ap1 presentation - epilepsy
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- 1. Epilepsy
- 2. What is Epilepsy? Epilepsy, commonly known as a seizure disorder, is a neurological condition which affects the nervous system. An individual who has two unprovoked seizures in a ten year period is considered to have epilepsy. A seizure is a caused by a disruption of normal communication between neurons in the brain. This disruption can cause changes in awareness, behavior, and/or abnormal movement. Epilepsy can be inherited genetically, as well as result from a traumatic brain injury. However, most cases are considered idiopathic and a cause cannot be determined. Over 2 million people in the United State have epilepsy and 1 in 26 people in the US will develop epilepsy at some point in their lifetime. One-third of people with epilepsy live with uncontrolled seizures because all available treatments fail.
- 3. Physiology of a Seizure A neuron or nucleus in the brain becomes hyperexcitable (loses inhibition) Depolarization is sustained An influx of extracellular Ca2+ signals the opening of voltage- gated Na+ channels Repetitive action potentials are generated Action potentials are discharged irregularly and without control
- 4. Types of Seizures Common to Epilepsy Primary generalized seizures Occur in both sides of the brain Partial seizures Occur in one localized portion of the brain Simple - interruption of one main brain function or motor skill Complex - able to travel throughout the brain, affecting multiple brain functions Absence seizures A lapse in the brain - a person may appear dazed or repeat a movement such as blinking or chewing Tonic seizures Cause a sudden and dramatic stiffening of the muscles Clonic seizures Cause a sudden and dramatic jerking of the muscles Tonic Clonic seizures (Grand Mal seizures) Combined symptoms of tonic and clonic seizures Long recovery period and can be dangerous if they go on too long due to the stress they inflict on the body Psychosomatic seizures Seizure-like activity becomes the body's default reaction to stress
- 5. Potential Symptoms of a Seizure Loss of awareness Loss of consciousness Feelings of distraction, confusion or memory lapse Inability to speak or confused speech Dilated pupils Hyperactivity or lack of activity in the eye and eyelids Increased flexion or relaxation of muscles Involuntary tremors or automatisms Convulsions No two seizures are identical and symptoms can manifest very differently from one person to the next. Some people show almost no symptoms at all while others are completely debilitated with every seizure.
- 6. Common Causes of Epilepsy Genetic inheritance Influencing genes are currently unknown Change in brain structure Reason for change often unknown Autism spectrum A specific connection between epilepsy and autism is unknown but suspected Brain infections Head injuries Stroke Brain tumor In approximately 60% of epilepsy cases, a cause for the development of epilepsy cannot be determined.
- 7. Treatments for Epilepsy Traditional Treatments Anti-epileptic drug therapy Approximately 26 AEDs used to treat seizures Diet Ketogenic diet, medium chain triglyceride diet, modified Atkins diet, low glycemic index diet Surgery Removal or disconnection of abnormal area of the brain Separation of the hemispheres of the brain by cutting of the corpus callosum Vagus Nerve Stimulation Electrical stimulation of the brain via the vagus nerve to counteract the effects of overactive nerve tracts Alternative Treatments Melatonin Cannabis Acupuncture While many treatment options are available, in approximately 30% of epilepsy cases, no known treatments are effective in controlling seizures.
- 8. Case Study Megan is a 26-year-old white female who has been living with epilepsy for the past 11 years. Megan developed post-traumatic epilepsy after a moderate closed head injury in 2003. Over the years, Megan has been put on more than 10 different anti-epileptic medications, none of which relieved her seizures. In the summer of 2013, Megan changed medications and began a ketogenic diet. Within 6 months, she had stopped having seizures and has now been seizure free for over a year.
- 9. Case Study Cont. Additional Possible Contributing Factors Polycystic Ovarian Syndrome It is estimated that 25%-30% of epileptic women have or exhibit symptoms of PCOS Genetic Tendency Maternal Great-Aunt and Great- Uncle also have post-traumatic epilepsy Chiari Malformation A structural defect in the cerebellum Part of the cerebellum is located inferior to the foramen magnum Active Treatments Controlling Seizure Activity Lamictal Anti-epileptic medication Ketogenic Diet
- 10. The Ketogenic Diet The diet structure is high fat, adequate protein, and low carbohydrates, which causes metabolic changes similar to starvation. Levels of plasma ketones, insulin, glucose, glucagon, and free fatty acids change. Which metabolic change is responsible for seizure control is not yet known although it is likely multifactorial. In a 2006 analysis of 19 separate studies, it was found that the ketogenic diet was effective in reducing seizures regardless of age or seizure type. After six months, approximately 60% of patients had a greater than 50% reduction in seizures, while 30% had a greater than 90% reduction in seizures.
- 11. References McCormick DA, Contreras D. On the cellular and network bases of epileptic seizures. Annu Rev Physiol 2001; 63:815. Wilfong MD. Overview of the classification, etiology, and clinical features of pediatric seizures and epilepsy. UpToDate Nov 2014. Schachter MD. Overview of the management of epilepsy in adults. UpToDate Nov 2014. Kossoff MD. The ketogenic diet. UpToDateNov 2014. http://www.epilepsy.com http://www.ncbi.nlm.nih.gov http://neuropathology-web.org http://www.epilepsymatters.com http://www.epilepsysociety.org.uk