Seizures Sheet # 5. What is a seizure and how do they occur?

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1 Seizures Sheet # 5 What is a seizure and how do they occur? Brain cells that usually communicate with each other may send abnormal messages (similar to electrical charges). The mis-communication of these messages is called a seizure. A sudden firing of neurons in the brain. Symptoms depend on where in the brain seizure activity occurs. The abnormal firing is seen on electroencephalogram (EEG). (Some seizure activity such as abnormal sensation (smell and taste) do not show up on EEG) Epilepsy is defined as more than two seizures. 5-7% of Australians will have one seizure in their lifetime. 1-2% of Australians will have epilepsy. Types of seizures Partial Seizure: The temporal lobe is the most common site of discharge. Some signs of temporal lobe seizure activity include: - Déjà vu (sense of familiarity with unfamiliar events) - Jamais vu (sense of unfamiliarity with familiar events) - Epigastric sensations, unpleasant smell and/or feeling of impending doom. Signs of occipital lobe seizures include visual symptoms (eg swirling colours). Simple partial seizures occur when conscious. Complex parietal seizures involve loss of conscious awareness. Generalised Seizure (or Grand Mal Seizure): The discharge initially is localised and then spreads to both sides of the brain. There is loss of consciousness occurrence after frequent rhythmic muscular contractions. Do these damage the brain? Generalised seizures can damage the brain if the seizure is longer than 5 min due to lack of oxygen. 1

2 Not every person diagnosed with a brain tumour will experience a seizure. About 10-20% will do. For some people a seizure may be one of the earliest signs of a brain tumour. Helpful suggestions for the carer Don t panic stay calm Lower the patient to the floor and loosen any clothing if it is restricting breathing Remove any items that might injure the person Do not restrain the person experiencing the seizure Protect the person from hurting themselves Move the person onto their side to allow saliva to flow freely from mouth Do not try to put anything in the person s mouth Do not leave the person alone during the seizure if possible Seek medical assistance if the generalised seizure occurs longer than 3-5 minutes. 99.9% of seizures do stop within 5 minutes. Call 000. Seizures are exhausting, allow for a period of re-orientation and rest Discuss the seizure event with the treating medical professional Helpful suggestions for the patient diagnosed with a tumour You may be very tired after a seizure so take time to rest and re-gather energy Take time to re-orientate after a temporary confusion time Communicating can be very difficult immediately after a seizure do not get frustrated Walking may be tiring due to limb weakness, so give yourself time to re-adjust Memory may be affected after a seizure, this usually recovers completely after about one week Do not drive without checking with your doctor & restrict strenuous physical activities Lifestyle factors influencing seizures Sleep deprivation is a big trigger for seizures. Infections, vomiting and diarrhoea can trigger seizures. You may need to take an additional (usually half of normal dose) of medication if you are concerned that 2

3 you have not absorbed the drug because of vomiting. It is a good idea to contact your doctor about this. Driving Seek advice from your specialist, a medical assessment is necessary before resuming driving activities. The RTA has a booklet with guidelines to follow re driving and seizures. Don t drive for 3 months after brain surgery Do not drive after a seizure (contact you doctor) With epilepsy which is difficult to control do not drive for 2 years When you resume driving have someone go with you the first few times as a safety precaution Medications used to control seizures Are called: Anti-convulsant medication Anti-epileptic medication Anti-seizure medication It is always wise to be knowledgeable about the uses and side effects of any medication you are taking! Drug therapy for Seizures (as per presentation by Dr Geoff Herkes, Neurologist 30/10/02) Drugs we use for 1. Generalised seizures: Epilim (Sodium Valproate) Ethosuximide (Zarontin) 2. For Parial seizures Carbamazepine (Tegretol) Phenytoin (Dilantin) Epilim (Sodium Valproate) There are several new drugs including Neurotin (Gabapentin) Lamictal (Lamotrigine) Topamax (Topiramate 3

4 Concepts of Drug Therapy With drugs such as Dilantin we need regular blood test to determine if the drug level in the bloodstream is therapeutic. This may happen frequently at first, once stable only every 6-12 months. Liver function tests are done to ensure the drug is not causing liver enzyme changes. Alcohol with anti-convulsants: small amount is fine eg one glass of wine. You may find to have a much lower tolerance for alcohol when on anti-convulsants. The Adverse Drug Reactions Committee (ADRAC) of the therapeutic Goods Association (TGA) provides some details on Vitamins, Brahmi (interacts with Dilantin), Gingko Biloba etc: Phone or at or on the web on Tips: Keep a diary and note when medication is to be taken & blood tests to be conducted Take the medication as prescribed and at the time of day/night recommended by your health practitioner. It is important to monitor the exact dosage taken Too much medication in the system is called a toxic level Not enough medication in you system can add to the risk of side effects or seizure risk can give seizures Have regular blood tests taken (as per you treating specialist) Contact your pharmacist or medical practitioner if you have any issues of concern Discuss your care plan with your doctor Do not reduce your medication or take it in different dosages without medical advice 4

5 Anticonvulsant Medication Side Effects & Suggestions Swelling of gums A rash Nausea / vomiting Constipation Tremors Tiredness Insomnia Feeling on edge or worked up Poor coordination, feeling off balance Concentration problems Use soft tooth brush or dietary advice Take regular rest periods Relaxation or meditation gives better sleep Relaxation or meditation can be calming Remember slow and steady wins the race Take time doing tasks, ask for assistance 5

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