What should you do if someone has a seizure?

This article details what one can do if one sees someone having a seizure. Remember to call EMS if you have concerns.!

THIS IS A GENERAL INFORMATION article and is not meant to substitute for seeing your dcotor. Always check with your neurologist about specifics for you or your child.  JR

If a friend, family member or co-worker has epilepsy, you should know what to do if he or she has a seizure.

Once a seizure begins, nothing can be done to make it end more quickly. But you can take steps to prevent seizure victims from hurting themselves:

• Move furniture and sharp objects away from the victim.
• Should the victim vomit, turn his or her head to the side so he or she does not choke.
• If the victim is unconscious, make sure nothing is obstructing the nose or mouth.

After a seizure ends, most people sleep deeply. Do not try to prevent this deep sleep. Once the victim awakens, he or she may be disoriented for a while.

Be sure to stay with the victim until he or she recovers fully, or until emergency medical help arrives. Also, keep an eye on the victim’s breathing rate and pulse.

Do not do the following things for a seizure victim. You will risk hurting the seizure victim and yourself:

• Do not restrain someone having a seizure.
• Do not put a spoon, tongue depressor or anything else in his or her mouth, especially not your fingers. It is a myth that seizure victims can swallow their tongues.
• Do not move the victim unless he or she is in immediate danger or near a hazard.
• Do not perform artificial respiration during a seizure, even if the victim is turning blue. Most seizures are over long before brain damage from lack of oxygen begins. However, if a seizure lasts longer than two minutes, call for emergency medical help.
• Do not give the victim food, drink or medication by mouth until the seizure has stopped and he or she is completely awake and alert.

Call immediately for emergency medical help for someone who:

• has seizures lasting longer than two minutes or has more than one seizure per hour
• does not wake up between two seizures
• is injured, ill or intoxicated
• has a seizure for the first time
• is pregnant or has diabetes or high blood pressure
• has a seizure in water

After other seizures, call the seizure victim’s healthcare provider.

Read more here

Protein Linked to Cognitive Deficits in Angelman Syndrome Discovered

Aug. 1, 2013 — A team of neuroscientists has identified a protein in laboratory mice linked to impairments similar to those afflicted with Angelman syndrome (AS) -- a condition associated with symptoms that include autism, intellectual disability, and motor abnormalities.

The findings appear in the journal Cell Reports.

"By isolating a protein that contributes to cognitive deficits in Angelman syndrome, these findings mark a step forward in not only addressing AS, but perhaps other developmental disorders as well," said Eric Klann, a professor in New York University's Center for Neural Science and one of the study's co-authors.

The study's researchers also included: Shelly Buffington and Matthew Rasband of the Baylor College of Medicine; Jerry Lingrel of the Department of Molecular Genetics, Biochemistry, and Microbiology at the University of Cincinnati; and Hanoch Kaphzan, Akila Ramaraj, and Emanuela Santini of NYU's Center for Neural Science.

Previous research has shown that AS model mice display brain dysfunctions that match neurological abnormalities observed in humans, including cognitive deficits such as long-term memory. A previous study by Klann and his colleagues pointed to a potential cause for the condition -- overexpression of a subunit of a protein termed Na/K-ATPase in AS model mice.

In the Cell Reports study, the authors hypothesized that if they could decrease expression of this subunit, they could improve cognitive function of AS model mice.

To do this, they ran different populations of mice through cognitive and memory tests -- including a water maze to examine spatial memory and a fear conditioning paradigm to examine associative memory. They examined behaviors of the following types of mice: normal mice, AS model mice, mice that had reduced levels of the Na/K-ATPase, and AS model mice in which expression of the subunit of Na/K-ATPase was reduced.

In the water maze test, the mice needed to elevate themselves onto a platform in a specific location to get out of the water. The AS mice took longer to learn this task, but AS mice with reduced levels of the Na/K-ATPase subunit learned the task as fast as normal mice. In the second test, the researchers removed the maze's platform and measured how long the mice searched for the platform in this part of the maze in order to measure their memory of the platform location. The normal mice and the AS model mice with diminished expression of the Na/K-ATPase subunit searched the correct area of the maze in the same amount of time. However, other AS model mice had no memory of the platform location....

Science Daily summary Here

Full article here

Seizures and Head Protection: BUYING A SEIZURE HELMET

:

I often get a question about helmets for children with seizures. The scariest seizures are drop seizures or  astatic seizures but generalized tonic clonic seizures can also cause injury. Its important to realize that with or without a helmet;  on or off medicines... accidental injury is more common in people with epilepsy.
 JR


Seizures and Head Protection: BUYING A SEIZURE HELMET

The doctor or another health care professional has just advised you to buy a protective helmet because you have been having seizures which have been causing sudden drops or falls that may lead to head injury. But what type of helmet is best? And where you should you go to get one?

To determine the best type of helmet, begin by thinking about your seizure behaviors. If you fall forward, a helmet with a face guard, face bar, or visor is needed. If you fall backward, the back of your head needs protection. A good helmet also needs a chinstrap that can be adjusted so that it is snug but not uncomfortable. No matter what direction you fall, the helmet should absorb the impact, so it will be useless if it does not remain securely on the head.

Not all types of helmets offer adequate protection. Bicycle helmets are comfortable and good-looking, but they do not offer the best protection for injuries from seizure activity. Coverage is insufficient in the back and on the sides of the head. When seizures cause forward falls, they do not protect the face, and if they are not adjusted properly, they move too much. Longevity of the helmet is another problem. With repeated hard falls, a bicycle helmet may crack.

Boxing helmets, made of soft leather, are comfortable but they offer no protection and do not allow adequate ventilation. Football helmets offer good protection but are large and uncomfortable to wear. Baseball batting helmets are loose-fitting and are made without a chinstrap, so they offer inadequate protection.

Suitable helmets are commercially available through sporting good stores, medical supply companies, and the rehabilitation departments of some hospitals. Hockey helmets (CCM and Bauer) are one of the best choices. They offer maximal protection, come in a variety of colors, fit all age groups (except infants) and can be purchased and fitted in any sporting goods store.

Other helmets are made especially to protect people with medical needs, including very small children. Some of them come in choices of style or color that may be more appealing to those who don't want to look like a hockey player.

Link Here

Febrile seizures and behavioural and cognitive outcomes in preschool children: the Generation R Study

Are febrile seizures really totally benign? JR


Febrile seizures and behavioural and cognitive

 outcomes in preschool children: 

the Generation R Study

Aim 

 General developmental outcome is known to be good in school-aged children who experienced febrile seizures. We examined cognitive and behavioural outcomes in preschool children with febrile seizures, including language and executive functioning outcomes.

Method  This work was performed in the Generation R Study, a population-based cohort study in Rotterdam from early fetal life onwards. Information about the occurrence of febrile seizures was collected by questionnaires at the ages of 1, 2, and 3 years. At the age of 3 years, behaviour and emotion were assessed using the Child Behavior Checklist. Information on expressive language development was obtained by the Language Development Survey at the age of 2 years 6 months. To assess executive functioning, parents completed the Behaviour Rating Inventory of Executive Function – Preschool Version when their children were 4 years old. Final analyses were based on 3157 children.

Results  No associations were found between febrile seizures and the risk of behavioural problems or executive functioning. In contrast to single febrile seizures, recurrent febrile seizures were significantly associated with an increased risk of delayed vocabulary development (odds ratio 3.22, [95% confidence interval 1.30–7.94]).

Interpretation  Febrile seizures are not associated with problem behaviour or executive functioning in preschool children, but the results suggest that children with recurrent febrile seizures might be at risk for delayed language development.

 link here

“Living With Epilepsy” Conference - May 5th 2012 - Houston TX, CME Available!

What: “Living With Epilepsy” Conference & Fundraising Launch Party

Who: The Epilepsy Warriors Foundation

When: Saturday, May 5th, 2012

Why:  The Goal of this Conference is to Educate those dealing, living and working with Epilepsy on what Epilepsy is, how it is managed, the Dangers of Sudden Death from Epilepsy (SUDEP) and not talking about it, the daily struggle of trying to manage epilepsy and also manage a family as well . The Main Goal is to provide Research Funding and Attention to the phenomenal research that is being done within the Houston Medical District both at University of Texas and Baylor College of Medicine and what we need to do to keep it moving forward towards a CURE

Where:  Memorial City-The Westin Hotel, Houston Texas
945 Gessner Road, Houston TX 77024

There is a block of rooms being held at a discounted rate of $109.00 for Friday and Saturday Evenings. Ask for the Epilepsy Warriors Foundation Room Block.

Each person is responsible for making their own room reservations contact the Westin Hotel Directly at 281-501-4300 or through this link you can make your reservations directlyhttps://www.starwoodmeeting.com/StarGroupsWeb/booking/reservation?id=1204184117&key=7F606

Time:  Conference Doors open 8:00 Am and Conference Runs from 9:00 Am-5:00 Pm

The Epilepsy Warriors Foundation Fundraising and Launch Party is from 7:00 Pm-11:00 Pm in the Ballroom of the Westin

RSVP if you would like to attend: Registration is $100.00 and This activity  has been approved forAMA PRA Category 1 Credit™

                                                                                                 

Susan Noble
President/Executive Director
239-233-2205
info@epilepsywarriors.org
www.epilepsywarriors.org

KeyNote Speaker: Richard Siravo of The Matty Fund

http://mattyfund.org/

Matthew Siravo was born on February 18, 1998, the son of Debra and Richard Siravo of Wakefield, Rhode Island. His three older brothers are; Joseph, Stephen and Christopher. Matthew was a healthy newborn child with no diagnosed medical conditions during most of his first year of life. Ten days before his first birthday, Matty suffered a gran mal seizure during the early morning of February 8, 1999.

In May 2003, at the advice of doctors, Matthew underwent brain surgery at Boston Childrens Hospital. The surgery reportedly went well however, Matthew suffered a prolonged seizure while in recovery, which caused cardiac arrest and massive brain damage. Matthew died peacefully on May 11, 2003, Mother’s Day, surrounded by his family and while his favorite church music played by his bedside.

The Matty Fund takes great pride in the programs and services which assist families dealing with epilepsy. While we admire our accomplishments, we must also move forward to meet the challenges ahead by creating innovative ways to inform and educate families, school and hospital personnel about the protocols surrounding epilepsy. It is the goal and positive attitude we acquired after losing young Matty in 2003. Richard and Debbie  Siravo, Founders of th Matty FundWe have committed ourselves to honor his legacy by helping children that face the uncertainties surrounding epilepsy.

Physicians Speaking: 

Dr. Joshua Rotenberg, MD, MMS, DABPN, DABP,DABSM

Diplomate American Board of Psychiatry and Neurology with Added Qualifications in Sleep Medicine

& Special Qualifications in Child Neurology

Dr. Melissa S. Jones, MD

Diplomate American Board of Psychiatry and Neurology with Special Qualifications in Child Neurology

Dr. Daniel J. Curry, M.D.

Texas Childrens Hospital -Director of Pediatric Surgical Epilepsy and Functional Neurosurgery 

Assistant Professor Neurological Surgery Baylor College of Medicine

Dr. Giridhar P. Kalamangalam, M.D., D.Phil.
American Board of Psychiatry and Neurology in Clinical Neurophysiology
CCST, Neurology Board Certification of the United Kingdom

What causes epilepsy in newborn babies?

Epilepsy in newborn babies

• What causes epilepsy in newborn babies?
• Types of seizures
• Diagnosis
• Treatment
• Outlook

What causes epilepsy in newborn babies?

There are many different causes of seizures in newborn babies and in the first six months of life. In very premature babies, the most common causes are a reduced blood and oxygen flow to the brain, and bleeding into the brain. Other causes include infections such as meningitis, low blood sugar or calcium, poor development of the brain and rarely, problems with the metabolism. In some cases, the seizures may be due to a faulty gene or chromosome. In other cases no cause can be found.

See also: What is epilepsy? 

Types of seizures

Seizures in newborn babies are often difficult to recognise. This is because the immature brain of a very young child is unable to produce the more obvious seizures that can be seen in older children. In a newborn baby seizures may be very subtle and consist simply of changes in breathing patterns, movements of the eyelids or lips or bicycling movements of the limbs. They may also consist of brief jerks or episodes of stiffening of the body and limbs. The jerks are called myoclonic or clonic seizures and the episodes of stiffening are called tonic seizures, or, sometimes, spasms.

More information about different types of seizures

Diagnosis

It is important that any baby who is suspected of having seizures is referred to a specialist, who may arrange for diagnostic tests. One of the most commonly performed tests is the electroencephalogram (EEG). While the EEG is not a conclusive test for epilepsy, it can be very useful in detecting subtle seizures, and can also provide information about specific seizure types. It is important that the EEG of a newborn baby is interpreted by someone who specialises in this age group. This is because the brainwave patterns and seizures are often very different to those in older children and adults. 

Treatment

There is a large range of anti-epileptic medication currently available and new ones continue to be developed. However, one of the older drugs, phenobarbital, seems to be particularly useful in treating seizures in babies; other drugs such as carbamazepine or phenytoin may also be effective. Ultimately, the choice of medication will depend on the child’s seizure type, the age when the epilepsy began, the cause of the epilepsy, if known, and the likely outcome of that particular type of epilepsy.

Outlook

Many parents become frustrated as they feel that doctors give them little information about how their child will develop and whether the epilepsy will ever go away. This frustration is understandable, but the lack of information may simply be due to the fact that the doctors themselves do not always know what will happen in the future.

One of the things parents may worry about is whether their child’s intellectual abilities will be affected by epilepsy. Many children with epilepsy will develop with the same range of intellectual abilities as children without the condition. However, where the epilepsy is caused by damage to the brain, this damage can, in some cases, also cause learning disabilities.

In the newborn period it is not always possible to predict what the outcome for each child will be. In some cases it is only when particular development milestones are reached, or not reached, that the doctors can try to predict what the future may hold for that child. Ultimately, the outlook for the future, both in terms of general development and future epilepsy, depends on the nature and, most importantly, on the underlying cause of the child’s epilepsy.

Epilepsy Action has fact sheets about some types of childhood epilepsy. Please contact the Epilepsy Helpline, freephone 0808 800 5050 (UK), orhelpline@epilepsy.org.uk

For the less common types of epilepsy the UK organisation Contact a Familymay be able to provide information on self-help groups for children with specific conditions.

article here

Are you sure its a pseudoseizure? Check again. 50% of people with pseudoseizures may also have epilepsy.

Arq Neuropsiquiatr. 2010 Apr;68(2):168-73.

Epilepsy in patients with psychogenic non-epileptic seizures.

Marchetti RL, Kurcgant D, Gallucci-Neto J, Von Bismark MA, Fiore LA.

Source

University of São Paulo School of Medicine, São Paulo, SP, Brazil. rlmarche@bighost.com.br

Abstract

The aim of this study was to evaluate the frequency of epilepsy in patients who presented psychogenic non-epileptic seizures (PNES). The evaluation was carried out during intensive VEEG monitoring in a diagnostic center for epilepsy in a university hospital. The difficulties involved in reaching this diagnosis are discussed. Ninety-eight patients underwent intensive and prolonged video-electroencephalographic (VEEG) monitoring; out of these, a total of 28 patients presented PNES during monitoring. Epilepsy was defined as present when the patient presented epileptic seizures during VEEG monitoring or when, although not presenting epileptic seizures during monitoring, the patient presented unequivocal interictal epileptiform discharges. The frequency of epilepsy in patients with PNES was 50% (14 patients). Our findings suggest that the frequency of epilepsy in patients with PNES is much higher than that of previous studies, and point out the need, at least in some cases, for prolonging the evaluation of patients with PNES who have clinical histories indicating epilepsy.

PMID:

 

20464279

 

[PubMed - indexed for MEDLINE] 

Free full text

DISCUSSION

Surely, one of the clinical situations that produce the greatest polemics is the association of epilepsy and PNES. The prevalence of epilepsy in patients with PNES has been estimated as ranging from 5.3 to 73%^3,11-16. This variability in different studies may reflect several methodological characteristics, such as the different inclusion criteria when determining epilepsy and PNES, the presence or not of ictal/interictal EEG abnormalities, the diagnostic environment (inpatient or outpatient), the presence of prolonged monitoring by VEEG, the monitoring duration and the sample size.

This diagnostic issue is extremely important. In the first place, omission of the PNES diagnosis may be very harmful and damaging to patients. Martin et al.²⁰ estimated that the lifetime costs borne by a person with PNES, in diagnostic tests, procedures and treatments would be around US$ 100,000. They also calculated that US$ 100 to 900 million are spent yearly in the USA on the PNES patient population. Several studies have shown that early and appropriate diagnosis of PNES, followed by adequate treatment, may lead to remission in 19 to 52% of cases, or to improvement in 75 to 95% of cases. Therefore, a significant reduction in the use of healthcare systems and in costs is involved^20-23. PNES leads to severe social and psychological consequences. These patients and their families face the same problems as patients with epilepsy: stigmatization, poor schooling, unemployment, difficulties in interpersonal relationships and social exclusion²⁴. From the medical point of view, patients are exposed to iatrogenic procedures, such as the use of high doses of AED²⁵, venous punctures, intravenous AED, and orotracheal intubation²⁶. Moreover, the rate of comorbidity with depressive and anxiety disorders is high^14,21, and the quality of life of these patients is worse than that of patients with difficult-to-control epilepsy²⁷.

On the other hand, to omit the diagnosis of epilepsy may be just as damaging, or even more so. Patients with a diagnosis of PNES may be counseled to halt their AED use and reduce their visits to emergency healthcare facilities, so as to reduce iatrogenic levels and costs^28,29. The treatment may be adapted to a condition of psychogenic nature³⁰. Wyler et al.³¹ dramatically pointed out the possible consequences of these procedures when reporting the case of a 15-year-old girl who perished as a result of an ES that occurred after PNES had been diagnosed by means of VEEG and after medical discharge following AED withdrawal.

This prevalence of epilepsy among patients with PNES was 50% in an epidemiological study carried out in Iceland⁶, but in two recent studies^12,16, relatively low frequencies of epilepsy were found, respectively 5.3 and 9.4%. In our study, this association occurred in 14 patients (50%), a high association level, even though our criteria for diagnosing epilepsy were more restrictive than in both of the abovementioned studies. As in these studies, epilepsy was defined as present when the patient presented ES during VEEG monitoring or otherwise, when unequivocal interictal epileptiform discharges were observed (sharp waves, spikes or complex spike-waves) although no ES occurred. Benign variants were not considered to be epileptiform conditions. However, unlike the two previous studies, interictal epileptiform discharges were considered to be present only when corroborated by clinical validation. Even if we had considered the presence of ES during VEEG monitoring as the one and only criterion for epilepsy, we would have had five patients (18%) under these conditions, i.e. approximately twice the number of both previous studies, presenting relatively low rates of epilepsy.

Following the validation criteria of our study, we concluded that out of the 14 patients with epilepsy, eight (57.1%) were in remission under treatment with AED or after AED withdrawal. Ramsay et al.³² drew attention to the need to distinguish between simultaneous and sequential presence of epilepsy and PNES, when these conditions coexist. According to these authors, their simultaneous presence is easier to establish, due to the probable occurrence of ES during VEEG monitoring, whereas that may not happen when their occurrence is sequential. Usually, in these cases, existence of epilepsy precedes PNESD, complicates it and may, as these authors suggest, be related to the appearance of PNES.

PNES is usually considered to be present when the patient presents complete absence of therapeutic response to AED, or loss of response (therapeutic failure), or perhaps paradoxical responses to AED (worsening or spontaneous and unexpected remission). Moreover, it can occur eventually in function of atypical, multiple, inconsistent or changing pattern seizures, or when these are unleashed by an evident and specific stressful event with close timing connections with the occurrence of seizures³³. The previous elements are particularly considered when the patient presents normal ancillary examinations (interictal routine EEGs and imaging studies such as CT, MRI and SPECT)^34,35. These situations lead the attentive physician to consider the possibility of referral to a center specializing in differential diagnosis and intensive monitoring by VEEG. Out of 22 patients from our sample who were referred for suspected PNES, nine (41%) presented associated epilepsy. Out of six patients in our sample who were referred for other reasons, the presence of epilepsy was not confirmed or observed in only one of them. In these cases, the patients presented PNES as an unexpected phenomenon set within an investigative process directed towards other aims, such as pre-surgical evaluation or diagnostic evaluation of refractory epileptic syndromes. This draws attention to the importance of PNES as a clinical phenomenon that complicates the diagnostic process and treatment of patients with epilepsy.

In one of our cases, the patient presented both spontaneous and suggestion-induced CNEP during VEEG monitoring, but its occurrence was not validated by the medical history data (clinical validation), or by observation of video-recorded events by an external observer with close ties to the patient (observer validation). In this case, although PNES occurred during intensive monitoring by VEEG, we do not believe these represented a real clinical problem. The patient also presented complex partial epileptic seizures during intensive VEEG monitoring, originating from the frontal lobe, which was validated by both clinical and observer validation. This case points out the possibility of isolated PNES occurrence in some gullible individuals, especially when exposed to a favorable situation such as VEEG monitoring¹⁷. It also points out the risk of giving up the investigation far too early because of PNES occurrence, thereby leading to failure to diagnosed epilepsy.

As previously reported, although our criteria may be considered more restrictive than the two previous studies with relatively low rates of epilepsy, our findings suggest that the frequency of epilepsy in patients with PNES is much higher. What might be responsible for these differences? In these three studies, the populations received care in tertiary centers, with patients evaluated for similar reasons. Martin et al.¹⁶ drew attention to the size of their sample (514 patients with CNEP) and to a high rate of referral of patients for suspected PNES. However, out of 22 patients in our sample who were referred on these grounds, nine (41%) presented associated epilepsy. This indicates that, even when the level of suspicion is high for PNES, coexistence of epilepsy may be a significant problem.

One significant difference between our study and others is the period of VEEG monitoring. In previous studies, evaluations typically lasted three days^12,16, and did not exceed five days to one week. In our study, the typical duration of VEEG monitoring was three weeks, with a range from one to six weeks. What was the result of this prolonged monitoring? In most of our patients, PNES presented spontaneous or provoked occurrence, by induction with our protocol of suggestive techniques over the first days of evaluation. Epileptic seizures occurred generally some time after reduction or complete withdrawal of AEDs. In some cases, interictal discharges were registered only after AED withdrawal and a delayed observation period. Lengthening of the monitoring period was usually guided by medical history information, suggesting epilepsy as well as PNES. Possibly, early ending of VEEG monitoring after occurrence of PNES would lead to failure in the diagnosis of epilepsy.

In conclusion, our findings point out the need, at least in some cases, for prolonging the evaluation of patients with PNES and clinical histories indicating epilepsy.