Treatments for Epilepsy:

1.) Medications:

Anti-seizure medication works best if taken regularly, around the same time each day. The aim of treatment is to stop all of your seizures with the lowest dose of the fewest number of ASMs and with the least side effects. Usually treatment starts using a single ASM at a low dose, which is increased slowly (called titration), until your seizures are controlled.  Titration meaning the MD first starts you on a therapeutic dose for you age and body weight.  If the dosage is not working he or she will increase till control of the seizure is accomplished. If your seizures are not controlled with this drug, a different ASM is usually tried (by adding in the new drug and then slowly withdrawing the first one, again doing titration-you can never stop ASMs abruptly since you would be at a high risk of a seizure). If your seizures are not controlled with a single drug, another drug might be added, so that you take two different ASMs each daye, which is not uncommon.

Most people’s seizures last the same length of time each time they happen and usually stop by themselves. However, sometimes seizures do not stop or one seizure follows another without the person recovering in between. When a seizure goes on for 5 minutes or more it is called status epilepticus (or ‘status’ for short).

Status during a tonic clonic (convulsive) seizure is a medical emergency and needs urgent treatment. Emergency medication is usually prescribed(like Valium through a IV site to do a intravenous push) to stop seizures once they have started and if they are going on longer than usual, or if someone has one seizure after another without recovering in between they maybe on a IV drip with IVPs till controlled. Specialist training is needed to give emergency medication.

Than there are also Medication trials:

At any time, a patient may be invited to participate in a trial of an experimental medication. Since about 1993, this is how all medications have received FDA approval. Often, patients are invited to join a trial after they have failed a number of other FDA-approved medications.

The advantages of participating in a clinical trial include:

● Access to new medication

● Close support and follow-up with the epilepsy team

● The opportunity to help medical researchers develop new treatments

The goal of medication clinical trials is to make sure the drugs are safe and effective. Clinical trials are experimental studies, so there is some risk involved with participating. However, clinical research teams follow extremely strict federal, state, and hospital guidelines to ensure that the risks are minimized.

Since there are so many anti-epilepsy drugs (AEDs) out there, it can get confusing talking to your doctor and pharmacist about them.  Here is a list of seizure medications listed to help you understand the seven most widely used Anti-epileptic Drugs-AEDs in the US that are FDA approved. 

7 most common seizure medications used for epilepsy:

When you are first diagnosed with epilepsy, your doctor will usually try to treat the condition with medication. The seven AEDs in this list are the most common ‘first line’ medications used for different kinds of epilepsy.

For some people, these ‘first line’ drugs work right away. But for others, the AED either doesn’t work, or the seizure medication side effects are very unpleasant. If so, their doctor will normally try an alternative medicine. For about one-third of people with epilepsy, medication doesn’t work. Fortunately, there are other treatment options available.

1. Valproic Acid

Brand names: Depakote, Depakene

Form: Can be taken as tablets, liquids, or granules (sprinkled on food)

Treats: Generalized, focal, absence – effective with most kinds of epilepsy

Since being introduced in 1978, Valproic Acid has become the most widely prescribed AED in the world. You will usually take it once or twice per day, in varying doses, depending on your age and weight.

Valproic Acid works by making it hard for your brain cells to work as fast, which means they can’t ‘fire’ off as much during a seizure.

2. Lamotrigine

Brand names: Lamictal

Form: Comes as tablets you can swallow or chew

Treats: Generalized (tonic clonic) seizures; atonic seizures

Lamotrigine is a widely used seizure medication among people with generalized epilepsy. You’ll take the tablets once or twice per day. It works by slowing down the bursts of electrical signals in the brain that happen during a seizure. Lamotrigine appears to be one of the safer AEDs to take during pregnancy – unlike many other AED medications.

3. Topiramate

Brand names: Topamax

Form: Comes as tablets to swallow

Treats: Generalized (tonic clonic) seizures; atonic seizures; Lennox-Gastaut syndrome

Topiramate is mainly used to treat generalized epilepsy. You’ll usually take the tablets twice per day. Like with other AEDs, it works by slowing down how fast your brain cells work, which helps stop seizures from developing. It should not be used if you are pregnant.

4. Carbamazepine

Brand names: Tegretol, Curatil

Form: Comes as tablets, liquids and suppositories

Treats: Focal seizures

Carbamazepine is a sodium channel blocker which was first approved to treat epilepsy in 1968. Sodium ion channels work a bit like gates in the brain, so by blocking them carbamazepine slows down how quickly signals get sent. It should not be used if you are pregnant.

5. Phenytoin

Brand names: Dilantin

Form: Comes as tablets for swallowing or chewing tablet and as a liquid

Treats: Focal seizures

Phenytoin was first approved by the FDA in 1939. It is believed to work by blocking sodium ion channels in the brain, and therefore stops high frequency firing of electric signals in the brain.

6. Oxcarbazepine

Brand names: Trileptal, Oxtellar XR

Form: Comes as tablets form, or as a liquid

Treats: Focal seizures

Oxcarbazepine is used to treat focal seizures and comes in quick and slow release forms. It’s not fully known how this AED works, but it’s believed that it blocks sodium channels in the brain.

7. Ethosuximide

Brand names: Zarontin

Form: Comes as tablets for or as a liquid

Treats: Absence seizures

Ethosuximide is a seizure medicine which is mainly used for the treatment of absence seizures, especially for children. We still don’t know quite how it works, but it seems to stop brain cells from firing so fast.

Over the past hundred years, scientists have discovered many powerful and effective AEDs which help many people lead seizure-free lives. These advances are great news for the epilepsy community as a whole. But many people who take AEDs find that they just don’t work for them – about one third of people have “refractory epilepsy”, which means they’ve tried two or more AEDs without being able to control their seizures.  So about 30 percent or slight more of epilepsy patients unfortunately do not respond to their AED meds.

The good news is that there are several alternative ways of treating epilepsy if AEDs don’t seem to work. These include special diets and medical devices.  Ending line alternate treatment levels of controlling Epilepsy!  That is this weekend’s topic, Hurray!

“Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages.  Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.  Nearly 80% of people with epilepsy live in low- and middle-income countries.  It is estimated that up to 70% of people living with epilepsy could live seizure-free if properly diagnosed and treated.  The risk of premature death in people with epilepsy is up to three times higher than for the general population.  Three quarters of people with epilepsy living in low-income countries do not get the treatment they need.  In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination.”

World Health Organization-WHO (https://www.who.int/news-room/fact-sheets/detail/epilepsy)

Symptoms of Epilepsy:

Seizure symptoms vary depending on the type of seizure. Because epilepsy is caused by certain activity in the brain, seizures can affect any brain process. Seizure symptoms may include:

• Temporary confusion.
• A staring spell.
• Stiff muscles.
• Uncontrollable jerking movements of the arms and legs.
• Loss of consciousness.
• Psychological symptoms such as fear, anxiety or deja vu.

Sometimes people with epilepsy may have changes in their behavior. They also may have symptoms of psychosis.

Most people with epilepsy tend to have the same type of seizure each time. Symptoms are usually similar from episode to episode.

Warning signs of seizures = AURAS for some not all people diagnosed with Epilepsy.

Some people with focal seizures have warning signs in the moments before a seizure begins. These warning signs are known as aura.

Warning signs might include a feeling in the stomach. Or they might include emotions such as fear. Some people might feel deja vu. Auras also might be a taste or a smell. They might even be visual, such as a steady or flashing light, a color, or a shape. Some people may experience dizziness and loss of balance. And some people may see things that aren’t there, known as hallucinations.

Seizures are classified as either focal or generalized, based on how and where the brain activity causing the seizure begins.

Etiologies or Causes of Epilepsy:

Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:

• Genetic influence. Some types of epilepsy run in families. In these instances, it’s likely that there’s a genetic influence. Researchers have linked some types of epilepsy to specific genes. But some people have genetic epilepsy that isn’t hereditary. Genetic changes can occur in a child without being passed down from a parent.For most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
• Head trauma. Head trauma as  a result of a car accident or other traumatic injury can cause epilepsy.
• Factors in the brain. Brain tumors can cause epilepsy. Epilepsy also may be caused by the way blood vessels form in the brain. People with blood vessel conditions such as arteriovenous malformations and cavernous malformations can have seizures. And in adults older than age 35, stroke is a leading cause of epilepsy.
• Infections. Meningitis, HIV, viral encephalitis and some parasitic infections can cause epilepsy.
• Injury before birth. Before they’re born, babies are sensitive to brain damage that could be caused by several factors. They might include an infection in the mother, poor nutrition or not enough oxygen. This brain damage can result in epilepsy or cerebral palsy.
• Developmental conditions. Epilepsy can sometimes occur with developmental conditions. People with autism are more likely to have epilepsy than are people without autism. Research also has found that people with epilepsy are more likely to have attention-deficit/hyperactivity disorder (ADHD) and other developmental conditions. Having both conditions may be related to genes.

Complications

Having a seizure at certain times can be dangerous to yourself or others.

• Falling. If you fall during a seizure, you can injure your head or break a bone.
• Drowning. People with epilepsy are 13 to 19 times more likely to drown while swimming or bathing than people without epilepsy. The risk is higher because you might have a seizure while in the water.
• Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment.Many states have driver’s license restrictions related to a driver’s ability to control seizures. In these states, there is a minimum amount of time that a driver must be seizure-free before being cleared to drive. The amount of time may range from months to years.
• Trouble with sleep. People who have epilepsy may have trouble falling asleep or staying asleep, known as insomnia.
• Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby. Also, certain anti-seizure medicines increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, get medical help as you plan your pregnancy.Most women with epilepsy can become pregnant and have healthy babies. You need to be carefully monitored throughout pregnancy. Your medicines may need to be adjusted. It’s very important that you work with your healthcare team to plan your pregnancy.
• Memory loss. People with some types of epilepsy have trouble with memory.

Emotional health issues

People with epilepsy are more likely to have mental health conditions. They may be a result of dealing with the condition itself as well as medicine side effects. But even people with well-controlled epilepsy are at increased risk. Emotional health problems that may affect people with epilepsy include:

• Depression.
• Anxiety.
• Suicidal thoughts and behaviors.

Other life-threatening complications of epilepsy are not common but may happen. These include:

• Status epilepticus. This condition occurs if you’re in a state of continuous seizure activity lasting more than five minutes. Or it may occur if you have seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
• Sudden unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows that it may occur due to heart or respiratory conditions.People with frequent tonic-clonic seizures or people whose seizures aren’t controlled by medicines may be at higher risk of SUDEP. Overall, about 1% of people with epilepsy die of SUDEP. It’s most common in those with severe epilepsy that doesn’t respond to treatment.

How Epilepsy is Diagnosed with a Epilepsy Assessment:

There are several different types of epilepsy, characterized by seizures, with symptoms causing changes in awareness, muscle tone, emotions, behavior and sensory experience. Proper treatment starts with a careful assessment of the person’s seizures, which may include:

• Medical and seizure history and neurological examination, particular a neurological doctor-a neurologist and in some cases with the neurologist being the attending doctor a neurosurgeon may be following also as a consulting doctor, if needed.  Remember having a neurologist, particularly one majored in epilepsy is what you want!  This is so nothing is over looked in the care for you or your family, you want only the best.
• Neuroimaging: magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), functional MRI (fMRI)
• Electroencephalogram (EEG), including outpatient video-EEG monitoring and long-term video-EEG monitoring-The diagnosis involves conducting a careful neurological history, a 30-minute brain wave study (electroencephalogram or EEG), and imaging of the brain (magnetic resonance imaging or MRI).Sometimes we need a longer period to monitor the brain. For example, we sometimes request a 72-hour EEG which usually is performed at home. If the diagnosis is unclear, we’ll admit the patient to an epilepsy monitoring unit (EMU), where we use video and EEG to observe the patient’s seizures. Once we fully understand the patient’s type of epilepsy  the neurologist chooses the right treatment medication but if doesn’t work than the alternative treatment best for that patient.
• Wada testing
• Neuropsychological, speech and hearing evaluations
• Physical and occupational therapy
• Counseling and support services for patients and caregivers

“Epilepsy is NOT contagious. You simply can’t catch epilepsy from another person.  People with epilepsy CAN handle jobs with responsibility and stress. People with seizure disorders are found in all walks of life. They may work in business, government, the arts, and all sorts of professions. If stress bothers their seizures, they may need to learn ways to manage stress. But everyone needs to learn how to cope with stress! There may be some types of jobs that people with epilepsy can’t do because of possible safety problems. Otherwise, having epilepsy should not affect the type of job or responsibility that a person has.  Epilepsy is a chronic medical problem that for many people can be successfully treated. Unfortunately, treatment doesn’t work for everyone. AT LEAST 1 million people in the United States have uncontrolled epilepsy.   Seizures can occur due to epilepsy or other conditions.  Epilepsy is NOT rare and can occur as a single condition or may be seen with other conditions affecting the brain, such as cerebral palsy, intellectual disability, autism, Alzheimer’s disease, and traumatic brain injury.”

Epilepsy Foundation (https://www.epilepsy.com/what-is-epilepsy/statistics)

**With how long it can take a ambulance to get to their destination and than get the pt to the hospital I recommend CALL 911 Immediately if never diagnosed before or if diagnosed with after 1 minute or so in the seizure.  Since the braisn can die with NO oxygen in 7 seconds.  Keep in mind the person in a seizure does not mean they have no oxygen immediately but status epilepticus (one seizure after another) going on minutes can cause that condition.  John Travolta’s son died due to a blood disorder caused Kawasaki Disorder and the son was taken off epileptic medications 1 wk by the parents but no fault on that was proven as the reason for the child’s death by coroner’s report. 

Seizures vary from person to person depending on what type of epilepsy they have. A seizure occurs when normal signals in the brain are interrupted. With epilepsy, it is usually a burst of abnormal brain activity that causes the disruption.  There are many different types of epileptic seizures.

Types of epileptic seizures:

Remember epileptic seizures vary from person to person and their are many different factors that could have caused it.

Recently in 2017, there was a new system established to describe the different types of seizures, aimed at making it clearer for doctors to notice and understand the onset and characteristics of different seizures and treat them effectively. It is still quite complex, but the types are named based on 3 characteristics:

• Where in the brain the seizure begins, whether it is on 1 or both sides of the brain, and another factor is how much of the brain is affected, a localized area or 1/2 the brain or the entire brain. Generalized seizures usually affect both sides, while a focal seizures affects a portion of the brain.
• How aware the person is during the seizure, partially or entirely unconscious.
  
• How much movement, or ‘jerking’ there is during the seizure

Tonic clonic seizures

These are the ones most people think of when they think of fits, that people use to call them. They affect both sides of the brain and are therefore generalized seizures, the person will not be aware during the seizure and may not remember it at all, and there is considerable movement. This also used to be known as a ‘grand mal’ seizure. A person will become suddenly stiff, then usually collapse, after which the muscles will tense and relax rhythmically. This can cause shaking, grunting, foaming at the mouth, and biting as the person has no control over the muscles in the body.  The person is unconcious.

Tonic and atonic seizures

A tonic seizure involves all the muscles suddenly becoming stiff, but doesn’t have the repetitive tensing and relaxing. An atonic seizure is the opposite, where all the muscles suddenly relax and the body goes floppy. Both these types are usually very quick and the body will probably fall over, and both are considered generalized seizures affecting both sides of the brain.  Again the person is unconcious.

Clonic seizures

Clonic seizures involve the rhythmical jerking without the initial stiffening of the muscles. They can be generalized, affecting the whole body, or focal, where only one side of the body is affected.  The

Myoclonic seizures

These are smaller jerking movements, similar to the feelings some people get when falling asleep. They can happen in clusters, with a series of jerks all at once. Although the person is conscious throughout, these are considered generalized seizures, as they are usually accompanied by other generalized seizures and often affect both sides of the brain.

Absence seizures

These generalized seizures are more common in children, and involve temporary absences, almost like daydreaming. The person may miss pieces of information in a conversation, all of a sudden garbled words – not making any sense and may blink rapidly or stare into space.  You snap your fingers in front the person’s eyes and no response of the person till they come out of the seizure.  The person is unconcious temporarily.

Focal onset aware seizures

A focal seizure begins in 1 part of the brain rather than both sides or the entire brain being affected, and as such rarely involves jerking or convulsions. Focal aware seizures occur when the person is aware and not unconcious of what is going on, but may feel a strange sensation. This can be an upset stomach, a wave going through the body, or deja vu, among many other things. They are often undetectable to anyone else, although can sometimes involve movement such as lip smacking or noises.

Focal onset impaired seizures

These similarly only affect a part of the brain, but they leave the person impaired in some way. They may be confused, have a loss of memory, or be unable to communicate or understand. Recovery periods can vary as well, with some needing to sleep or rest afterwards, while others recover almost immediately.

Focal to bilateral tonic clonic seizures

Focal seizures can sometimes spread to the whole brain, resulting in a tonic clonic seizure.

Unknown onset seizures

Sometimes the origin of the seizure is unknown, usually because the seizure was not seen by anyone else or occurred during sleep. This is then called an unknown onset seizure, and future seizures may help to understand more about this person’s epilepsy.

As you can see there are many different types of epileptic seizures that occur for many different reasons as well, and within this many symptoms or possible reactions for the body and brain.  We will cover causes and symptoms this week in one of our topis for epilepsy.  Understanding the type of seizure with how a seizure starts and how a person behaves while having a seizure can help determine how best to treat the epilepsy.  People also get to know any triggers that can cause their epileptic seizures. The most common triggers are flashing lights, stress, anxiety and sleep deprivation. As we said earlier, some people stop having seizures after a while, although the reasons behind this are as unknown as the causes for many people with epilepsy,  in the first place others.

Epilepsy is a neurological condition involving the brain that makes people more susceptible to having recurrent unprovoked seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races and ethnic background. According to the CDC, almost 3 million Americans live with epilepsy and nearly 200,000 people in the U.S. develop this condition annually.

Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure; this includes a high fever, low blood sugar, alcohol or drug withdrawal, or a brain concussion. Under these circumstances, anyone can have one or more seizures. However, when a person has two or more recurrent unprovoked seizures, he or she is considered to have epilepsy. There are many possible causes of epilepsy, including an imbalance of nerve-signaling chemicals called neurotransmitters, tumors, strokes, and brain damage from illness or injury, or some combination of these. In the majority of cases, there may be no detectable cause for epilepsy.

Epilepsy is the fourth most common neurological disorder in the world. If you have epilepsy, surges of electrical activity in your brain can cause recurring seizures.

“Not all parents and caregivers experience empty nest syndrome, but those who do often describe it as “bittersweet.” It combines the melancholy of suddenly living alone, with the intrigue of finally having time for yourself.

What is empty nest syndrome?

Empty nest syndrome refers to the feelings of sadness, anxiety, and loss of purpose that some parents and caregivers feel when their grown children move out of the family home.

Empty nest syndrome isn’t a medical or psychiatric health condition listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

However, research shows that empty nest syndrome can lead to mental health issues, such as depression and anxiety, or engaging in behaviors that can have a negative impact such as financial risk-taking or substance use disorders.”

Psych Central (https://psychcentral.com/health/empty-nest-syndrome#empty-nest-defined)

Empty nest syndrome is not a clinical diagnosis. Instead, empty nest syndrome is a phenomenon in which parents experience feelings of sadness and loss when the last child leaves home. Empty nest syndrome usually happens in female parents aged between 40-50. When their children have to leave home e.g. for continuing their study in the college or university, parents have to stay home alone without routine activities with their children. Although parents might actively encourage their children to become independent, the experience of letting go can be painful. Parents might find it difficult to suddenly have no children at home who need their care. Parents might miss being a part of their children’s daily lives as well as the constant companionship. These changes might develop stress, anxiety and depression. It might eventually induce suicidal thought of the parents.

With reference to Kübler-Ross, Swiss-American psychiatrist, Grieving Process consists of 5 stages:

1. Denial and rejection;
2. Anger and acting against what had happened;
3. Bargaining for keeping the hopes;
4. Depression and grief; and
5. Acceptance of the loss.

If parents experience feelings of loss due to empty nest syndrome, advices that might help parents adapt to this major life change include accepting the timing, keeping in touch with children, seeking support if necessary and staying positive.

If the last child is about to leave home and parents are worried about empty nest syndrome, it is highly recommended to look for new opportunities in personal and professional life. Changing focus from taking care of children in the last 2-30 years, it is more beneficial to look after parent’s own health. Keeping busy or taking on new challenges at work or at home can help ease the sense of loss as well.

TIPS IN DEALING WITH THIS IN YOUR LIFE:

1 Time management tools can help you manage your time.

2 Space time out for a verse of the day, things you’re praying about, truths to remember, and even what to let go.

3 Make a Planner from daily to weekly to monthly in what you will be doing.

4 Like I say so many times as a RN, not to far from 40 years in this career, TAKE ONE DAY AT A TIME!

5 Remember anyone can start strong but the your goal should be “finish strong”.  Example, How many times have we said we would loose weight and started strong but ended weak loosing nothing putting the white flag up and restarting later all over again and it was just a broken record finishing with no results?  I have, but ending strong with starting strong is much better in results making you a more confident, stronger and happier as a person.

6 What ever your dreams are in wanting to accomplish but couldn’t with the kids at home due to busy now you can try to reach your goals you wanted to strive for.  Ex. Retired now, the kids left the nest, less to do at the house now but  you took a degree in art years ago, have been an artist at times in your working life but had to put it on hold since you had work elsewhere to do in paying the bills but not you can now do art work.  Just make sure that they are reachable goals and not impossible to reach in art work now.  So you don’t set your self up for failure.  You need to approach that before starting that new life goal.

Remember everything comes to an end, some things sooner than others of course, but it does not mean life is over!