Archive | January 2011

How to HandleEpilepsy at Work

Whether it’s epilepsy or peanut allergies here are some tips on who to tell, what your employer needs to know, and what people should do in case of an emergency.

When you have a chronic illness, such as epilepsy, peanut allergies, or diabetes, you need an ally at your place of work.
Who should that ally be, how does he need to handle himself, and what should he do in case of an emergency? Here are some practical tips experts offer that will help you balance your health with your career.
Living With Epilepsy: Who Needs to Know
“Start by talking to your doctor,” says Susan Kerner, director of the Employee Assistance Program for Southern NH Health System in Nashua, N.H. “Your doctor can help you better understand and articulate what your symptoms are, how severe they are, and exactly what you need to be prepared for.”
Next, find out if the company you work for has a corporate or employee health department.
“It’s sometimes helpful to talk to an occupational health or corporate health representative who can give you words of wisdom,” says Kerner. “They are experienced in areas such as helping employees deal with issues like these in the workplace.”
You should also ask yourself if your epilepsy will require certain accommodations, like a different work schedule because of medications, or frequent breaks. If that is the case, then a discussion with human resources is warranted.
“Talk to someone from human resources about your health needs at work, especially if you need them to be aware of certain issues that might impact your work schedule,” says Kerner.
Then, it’s time to talk to the people you spend eight or more hours a day with, and help them better understand how they can help with your chronic illness.
“You need to tell the people who work physically near you, as well as your manager, so practically, if there is an emergency, they can handle the situation,” says Kerner.
So what, exactly, do they need to understand about your chronic illness in case of an emergency?
Your Epilepsy: What They Need to Know
“Be realistic about what they need to know,” says Kerner. “Make people aware while not creating excessive concern, and alleviate their fears about what to do when something happens.”
Bottom line — help them understand what they need to do so they don’t panic.
“The things that I emphasize are a calm, demeanor, a semblance of order, and the avoidance of panic,” says Eric B. Larson, MD, MPH, chair of the board of regents for the American College of Physicians. “This is absolutely the most valuable thing to bring to the situation.
“It’s also advanced planning.  It’s not the person’s personality that allows [him or her] to be calm in a frightening situation. It’s a sense of mastery, preparedness, and doing what you need to do when it matters.”
For chronic illnesses such as epilepsy, diabetes, and severe food allergies, such as peanut allergies, there are specific dos and don’ts. Make sure your co-workers understand what these rules are, so they are fully prepared when it matters most.
Epilepsy
What should someone do if you have a seizure? Here’s a list of what to do and what not to do. Print out the following and share it with friends and family:
Loosen clothing around the person’s neck.
Do not try to hold the person down or restrain her; this can result in injury.
Do not insert any objects in the person’s mouth; this can also cause injury.
Reassure bystanders who may be panicking and ask them to give the person room.
Remove sharp objects (glasses, furniture, and other objects) from around the person to prevent injury.
After the seizure, it is helpful to lay the person on his or her side to maintain an open airway and prevent the person from inhaling any secretions.
After many seizures, there may be confusion for a period of time and the person should not be left alone.
In many cases, especially if the person is known to have epilepsy, it is not necessary to call an ambulance. If the seizure lasts longer than five minutes, or if another seizure begins soon after the first, or if the person cannot be awakened after the movements have stopped, someone should call an ambulance. If you are concerned that something else may be wrong or the person has heart disease or diabetes you should contact a doctor immediately.

Epilepsy Seizures and Driving

Driving with epilepsy means balancing the need for independence against the need for safety.
We would all enjoy the freedom of being able to travel independently whenever we need to. For this reason, many of us rely predominantly on cars to get to work, school, shopping, and social events. Therefore, for many young adults, obtaining a driver’s license is very important.
 
 
Each state has individual driving regulations. Those with epilepsy are required to report their condition to the Department of Motor Vehicles (DMV). However, states differ regarding the identity of the person required to do the reporting. Some states require the doctor to contact the DMV. Other states require the patient to sign a simple form at the time of application for a license or at the time of license renewal, declaring that they will notify the DMV of changes in their health status or driving ability.
When a person with epilepsy wishes to drive for the first time, an application will need to be filled out. When someone who already holds a driver’s license is newly diagnosed with epilepsy, that person is responsible to notify the proper authority.
Individuals with uncontrolled seizures have a higher risk of an accident if they drive. That is why doctors advise patients with seizures that they should not drive until their seizures are under reasonable control. If a well-controlled patient has a seizure after the doctor changes the medication, the patient may or may not be able to continue driving.
Seizures are unpredictable and even a small seizure at the wrong time can lead to an injury or death. The best solution, if possible, is to get the seizures under control. To do this, work together with your doctor to get on the right treatment and to honestly discuss your seizures with him or her.

Birth Control for Women With Epilepsy

Image of vaginal birth control device NuvaRingImage via Wikipedia
If you are a woman who has epilepsy, there are some important things you should know before using birth control or planning a pregnancy.
Any birth control that is safe for women in general, is safe for women with epilepsy. However, having epilepsy — and some treatments for the condition — can make some forms of birth control less effective. Also, since antiseizure medications for epilepsy can increase the risk of birth defects, it’s important to plan pregnancy carefully.
 
 
Birth Control and Antiseizure Drugs
If you have epilepsy and take antiseizure drugs, your birth control options could include hormones such as birth control pills or Depo-Provera injections, barrier methods like condoms or a diaphragm, or an intrauterine device (IUD). Natural family planning such as the rhythm method — abstaining on your fertile days — can also be used, although this method may not be as reliable as others. All of these methods are safe for you.
If you are taking antiseizure medications, some of these drugs can interact with some hormonal types of birth control and make them less effective. If you understand these interactions, most of the time you can use the pill and other kinds of hormonal birth control effectively.
Different types of antiseizure medications interact with hormonal birth control in different ways.
* One group of antiseizure drugs is known as “liver enzyme-inducing” drugs. They increase the rate at which the liver breaks down the contraceptive hormones that you get from birth control. This means that the contraception medication will leave your body faster. Liver enzyme-inducing drugs include carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), phenytoin (Dilantin), phenobarbital (Luminal), primidone (Mysoline), and topiramate (Topamax). If you are taking one of these drugs, it can make your hormonal birth control less effective.
* Two drugs — valproate (Depakote) and felbamate (Felbatol) — can even increase hormonal levels. If you are on one of these drugs, your doctor may need to adjust the dosage of your birth control so that you don’t have too much of the contraceptive in your body.
* Finally, there are “neutral” drugs which don’t have any effect on hormone breakdown. Gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), clobazam, clonazepam, ethosuximide, Lyrica, sodium valproate, Zonegran, and tiagabine (Gabitril) will not interfere with your birth control.
Reliable Birth Control When You Have Epilepsy
If you are taking a liver enzyme-inducing drug, and you want to use hormonal birth control, you should talk to your neurologist and your gynecologist. It is a good idea to use a second method of birth control as a backup. Barrier methods, like condoms or diaphragms, are good options.
In the past, doctors have sometimes prescribed higher-dose birth control pills to make up for the rapid breakdown of the contraceptive drug. That may work, but there is no clear research to tell us one way or the other. “Doctors used to say that increasing the amount of the estrogen in the pill took care of this problem,” says Jacqueline French, MD, co-director of the Epilepsy Center at the University of Pennsylvania in Philadelphia. “But we have no data to confirm that.”
In one case, hormonal birth control might make your antiseizure drug less effective. That can happen if you are taking lamotrigine (Lamictal). The body’s levels of Lamictal appear to be reduced when a woman takes hormonal birth control. “This is the only antiseizure drug we know of that acts like that,” says Mark Yerby, MD, MPH, founder of North Pacific Epilepsy Research in Portland, Oregon. “If Lamictal is controlling a woman’s seizures very well, and she begins to take the pill, sometimes the seizure control is not as good.” (Lamictal and other seizure medications can also become less effective when a woman is pregnant.)
Hormonal methods like the pill, Depo-Provera, and others are not the only way to prevent pregnancy. Barrier methods are an effective option for many women. They are not affected by the medication that you take to control your seizures. Condoms, diaphragms, and new-generation IUDs are all choices you can consider.
What if you want to use natural family planning to prevent pregnancy? There are a number of natural family planning methods. In general, they work by tracking your menstrual cycle, and that’s why you probably want to reconsider using this method. If you have epilepsy, there is more of a chance that your cycles are irregular. That would make natural family planning very unreliable for you.
Epilepsy and Planning Ahead for Pregnancy
If you have epilepsy, keep in mind how important it is for you to plan ahead for a pregnancy. As part of that planning, be sure to start taking folic acid supplements before getting pregnant. It’s a good idea for women with epilepsy who are of childbearing age to start taking 0.4 milligrams a day of folic acid just in case they get pregnant. This helps prevent birth defects of the spinal cord and brain.
And as you think about what kind of birth control is right for you and do your planning, it’s important to talk with your neurologist and your gynecologist. Both of these doctors should be very involved in your care. Each of them needs to know about the drugs or treatments that the other prescribes.
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Diagnosing Epilepsy

This is a transaxial slice of the brain of a 5...Image via Wikipedia
The evaluation of patients with epilepsy is aimed at determining the type of seizures (epileptic versus nonepileptic) and their cause, since various seizure types respond best to specific treatments. The epilepsy diagnosis is based on:
* The patient’s medical history, including any family history of seizures, associated medical conditions and current medications. Some important questions you will be asked include:
o At what age did the seizures begin?
o What circumstances surrounded your first seizure?
o What factors seem to bring on the seizures?
o What do you feel before, during, and after the seizures?
o How long do the seizures last?
o Have you been treated for epilepsy before?
o What medications were prescribed and in what dosages?
o Was the treatment effective?
* Others who have often seen you before, during, and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness.
* A complete physical and neurological exam of muscle strength, reflexes, eyesight, hearing, and ability to detect various sensations are tested so your doctors can better understand the cause of your seizures
* An electroencephalogram (EEG) test, which measures electrical impulses in the brain*
* Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI)
* Blood tests to measure red and white blood cell counts, blood sugar, blood calcium, and electrolyte levels; and to evaluate liver and kidney function. Blood tests help rule out the presence of other illnesses.
* Other tests, as needed, including magnetic resonance spectroscopy (MRS), positron emission tomography (PET) and single photon emission computed tomography (SPECT)
*The most important part of the evaluation is the electroencephalogram (EEG) because it is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain’s electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.
 
 
A routine EEG only records about 20 minutes of brain waves (however, the entire EEG procedure takes about 90 minutes). Because 20 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have epilepsy. Therefore, prolonged EEG monitoring may be necessary.
Prolonged EEG-video monitoring is an even better diagnostic method. During this type of monitoring, an EEG monitors the brain’s activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special hospital facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy
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Types of Epilepsy

A fMRI scan showing regions of activation in o...
Epilepsy is the occurrence of sporadic electrical storms in the brain commonly called seizures. These storms cause behavioral manifestations (such as staring) and/or involuntary movements (such as grand mal seizures).
There are several types of epilepsy, each with different causes, symptoms, and treatments.
When making a diagnosis of epilepsy, your doctor may use one of the following terms: idiopathic, cryptogenic, symptomatic, generalized, focal, or partial. Idiopathic means there is no apparent cause. Cryptogenic means there is a likely cause, but it has not been identified. Symptomatic means that a cause has been identified. Generalized means that the seizures are involving the whole brain at once. Focal or partial means that the seizure starts from one area of the brain.
 
Idiopathic Generalized Epilepsy
In idiopathic generalized epilepsy, there is often, but not always, a family history of epilepsy. Idiopathic generalized epilepsy tends to appear during childhood or adolescence, although it may not be diagnosed until adulthood. In this type of epilepsy, no nervous system (brain or spinal cord) abnormalities other than the seizures have been identified as of yet. The brain is structurally normal on a brain magnetic resonance imaging (MRI) scan.
People with idiopathic generalized epilepsy have normal intelligence and the results of the neurological exam and MRI are usually normal. The results of the electroencephalogram (EEG — a test which measures electrical impulses in the brain) may show epileptic discharges affecting the entire brain (so called generalized discharges).
The types of seizures affecting patients with idiopathic generalized epilepsy may include:
* Myoclonic seizures (sudden and very short duration jerking of the extremities)
* Absence seizures (staring spells)
* Generalized tonic-clonic seizures (grand mal seizures)
Idiopathic generalized epilepsy is usually treated with medications. Some forms of this condition that may be outgrown, as is the case with childhood absence epilepsy and a large number of patients with juvenile myoclonic epilepsy.
Idiopathic Partial Epilepsy
Idiopathic partial epilepsy begins in childhood (between ages 5 and 8) and may have a family history. Also known as benign focal epilepsy of childhood (BFEC), this is considered one of the mildest types of epilepsy. It is almost always outgrown by puberty and is never diagnosed in adults.
Seizures tend to occur during sleep and are most often simple partial motor seizures that involve the face and secondarily generalized (grand mal) seizures. This type of epilepsy is usually diagnosed with an EEG.
Symptomatic Generalized Epilepsy
Symptomatic generalized epilepsy is caused by widespread brain damage. Injury during birth is the most common cause of symptomatic generalized epilepsy. In addition to seizures, these patients often have other neurological problems, such as mental retardation or cerebral palsy. Specific, inherited brain diseases, such as adrenoleukodystrophy (ADL) or brain infections (such as meningitis and encephalitis) can also cause symptomatic generalized epilepsy. When the cause of symptomatic general epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. These epilepsies include different subtypes — the most commonly known type is the Lennox-Gastaut syndrome.
Multiple types of seizures (generalized tonic-clonic, tonic, myoclonic, tonic, atonic, and absence seizures) are common in these patients and can be difficult to control. Learn more about these seizure types.
Symptomatic Partial Epilepsy
Symptomatic partial (or focal) epilepsy is the most common type of epilepsy that begins in adulthood, but it does occur frequently in children. This type of epilepsy is caused by a localized abnormality of the brain, which can result from strokes, tumors, trauma, congenital (present at birth) brain abnormality, scarring or “sclerosis” of brain tissue, cysts, or infections.
Sometimes these brain abnormalities can be seen on MRI scans, but often they cannot be identified, despite repeated attempts, because they are microscopic.
This type of epilepsy may be successfully treated with surgery that is aimed to remove the abnormal brain area without compromising the function of the rest of the brain. Epilepsy surgery is very successful in a large number of epilepsy patients who failed multiple anticonvulsant medications (at least two or three drugs) and who have identifiable lesions. These patients undergo a presurgical comprehensive epilepsy evaluation in dedicated and specialized epilepsy centers.
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Symptoms of Epilepsy and Seizures

PET scan of a human brain with Alzheimer's disease
Epilepsy Symptoms

Almost any type of behavior that happens repetitively may represent a seizure.

* Generalized seizures: All areas of the brain (the cortex) are involved in a generalized seizure. Sometimes these are referred to as grand mal seizures.

o To the observer, the person experiencing such a seizure may cry out or make some sound, stiffen for some seconds, then have rhythmic movements of the arms and legs. Often the rhythmic movements slow before stopping.

o Eyes are generally open.

o The person may not appear to be breathing. The person is often breathing deeply after an episode.

o The return to consciousness is gradual and should occur within a few moments.

o Loss of urine is common.

o Often people will be confused briefly after a generalized seizure.

* Partial or focal seizures: Only part of the brain is involved, so only part of the body is affected. Depending on the part of the brain having abnormal electrical activity, symptoms may vary.

o If the part of the brain controlling movement of the hand is involved, for example, then perhaps only the hand may show rhythmic movements or jerking.

o If other areas of the brain are involved, symptoms might include strange sensations or small repetitive movements such as picking at clothes or lip smacking.

o Sometimes the person with a partial seizure appears dazed or confused. This may represent a partial complex seizure. The term complex is used by doctors to describe a person who is between being fully alert and unconscious.

* Absence or petit mal seizures: These are most common in childhood.

o Impairment of consciousness is present with the person often staring blankly.

o Repetitive blinking or other small movements may be present.

o Typically, these seizures are brief, lasting only seconds. Some people may have many of these in a day.

o Other seizure types exist, particularly in very small children.

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Understanding Seizures and Epilepsy

A chimpanzee brain at the Science Museum LondonImage via Wikipedia

What Is a Seizure and What Is Epilepsy?

Seizures — abnormal movement or behavior due to unusual electrical activity in the brain — are a symptom of epilepsy. But not all people who appear to have seizures have epilepsy. In contrast, epilepsy is a group of related disorders characterized by a tendency for recurrent seizures.

Non-epileptic seizures (called pseudoseizures) are not accompanied by abnormal electrical activity in the brain and may be caused by psychological issues or stress. This type of seizure may be treated with psychiatric intervention.
 
Provoked seizures are single seizures that may occur as the result of trauma, low blood sugar (hypoglycemia), low blood sodium, high fever, or alcohol or drug abuse. Fever-related (or febrile) seizures may occur during infancy and children usually outgrow them by age 6. After a careful evaluation to estimate the risk of recurrence, patients who suffer a single seizure may not need treatment.

Seizure disorder is a general term used to describe any condition in which seizures may be a symptom. In fact, seizure disorder is so general that it is not a useful term. Unfortunately, “seizure disorder” is often used to avoid the term epilepsy.

Who Is Affected by Epilepsy?

Epilepsy is a relatively common condition, affecting 0.5% to 1% of the population. In the United States, about 2.5 million people have epilepsy. In fact, about 9% of Americans will have at least one seizure during their lives

What Causes Epilepsy?

Epilepsy occurs as a result of abnormal electrical activity originating from the brain. Brain cells communicate by sending electrical signals in an orderly pattern. In epilepsy these electrical signals become abnormal, giving rise to an “electrical storm” that produces seizures. These storms may be within a specific part of the brain or be generalized, depending on the type of epilepsy.

Types of Epilepsy

Patients with epilepsy experience more than one seizure type. This is because seizures are only symptoms. Therefore, it is essential that your neurologist diagnose your type of epilepsy, not just the type(s) of seizure you are having.

How Is Epilepsy Treated?

The majority of epileptic seizures are controlled through drug therapy. Diet may also be used along with medications.

In certain cases in which medications and diet are not working, surgery may be used. The type of treatment prescribed will depend on several factors including the frequency and severity of the seizures as well as the person’s age, overall health, and medical history.

An accurate diagnosis of the type of epilepsy is also critical to choosing the best treatment.

Coping With Epilepsy

Educational, social, and psychological treatment are all part of the total treatment plan for epilepsy. The most important step you can take is to seek help as soon as you feel less able to cope. Epilepsy is best managed by a team of doctors allowing the patient not only to have medical but psychosocial and educational supports. If you have a problem with school, work, or daily activities, it is important for you to discuss it with a member of the epilepsy team.

Taking action early will enable you to understand and deal with the many effects of epilepsy. Learning to manage stress will help you maintain a positive physical, emotional, and spiritual outlook on life. There are specialists on the team who can help you including social workers, financial counselors, and many others.

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Epilepsy Letter # 3

Gehirn lobi seitlich

Dear Stacey,

I have simple partial seizures. Sometimes they are borderline complex partial. Medication has not totally controlled my seizures and I am not a candidate for epilepsy surgery. My medication reduces my seizures from fifty to sixty seizures a day to seven to twelve a day. I had my first seizure at age forty-two. I am now age forty-seven. The doctors do not know why my seizures began. I have had many tests, but no answers. I still hope one-day new research will produce a new medicine that will give me freedom from seizures.

I face the challenge of dealing with my epilepsy in many ways. Number one is through prayer. Secondly, I use every chance to educate someone about the subject of epilepsy or seizures. I often find out that many people are surprised that I do not fall onto the floor or violently shake when I have a seizure. They are not aware that there is more than one type of epilepsy. They wrote me once up in a newspaper article for our local paper and I was featured in an article about epilepsy for Women’s Day magazine. Epilepsy still unfortunately, has many stigmas and until we can talk about it freely and educate the public, many of those stigmas will remain. A doctor or counselor can talk about it all day. You and I are the people who live with it and should explain to the public what it really feels like.

I believe this person has also realized that epilepsy is beginning to come out into the open, but there is still a lot of work to be done in educating the public on epilepsy. When I read this letter, I felt very proud of her because she used what she had to help others. She reached out so others could understand what the disorder is. By following her goals and dreams, she was able to pursue her life and not let epilepsy stand in her way.

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Happy New Year

Epilepsy Awareness RibbonImage by Cynr via Flickr

Dear Epilepsy Recovery Readers,

Thank you for your comments on http://www.epilepsyrecovery.blogspot.com/ throughout the year and every now and then. It’s greatly appreciated! This is my prayer for you for 2011: May your ups outweigh your downs. May your smiles outweigh your frowns. May you always feel as young as you are today. May your faith and joy in life prosper in every way. May the words that you write and the things you say in 2011, grant you love and peace from Our Father who art in Heaven.

HAPPY NEW YEAR dear friend!

Your Friends at Epilepsy Recovery

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Epilepsy Letter # 6

Temporal lobe(red). Polygon data are from Body...

Dear Stacey,

I often read the letters in Epilepsy USA, so I have found yours quite interesting. I found growing up what they finally diagnosed as psychomotor epilepsy rather than petite-mal.

I had removal of 2/3 of the right temporal lobe and graduated in 1958. Try explaining that to those many people who through the years looked at me as though (and thought) the devil possessed me or else I was a witch! People kept children in some cases from playing with me.

I could not really understand what was happening to me or why. It was not something that we discussed outside the family either.

In fact, to the day she died last year, my mother was horrified that I should tell my friends I had epilepsy! After all, what would her friends think?

I went off to college to major in agriculture. I found out that due to surgery my seizures were less. Nevertheless, the people with whom I was in contact accepted my epilepsy and my social life was great.

I am convinced students away for college drop the fear of their parents! Bosses, friends and, of course, my husband accept my epilepsy-that is the way it has gone.

I believe this woman had difficultly growing up with epilepsy because not until recently was epilepsy brought out into the open. Many people did not know what seizures were and when they saw someone go into a convulsion they did not know to react. People with epilepsy were looked at strangely and were singled out. This strong young woman did not let her past affect her. She went on with her life and got a college degree. She met friends who accepted her epilepsy. She got married and created a family for herself. She reached out for help through medical attention and the magazine Epilepsy USA.

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