Upload
harmony-halden
View
212
Download
0
Embed Size (px)
Citation preview
Epilepsy and Epilepsy and Seizure Seizure
ManagementManagementFor EMS Personnel
This product was developed with support from the Centers for Disease Control and Prevention under cooperative agreement number 5U58DP000606-05. Its contents are
solely the responsibility of the authors and do not necessarily represent the official views of the CDC.
This training is designed to:This training is designed to:
Prepare EMS responders to Prepare EMS responders to recognize and respond recognize and respond
appropriately to seizures caused appropriately to seizures caused by epilepsy or as a result by epilepsy or as a result of trauma or other acute or chronic of trauma or other acute or chronic
illness.illness.
A seizure is:A seizure is:
A sudden, brief disruption of the normal A sudden, brief disruption of the normal functioning of neurons in the brainfunctioning of neurons in the brain
A seizure may appear as:A seizure may appear as:
A sudden cry and fall, followed byA sudden cry and fall, followed by Convulsive movements of all limbsConvulsive movements of all limbs Shallow/interrupted breathing - Shallow/interrupted breathing -
cyanosiscyanosis Loss of bowel/bladder controlLoss of bowel/bladder control Slow return to consciousness, post-Slow return to consciousness, post-
seizure confusion and/or fatigueseizure confusion and/or fatigue
This is a generalized tonic-clonic or “grand mal” seizure.
or a seizure may be…or a seizure may be…
Blank staring, chewing, other repetitive Blank staring, chewing, other repetitive purposeless movementspurposeless movements
Wandering, confusion, incoherent speechWandering, confusion, incoherent speech Crying, screaming, running, flailingCrying, screaming, running, flailing A sudden loss of muscle tone and fallA sudden loss of muscle tone and fall Picking at clothes, disrobingPicking at clothes, disrobing
This is one type of partial seizure known as a complex partial seizure.
Seizure CausesSeizure Causes
High fever, especially in infantsHigh fever, especially in infants Drug use, alcohol withdrawalDrug use, alcohol withdrawal Near-drowning or lack of oxygen Near-drowning or lack of oxygen
from another cause from another cause Metabolic disturbancesMetabolic disturbances Head traumaHead trauma Brain tumor, infection, strokeBrain tumor, infection, stroke Complication of diabetes or pregnancyComplication of diabetes or pregnancy
A common cause of A common cause of seizures is seizures is epilepsyepilepsy – –
Epilepsy (also known as a ‘seizure disorder’) is a chronic neurological disorder characterized by recurring
seizures that are not otherwise provoked by an acute injury or health
emergency.
Epilepsy is Epilepsy is not contagiousnot contagious, , it is it is not a mental illnessnot a mental illness or a cognitive or a cognitive
disabilitydisability. The . The neurological dysfunction seen in neurological dysfunction seen in
epilepsy can begin at birth, epilepsy can begin at birth, childhood, adolescence, or even childhood, adolescence, or even
in adulthood.in adulthood.
StrokeStroke Brain tumorBrain tumor Brain infectionBrain infection Past head injuryPast head injury Metabolic problemsMetabolic problems
Causes of epilepsy include:Causes of epilepsy include:
Over 3 million Americans of all ages have epilepsy. Other neurological conditionsOther neurological conditions
Genetic factorsGenetic factors
Epilepsy may occur with:Epilepsy may occur with:
Cerebral palsyCerebral palsy Cognitive Cognitive
impairmentsimpairments ADD/ADHDADD/ADHD
Developmental Developmental disabilitiesdisabilities
AutismAutism
… … but the majority of people who have epilepsy do not have other impairments and live very normal lives.
In a In a generalized generalized seizure seizure
the the electrical electrical disruption disruption
involves the involves the entire brain.entire brain.
Loss of consciousness, fall and Loss of consciousness, fall and stiffening of limbs, followed by stiffening of limbs, followed by rhythmic shaking.rhythmic shaking.
Breathing may stop temporarily - Breathing may stop temporarily - skin, nails, lips may turn blue skin, nails, lips may turn blue
Loss of bladder/bowel control may occurLoss of bladder/bowel control may occur Generally lasts 1 to 3 minutesGenerally lasts 1 to 3 minutes Followed by confusion, sleepinessFollowed by confusion, sleepiness
Tonic-Clonic SeizureTonic-Clonic Seizure -“grand mal”
In a partial seizure In a partial seizure
the electrical the electrical disruption disruption
involves a limited involves a limited area of the brain.area of the brain.
Seizure activity in the brain causing:Seizure activity in the brain causing: Rhythmic movements - Rhythmic movements -
isolated twitching of arms, face, isolated twitching of arms, face, legslegs
Sensory symptoms - Sensory symptoms - tingling, weakness, sounds, smells, tingling, weakness, sounds, smells, tastes, tastes, feeling of upset stomach, feeling of upset stomach, visual distortionsvisual distortions
Psychic symptoms - Psychic symptoms - déjà vu, hallucinations, déjà vu, hallucinations, feelings of fear or anxietyfeelings of fear or anxiety
Usually last less than one minuteUsually last less than one minute May precede a generalized seizureMay precede a generalized seizure
Simple Partial SeizureSimple Partial Seizure
Characterized by altered awarenessCharacterized by altered awareness Confusion, inability to respondConfusion, inability to respond Automatic, purposeless behaviors such Automatic, purposeless behaviors such
as picking at clothes, chewing or as picking at clothes, chewing or mumbling.mumbling.
Emotional outburstsEmotional outbursts May be confused with:May be confused with:
Drunkenness or drug useDrunkenness or drug use Willful belligerence, aggressivenessWillful belligerence, aggressiveness
Complex Partial SeizureComplex Partial Seizure
Anti-epileptic MedicationsAnti-epileptic Medications
• Depakote (Valproic Depakote (Valproic acid)acid)
• Felbatol (felbamate)Felbatol (felbamate)• Gabatril (tiagabine)Gabatril (tiagabine)• Keppra Keppra
(levetiracetam)(levetiracetam)• Lamictal (lamotrigine)Lamictal (lamotrigine)• Dilantin (phenytoin)Dilantin (phenytoin)• phenobarbitolphenobarbitol
•Neurontin (gabapentin)
•Tegretol
(carbamezepine)
•Trileptal (oxcarbazepine)
•Topamax (topiramate)
•Zonegran (zonisamide)
•Lyrica (pregabalin)
Medications Chart (cont.)Medications Chart (cont.)[This chart also found on pages 30 and 36 of the final Participant’s and Trainer’s Guides, [This chart also found on pages 30 and 36 of the final Participant’s and Trainer’s Guides,
respectively].respectively].
Surgical treatmentSurgical treatment
Factors influencing decision:Factors influencing decision: Ability to identify focus of seizuresAbility to identify focus of seizures Area of brain involved can Area of brain involved can
be safely removed – without be safely removed – without resulting in a significant deficitresulting in a significant deficit
Other treatments have been Other treatments have been unsuccessfulunsuccessful
Vagus Nerve StimulatorVagus Nerve Stimulator
An implanted device that An implanted device that sends regular, mild sends regular, mild electrical pulses to the electrical pulses to the brain via the vagus nerve brain via the vagus nerve
May also be activated May also be activated by an external magnetby an external magnet Functioning of the VNS may be Functioning of the VNS may be affected by the use of a taser device.affected by the use of a taser device.
More information about the VNS can be found at: www.cyberonics.org
Patients with epilepsy may Patients with epilepsy may still have seizures due to: still have seizures due to:
Failure to take medication Failure to take medication correctlycorrectly Variation in medication Variation in medication effectivenesseffectiveness Sleep deprivationSleep deprivation Stress/Stress/ IllnessIllness Hypoglycemia/dehydrationHypoglycemia/dehydration Alcohol/drug use or withdrawalAlcohol/drug use or withdrawal Hormonal fluctuationsHormonal fluctuations Flashing lights or other triggersFlashing lights or other triggers
Some epilepsy patients never achieve Some epilepsy patients never achieve effective seizure control and may effective seizure control and may
experience varying degrees of experience varying degrees of financial, social and legal problems.financial, social and legal problems.
DVD: DVD: A Guide toA Guide to
Seizure Management for Seizure Management for Emergency Medical Emergency Medical
RespondersResponders
Pre-hospital Treatment – Pre-hospital Treatment – Generalized tonic-clonic Generalized tonic-clonic
seizureseizure Assure scene safety If trauma is not suspected,
place patient in recovery position Protect head/limbs from injury Follow A B C protocol:
Maintain airway – suction PRN
Administer O2
Monitor cardio-respiratory status
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
During GTC seizure, assess During GTC seizure, assess for:for:
When present, activate When present, activate ALS and/or rapidly transport to ALS and/or rapidly transport to
receiving facility receiving facility
After the seizure stops:After the seizure stops: Continue to monitor cardiorespiratory status Evaluate for injury Assess for return of consciousness/re-orient Obtain pertinent medical history and
emergency contact information if possible
Activate ALS and/or rapidly Activate ALS and/or rapidly transport to receiving facility if transport to receiving facility if
consciousness does not return, or consciousness does not return, or confusion persists more than 20 confusion persists more than 20
minutes post-seizureminutes post-seizure
Question witnesses:Question witnesses:
Description of seizure event Identifying information for patient,
emergency contacts Prior history of seizures or other
medical problems
After a first-time GTC seizure, or if After a first-time GTC seizure, or if there is another medical condition, there is another medical condition,
medical evaluation is necessary medical evaluation is necessary to identify and treat the cause.to identify and treat the cause.
ALS response to a GTC seizure ALS response to a GTC seizure that has lasted longer than 5 that has lasted longer than 5
minutes:minutes:Per local protocols, administer
meds to stop seizure activity: Diazepam (Valium) – IV or Diastat rectal gel form * Midazolam (Versed) – IV, IM,
buccal or intranasal
Lorazepam (Ativan) – IV or IM
Support ventilation PRN
*For more information about Diastat see: www.diastatacudial.org
Options for Treating Options for Treating Repetitive SeizuresRepetitive Seizures
The only FDA-approved treatment for acute repetitive seizures is rectal Diastat, but nasal or buccal midazolam have been shown to be equally effective. Some services make arrangements to use alternate forms.*
* These alternate methods are currently in a Phase 1 FDA clinical trial. (www.clinical trials.gov) with an estimated completion date of April 2012.
After stabilizing the patient, transport to receiving facility. Monitor vital signs.
Report to ED the type and dose of seizure rescue medication that was administered.
Pre-hospital Treatment – Pre-hospital Treatment – Complex Partial Seizure (CPS)Complex Partial Seizure (CPS)
May be reported as drunkenness/illegal drug use medical conditions such as a
stroke or diabetic reaction “person acting strangely”
Look for sudden loss of awareness Look for sudden loss of awareness and automatic, purposeless and automatic, purposeless
behaviors such as behaviors such as picking at clothes, chewing, picking at clothes, chewing,
mumbling or wandering.mumbling or wandering.
Response to suspected Response to suspected complex partial seizure:complex partial seizure:
Approach cautiously, speak calmly Contain – don’t restrain Prevent from injuring self Look for medical ID, identifying
information
Avoid triggering violent behavior Avoid triggering violent behavior by minimizing physical contact.by minimizing physical contact.
Post-ictal phase (post-Post-ictal phase (post-seizure):seizure): Monitor recovery, check blood glucose Re-orient to surroundings Evaluate for injury More in-depth history as appropriate
Activate ALS and/or rapidly Activate ALS and/or rapidly transport to receiving facility if transport to receiving facility if injury is present or if confusion injury is present or if confusion
persists over 20 minutes persists over 20 minutes after seizure ends.after seizure ends.
Question Question witnesses: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, After a first-time seizure, medical evaluation is medical evaluation is necessary to identify necessary to identify
and treat the cause.and treat the cause.