rcs 6080 medical and psychosocial aspects of rehabilitation counseling epilepsy
TRANSCRIPT
RCS 6080 Medical and Psychosocial
Aspects of Rehabilitation Counseling
Epilepsy
Epilepsy
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
Diagnosed with the occurrence of two or more seizures 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
“Provoked” 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
Seizures
“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
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 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 Tonic-clonic seizures
“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”
Absence seizures Non-convulsive. Person may be unaware of surroundings and stare off.
Lasts only 5-30 seconds Atonic seizures
Loss of muscle tone – causes person to fall down Myoclonic seizures
Involves motor cortex and causes twitching or jerking of certain body parts. Status epilepticus
Frequent, long-lasting electrical activity with no regaining of consciousness between attacks. Very dangerous and requires immediate medical attention.
Partial seizures
Simple partial seizures “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 “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
Syncope “Psychogenic” seizures Breath-holding spells Paroxysmal REM sleep behavior Panic attacks
International classification of epilepsies
Originally established in 1989 – currently under revision Current system comprises two major categories:
Localization-related syndromes Idiopathic Symptomatic
Generalized-onset syndromes Idiopathic with age-related onset Idiopathic &/or symptomatic Symptomatic Nonspecific etiology Specific syndromes
Evaluation of single seizure History of event Medical History Family History Social History Physical Examination Neurological Examination Laboratory Evaluation
EEG MRI Routine lab work
Treatment and Prognosis
Antiepileptic (anticonvulsant) medications Carbamazepine (Tegretol) Clobazam (Frisium) Clonazepam (Rivotril) Diazepam (Valium) Divalproex sodium (Depakote) Ethosuximide (Zarontin) Phenobarbital (many different names) Phenytoin (Dilantin) Valproic Acid (Depakene)
Surgery
Temporal Lobe surgery removal of cortex of temporal lobe where the epileptic
seizure starts. May also remove hippocampus and amygdala.
Corpus Callostomy 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 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 Vagal nerve stimulation
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 High fat, low
protein/carbohydrate diet
Vocational Implications
For an individual client, the counselor must understand the following: 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
Driving – Florida’s Law 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
Epilepsy Foundation of America (www.epilepsyfoundation.org)
Epilepsy Foundation of Northeast Florida (www.efnef.org)
Online resource of Epilepsy Project(www.epilepsy.com)
JAN’s webpage (www.jan.wvu.edu/media/Epilepsy.htm)