Epilepsy & Homelessness. Anthony Linklater Epilepsy Specialist Nurse National Hospital for Neurology and Neurosurgery
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1 Epilepsy & Homelessness Anthony Linklater Epilepsy Specialist Nurse National Hospital for Neurology and Neurosurgery
2 Scope of Talk Outline what epilepsy is & how it is treated Identify issues around living with epilepsy Highlight issues around vulnerability Discuss how services can meet everyone s needs
3 What Is Epilepsy? Epilepsy is defined as a tendency to recurrent seizures of primary cerebral origin. Epilepsy is the most common serious neurological condition in the United Kingdom. There are many causes of epilepsy. For updated operational definition, see:
4 What is Epilepsy? Possible Causes Infection of the brain Meningitis Encephalitis Cerebral abscess Inherited causes Low seizure threshold Rare genetic disorders, of which epilepsy can be a symptom e.g., tuberous sclerosis, Structural damage to the brain Stroke Tumour Scarring, following injury Lesions or other abnormalities Prolonged alcohol/drug abuse Birth trauma
5 What Is Epilepsy? Possible Causes Children Adults Term: hypoxic damage Pre-term: haemorrhage Congenital malformation Adolescents Idiopathic generalised epilepsies Focal epilepsies due to structural lesions: Scarring due to trauma Infection Stroke Tumour Prolonged alcohol or drug abuse
6 Not all seizures are epileptic Diagnosis aided by: Seizure semiology Neuroimaging - MRI EEG (routine +/- ambulatory) Video EEG telemetry Physical exam, ECG, blood tests, etc
7 What Are Seizures? A disturbance of normal brain activity Disorganised & excessive discharges of neurons Brief stereotyped disturbance of awareness, behaviours, emotion, motor function or sensation Seizures are classified in various ways.
8 Seizure Classification (ILAE) Focal / Partial seizures Generalised seizures Simple Partial No loss of awareness Sensations e.g. déjà vu, smell, taste, etc. Autonomic signs e.g. sweat, tachycardia Muscular movement. AKA auras or warnings May progress
9 Seizure Classification (ILAE) Focal / Partial seizures Generalised seizures Simple Partial Complex Partial May start with simple partial Impaired awareness Blank and unresponsive Falling may occur Automatisms Repeated speech, Mumbling Incontinence Followed by confusion. May progress or cluster
10 Seizure Classification (ILAE) Focal / Partial seizures Generalised seizures Simple Partial Complex Partial Secondary Generalised Tonic Clonic Absence Atonic Tonic Myoclonic.
11 Tonic Clonic Seizures Presentation Increase in muscle tone May cry out May bite tongue or inside of cheek Will fall if standing Rapid jerking of limbs and head Jerking slows and stops after 2-3 minutes usually Breathing noisy and may be interrupted with cyanosis Excessive salivation Possible urinary or faecal incontinence Drowsiness, confusion, headache and sleep often follows Muscular aching the following day
12 Impact of Epilepsy Seizures are disruptive to daily life Vulnerability is increased They may cause physical harm: Accidents & Injuries Status epilepticus SUDEP
13 Impact of Epilepsy Social stigma Discrimination Reduced social interaction Higher unemployment Reduced quality of life Anxiety caused by fear of seizures can be more disabling than the seizures themselves.
14 Adjusting to Epilepsy Incorporating treatment Minimising risk First aid for seizures Lifestyle adjustment Driving regulations Specific issues for females Avoiding isolation / over protection Access to information
15 Treatment Options Aim of Treatment: Prevent seizures; Minimal adverse effects; Enhance QOL Medication Resective Surgery Other Treatment
16 Vagus Nerve Stimulation (VNS)
17 Epilepsy & the Homeless Suggestion that prevalence is far higher Risk may be higher for those: with alcohol problems homeless for >2 years
18 Epilepsy & the Homeless Seizure frequency worse at onset of H. Reasons given for this: Excessive alcohol Sleep deprivation Anxiety Stress
19 Challenges Access to specialist advice / care Medication: taking regularly /obtaining supply Adjustment in unhealthy & dangerous environment Prioritising ep. in complex mix of co-morbidities Access to benefits / concessions Meeting information needs
20 so how do we address these challenges?
21
22 Resources NICE pathways: Epilepsy Society: Epilepsy Action:
23 Thank
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