (pregabalin) Anti-Epileptic Drugs (AEDs)

43 PhenobarbitolPhenobarbitol Dilantin (phenytoin)Dilantin (phenytoin) Depakote (Valproic acid) -Depakote (Valproic acid) - Gabatril (tiagabine)Gabatril (tiagabine) Keppra (levetiracetam)Keppra (levetiracetam) Lamictal (lamotrigine)Lamictal (lamotrigine) Topamax (topiramate)Topamax (topiramate) calcium current inhibitor Tegretol (carbamezepine)Tegretol (carbamezepine) Trileptal (oxcarbazepine)Trileptal (oxcarbazepine) Felbatol (felbamate)Felbatol (felbamate) Zonegran (zonisamide)Zonegran (zonisamide) Lyrica (pregabalin)Lyrica (pregabalin) Anti-Epileptic Drugs (AEDs)

44 PhenobarbitolPhenobarbitol Dilantin (phenytoin)Dilantin (phenytoin) Depakote (Valproic acid)Depakote (Valproic acid) Gabatril (tiagabine)Gabatril (tiagabine) Keppra (levetiracetam)Keppra (levetiracetam) Lamictal (lamotrigine)Lamictal (lamotrigine) Topamax (topiramate)Topamax (topiramate) Neurontin (gabapentin)Neurontin (gabapentin) Tegretol (carbamezepine)Tegretol (carbamezepine) Trileptal (oxcarbazepine)Trileptal (oxcarbazepine) Felbatol (felbamate)Felbatol (felbamate) Zonegran (zonisamide)Zonegran (zonisamide) Lyrica (pregabalin)Lyrica (pregabalin) Anti-Epileptic Drugs (AEDs)

45 PhenobarbitolPhenobarbitol Dilantin (phenytoin)Dilantin (phenytoin) Depakote (Valproic acid)Depakote (Valproic acid) Gabatril (tiagabine)Gabatril (tiagabine) Keppra (levetiracetam)Keppra (levetiracetam) Lamictal (lamotrigine)Lamictal (lamotrigine) Topamax (topiramate)Topamax (topiramate) migraine headaches, diabetic neuropathy, migraine headaches, diabetic neuropathy, and bipolar disorders. and bipolar disorders. Neurontin (gabapentin)Neurontin (gabapentin) pain following "shingles" (postherpetic neuralgia) and restless leg syndrome. T rileptal (oxcarbazepine)T rileptal (oxcarbazepine) Felbatol (felbamate)Felbatol (felbamate) Zonegran (zonisamide)Zonegran (zonisamide) Lyrica (pregabalin)Lyrica (pregabalin) Anti-Epileptic Drugs (AEDs) Other Uses

46 Ictus, event, spell, attack, and fit are all used to refer to? What’s in a name? Convulsion or Seizure

47 What’s in a name? Ictus: A sudden attack, blow, stroke, or seizure. Ictal: Of or relating to a seizure or convulsion Ictus: A sudden attack, blow, stroke, or seizure. Ictal: Of or relating to a seizure or convulsion Ictus: A sudden attack, blow, stroke, or seizure. Ictal: Of or relating to a seizure or convulsion

48 Pre-ictal Ictus Post-ictal Ictus: A sudden attack, blow, stroke, or seizure. Ictal: Of or relating to a seizure or convulsion What’s in a name? Add video, photo or drawing to help student cognitively understand above listed words.

49 Generalized Partial Seizure Classification Full Brain Half Brain

50 Generalized Seizure ( consciousness is lost ) Partial Seizure (consciousness is not lost) Seizure Classification Add video, photo or drawing showing half brain.

51 Partial Seizure (consciousness is not lost) Simple Partial - Awareness is not altered Complex Partial - Awareness is altered Seizure Classification

52 Partial Seizures: (No Loss of Consciousness) Simple and Complex Add video, photo or drawing showing half brain.

53 Simple Partial (Awareness NOT impaired)

54 Different parts have different functions, and different seizures!

55  Seizure activity in the brain causing: Rhythmic movements - isolated twitching of arms, face, legs Sensory symptoms – tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions Psychic symptoms - déjà vu, hallucinations, feelings of fear or anxiety  Usually last less than one minute  May precede a generalized seizure Simple Partial Seizure:

56 Simple Partial See the YouTube video at: https://www.youtube.com/watch?v=rtjPs_B99Bo&list=PLA14AEA342DA6F8C4

57 Simple Partial

58 Pre-hospital Treatment - Simple Partial Seizure (SPS) Usually no medical treatment necessary  If confused, assess per altered mental status protocols. Consult OLMC, activate ALS and/or rapidly transport to receiving facility if confusion or loss of consciousness occurs.

59 Complex Partial (Awareness IS impaired)  Altered awareness, Blank staring  Confusion, inability to respond  Emotional outbursts

60 Complex Partial Seizure (CPS) -  Automatisms: purposeless behaviors such as picking at clothes, disrobing, chewing or mumbling  Altered awareness, Blank staring  Confusion, inability to respond  Emotional outbursts May be confused with drunkenness or drug use, willful belligerence, non-responsive

61 Complex Partial See the YouTube Video at: https://www.youtube.com/watch?v=E0o1ktu-9C4

62 Complex Partial Sound See the YouTube video at: https://www.youtube.com/watch?v=wvG5wY0LgJg

63 (Clues to help differentiate between CPS and other causes)  Look for sudden loss of awareness, mumbling, automatisms and/or wandering.  Look for medical or identifying information. Pre-hospital Treatment - Complex Partial Seizure (CPS)

64   Usually no medical treatment required.  Approach cautiously, speak calmly  Contain – don’t restrain  Avoid triggering violent behavior by minimizing physical contact. Pre-hospital Treatment - Complex Partial Seizure (CPS)

65 Question witnesses:  Description of seizure event  Any known history of seizures?  If possible, obtain medical history, ID and emergency contact information After a first-time seizure, medical evaluation is necessary to identify and treat the cause

66 Post-CPS phase:  Monitor recovery, check blood glucose  Re-orient to surroundings  Evaluate for injury  More in-depth history as appropriate If confusion persists or loss of consciousness occurs and lasts more than 5 minutes, consult OLMC, activate ALS and/or rapidly transport to ED.

67 Generalized Seizures Add video, photo or drawing showing full brain.

68 Generalized Seizures In a generalized seizure the electrical disruption involves the entire brain Consciousness is Consciousness is always lost! always lost! Add video, photo or drawing showing how full brain.

69 Absence (“Petit mal”, non-convulsive transient) (Mal = illness; disease) Atonic (without muscle tone, aka “Drop” seizure) Myoclonic (Muscle + Rapid contraction) Tonic (Prolonged muscle tone, contraction) Tonic - Clonic (“Grand mal” – Contraction + Relaxation) Generalized Seizure Types

70 Absence Seizure Sound See the YouTube Video at: https://www.youtube.com/watch?v=UACyepoANVA

71 Atonic Seizure See the YouTube Video at: https://www.youtube.com/watch?v=9obFVWW47NE

72 Myoclonic Seizure See the YouTube Video at: https://www.youtube.com/watch?v=VC6HJPZr1VU

73 Tonic Seizure See the YouTube Video at: https://www.youtube.com/watch?v=2m0qkKSpq9k

74 Generalized Tonic-Clonic Seizure (GTC)

75 A GTC seizure may appear as: A sudden “cry,” and fall, followed by:  Loss of consciousness, fall and stiffening of limbs, followed by rhythmic shaking and convulsive movements of all limbs.  Shallow/interrupted breathing or breathing may stop temporarily - skin, nails, lips may turn cyanotic.  An eTCO2 monitor may show: monitor may show:

76 A GTC seizure may appear as:  Convulsive movements generally last 1 to 3 minutes, followed by confusion, sleepiness  Slow return to consciousness, post-ictal confusion and/or fatigue  Loss of bladder/bowel control may occur. May bite their tongue.

77 GTC Seizure Sound See the YouTube Video at: https://www.youtube.com/watch?v=0VEdCXZ10Ms

78 DO NOT - Restrain person DO NOT - Put anything in the person’s mouth DO NOT - Try to hold down or restrain the person DO NOT - Give oral anti-seizure medication Generalized Seizure Treatments DO NOT...

79  Assure scene safety - Protect head and limbs from injury Generalized Seizure Treatments DO...  If trauma is not suspected, place patient in recovery position - Maintain Airway  Medical treatment usually NOT required Follow the C-A-B protocol: Monitor cardio-respiratory status Maintain airway – suction PRN Administer O 2 Add photo of Recovery Position

80  First time GTC seizure  Traumatic injury  Possible aspiration (seizure in water)  Elderly, pregnant or diabetic patient Check blood glucose  Seizure lasting longer than 5 minutes, or occurring in a series when present activate ALS and/or rapidly transport to receiving facility Generalized Seizure Treatments

81 Question witnesses:  Description of seizure event  Identifying information for patient, emergency contacts  Prior history of seizures or other medical problems

82 After the seizure stops: The Post-ictal Phase See the YouTube video at: https://www.youtube.com/watch?v=Uyx65dqm33M

83 After the seizure stops:  Continue to monitor cardio-respiratory status  Evaluate for injury  Assess for return of consciousness/re-orient  Obtain pertinent medical history and emergency contact information if possible If consciousness does not return, or confusion persists more than 5 minutes post-seizure, activate ALS and/or rapidly transport to receiving facility

84 After the seizure stops: Understand the embarrassment that many individuals feel after a seizure. –Confused, partial loss of memory –Incontinent –Very tired –Painful, bitten tongue –Musculoskeletal pains

85 ALS response to a seizure lasting longer than 5 minutes: Status Epilepticus! MUST It MUST be STOPPED!

86 Status Epilepticus (SE) 1) Continuous seizure lasting 30 minutes, or 2) Two or more discrete seizures between which the patient does not recover consciousness. Sustained by excess excitation and reduced inhibition. Too much Glutamate or too little GABA! SE may be used to describe a continuing seizure of any type.

87 Why stop it? The sooner you stop SE, the easier it is to stop it. After 30 minutes: pathologic changes seen. After 60 minutes: neurons start to die. Tachycardia, cardiac arrhythmias, hyperglycemia: Thought to result from the catecholamine surge that accompanies the seizures. Body temperature increases: correlated with poor neurologic outcomes. Status Epilepticus

88 Why stop it? Marked acidosis: Both respiratory and metabolic, resolves with termination of the seizure. Not normally treated. Pulmonary edema: Fluid accumulation in the lungs from an increase in pulmonary capillary hydrostatic pressure can cause a neurogenic pulmonary edema.. Increased cerebral metabolic demand: Cerebral blood flow and oxygenation are thought to be preserved or even elevated in the course. Status Epilepticus

89 TREATMENT: HOW DO WE STOP IT? 1. Need chemical that slows the Action Potential: Either increase GABA or decrease GLUTAMATE 2. Chemical must rapidly cross the Blood-Brain Barrier 3. Side-effects must be manageable Status Epilepticus

90 TREATMENT: Benzodiazepines! Results in anticonvulsant, sedative, anti-anxiety, muscle relaxant and amnesic action. Enhance the action of GABA! Status Epilepticus

91  For seizures lasting longer than 5 minutes, administer: Diastat (Diazepam) Rectal Gel ($300/10mg tube!) Diazepam (Valium) – IV Lorazepam (Ativan) – IV, IM Midazolam (Versed) – IV, IM, IN, Buccal  Support ventilation PRN  Oxygen per nasal cannula Transport for further evaluation/treatment General Treatment of SE

92 IM versus IV? “RAMPART STUDY” (Feb. 16, The New England Journal of Medicine) Pre-hospital Double-blind Randomized Clinical Trial of the Efficacy of IM Midazolam vs. IV Lorazepam % of IM group seizure-free upon hospital arrival. 63% of IV group seizure-free upon hospital arrival. Patients received IM 3.6 minutes faster than IV Both groups had similarly low rates of recurrent seizures.

93 Can your patient be in Status Epilepticus and NOT exhibit convulsive activity? YES!

94 Non-convulsive Status Epilepticus (NCSE) A mental status change from base line of at least 30 to 60 minutes duration associated with continuous or near continuous ictal discharges on EEG. May present as absence, complex partial, or electrographic SE.

95 Non-convulsive Status Epilepticus (NCSE) If no improvement in LOC and awareness after 5 minutes of being post-ictal, consult with OLMC for possible administration of a benzodiazapine and/or transport to ED.

96 Looks like an seizure, but not caused by abnormal electrical discharges. Stress-related or “emotional.” Most common condition misdiagnosed as epilepsy. Psychogenic Non-Epileptic Seizures (PNES) AKA Non-Epileptic Attack Disorder (NEAD) AKA Pseudoseizures

97 Psychogenic Non-Epileptic Seizures (PNES) See the YouTube Video at: https://www.youtube.com/watch?v=6f69Zz19Mg8

98 Additional TREATMENT Options

99 Ketogenic Diet High fat Diet: low carbohydrate and protein intake Starvation - burning fat has antiepileptic effect. Each meal has about four Each meal has about four times as much fat as times as much fat as protein or carbohydrate. protein or carbohydrate. Each meal must be customized for each person.

100  Implanted device, sends regular, mild electrical pulses to the brain via the vagus nerve  May be activated by an external magnet an external magnet  Functioning may be affected by the use of a Taser type device. Vagus Nerve Stimulator (VNS)

101 Surgical treatment/Ablation (Surgical, Laser and ‘Gamma Knife’) Factors influencing decision:  Ability to identify focus of the seizures of the seizures  Area of brain involved can be safely removed – can be safely removed – without resulting in a without resulting in a significant deficit significant deficit  Other treatments unsuccessful

102 Experimental Treatment – Deep Brain Stimulator (DBS) Responsive Neurostimulator (RNS)

103 IS TRANSPORT ALWAYS NECESSARY?

104  First time seizure  Traumatic injury  Possible aspiration (seizure in water)  Elderly, pregnant or diabetic patient (Check blood glucose)  Seizure lasting longer than 5 minutes, or occurring in a series when present activate ALS and/or rapidly transport to receiving facility Always necessary if:

105 Legal age Alert and oriented (Person, Place, Time, Event, Understands risks of refusing transport) History of seizures Under a physician’s care Currently taking anti-seizure medications as prescribed, Usual frequency of seizure activity. Do they have a plan? (If not transported, document per agency standards.) Might be unnecessary if:

106 Patient’s Legal Rights Always consider a ‘seizure’ as a possible cause of altered mental status. Don’t provoke the patient Don’t restrain the patient Don’t be in a hurry to transport due to ‘system’ issues. Contact OLMC if there is a question. Always err on the side of caution

107 Common Q&A

108 Can brushing your teeth, reading, looking at a dress with a plaid pattern, sunshine shimmering off water or flickering through trees trigger a seizure? Yes. It’s called “Reflex Seizure”

109 Can menses influence seizure activity? YES Catamenial Epilepsy Frequency and severity exacerbated by menstrual hormonal changes.

110 Sudden, unexpected, non-traumatic, non-drowning death in an individual with epilepsy, witnessed or unwitnessed, in which postmortem examination does not reveal an anatomic or toxicologic cause for the death. SUDEP Can people die from epilepsy?

111 Clarifying the Misperceptions, Misunderstandings and Misinterpretations around epilepsy Increasing Knowledge and Understanding - Reducing Stigma - Aldith Steer, MA Program Manager, Multicultural Affairs Epilepsy Foundation, Landover, MD (301)

112 More common than you think… 1 in 26 people in the United States will develop epilepsy at some point in their lifetime. For about 60% of people with epilepsy, the cause is unknown. Approximately one third of people with epilepsy live with uncontrollable seizures because no available treatment works for them. More than 2.1 million adolescents nationwide are impacted by major depressive episodes.

113 Epilepsy is not a true medical illness like heart disease and diabetes. Epilepsy is a product of witchcraft. Epilepsy is contagious. People with epilepsy are usually dangerous and violent. Epilepsy results from a personality weakness or character flaw. Misperceptions, Misunderstandings & Misinterpretations

114 People could just snap out of it if they tried hard enough. People with epilepsy shouldn't be in jobs of responsibility and stress. Epilepsy is rare and there aren't many people who have it. People with epilepsy are physically limited in what they can do. With today's medication, epilepsy is largely a solved problem. Misperceptions, Misunderstandings & Misinterpretations

115 … a “collection of negative attitudes, beliefs, thoughts, and behaviors that influence the individual, or the general public, to fear, reject, avoid and discriminate against others. ” STIGMA… Stigma manifests in and through social interactions with others. Attitudes, beliefs and stigma about epilepsy develop during childhood and adolescence.

116 Self, children, adolescents, women, elderly, family members Education, employment, social relationships, sexual relationships Impact on the Quality of Life for people living with epilepsy

117 Effective Stigma Reduction STARTS EARLY! The youth and young adult years are an opportune time to encourage positive attitudes, reduce stigma and reduce the burden of illness across the life span. Reducing stigma among all youth and young adults reforms the culture, within social networks, that embraces discussion about epilepsy, and is inclusive of young people living with epilepsy.

118 1. Emphasize being a “real” person comes first – epilepsy and/or a mental health need second. 2. Use personal stories to broaden others’ ideas about people with epilepsy and/or mental health needs. 3. Emphasize the link between treatment and positive outcomes. Promote inclusion so people with epilepsy can live, learn, work, play, thrive and participate fully. Effective Stigma Reduction STARTS EARLY!

119 How Can EMS Personnel Help? Be an informed and empathic listener Encourage compliance Provide information to individual, family members and community… and to your co-workers !

120 EMS Responder Resources: 1. Link with your local affiliate! 1. Link with your local affiliate! Free ( CECBEMS approved ) online EMS education - Free ( CECBEMS approved ) online EMS education - Training programs for EMS - Training programs for EMS - Training programs for law enforcement - Training programs for law enforcement

121 EMSWorld EXPO November 13, 2014 – Nashville Aldith Steer, M.A., Program Manager, Epilepsy Foundation Gary McLean, RN, Paramedic – Sandy, OR Funded by CDC grant #1U58DP Seizures and the EMS Response: “Treating the Cause”


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