EPILEPSY


SEIZURE TRIGGERS For many people with epilepsy, seizures can occur without any obvious cause, however certain circumstances or the use of certain substances can precede a seizure. These include stress, lack of sleep, drinking alcohol, in women – monthly periods, and flashing lights (it may be surprising to know that this is an uncommon trigger that affects only 5% of people with epilepsy, and is known as photosensitive epilepsy). People who suffer from epilepsy are often advised to keep a seizure diary. Each time a person has a seizure, they record it, and make a note of what they were doing. Over time it is often possible to find trends, and notice some potentially avoidable situations, which trigger symptoms.2


WHAT ARE THE SYMPTOMS OF EPILEPSY?


Firstly it is important to note that each person’s experience of epilepsy is unique. There are many different types of seizures, which depend on the area of the brain affected. People with epilepsy can experience any type of seizure, although most people have a consistent pattern of symptoms. Often seizures are classified as:


• Partial (or focal) seizures – where only a small part of the brain is affected


• Generalised seizures – where most or all of the brain is affected


Some seizures do not fit into these categories and are known as unclassified seizures.


FOR MANY PEOPLE WITH


EPILEPSY, SEIZURES CAN OCCUR WITHOUT ANY OBVIOUS CAUSE, HOWEVER CERTAIN CIRCUMSTANCES OR THE USE OF CERTAIN SUBSTANCES CAN PRECEDE A SEIZURE


38 - SCOTTISH PHARMACIST


Partial seizures can be further broken down into two main types:


Simple partial seizures – The person remains conscious throughout, and can experience a general “strange feeling”, a “rising feeling in the stomach”, or an intense feeling that events have happened before, called déja vu. These can sometimes be known as warnings or “auras”, because they can be an indicator that another type of seizure is on its way.


Complex partial seizures – The person loses their sense of awareness and is unable to remember what happened once the seizure has passed. This type of seizure often shows strange and apparently random bodily behavior, such as: smacking lips, rubbing hands, moving arms around, picking at clothes, fiddling with objects, adopting an unusual posture, and chewing or swallowing. During a complex partial seizure, the person will be unable to respond to anyone else and they will be unlikely able to remember the event.2


Generalised seizures can be broken down into six main types:


Absences seizures (previously petit mal) – Mainly affect children, but can also occur in adults. They cause the person to lose awareness of their surrounding, usually up to 15 seconds. The person will stare vacantly into space, although some will flutter eyes or smack their lips. Absence seizures can occur several times throughout the day. They can affect a child’s performance at school, and can be dangerous if they occur at a critical time, such as crossing a road.


Myoclonic seizures – causes arms, legs or upper body to jerk or twitch. They often only last a fraction of a second, and consciousness is usually not lost during this time. Myoclonic jerks often happen in the first few hours of waking up and can occur in combination with other seizure types.


Clonic seizures – cause similar twitching as myoclonic jerks, except the symptoms will last longer, usually up to two minutes, and in this case loss of consciousness may occur.


Atonic seizures - cause all of a person’s muscles to suddenly relax. This will usually result with a fall to the ground and there is a chance the person could be injured as a result of the fall.


Tonic seizures – cause all muscles to suddenly become stiff, which can result in a loss of balance, ending with a fall. Similarly to atonic seizures, often it is the fall that causes the injury.


Tonic-clonic seizures (previously grand mal) – Initially the body becomes stiff, and then arms and legs will begin to twitch. The person will loose consciousness and some people will lose the control of their bladder. The seizure usually lasts a few minutes, but can last longer. This is what most people think of as an epileptic fit.


If a person is having a seizure, there are a number of simple things you can do to assist them. It is important to protect the person from injury by removing any dangerous or potentially harmful objects nearby, and cushioning their head. Avoid the urge to restrain them, and when the convulsions have stopped, put them in the recovery position. Stay with them and comfort them until they have fully recovered. It is not usually necessary to call an ambulance after a seizure, however medical help should be sought if: the seizure has not stopped after 5 minutes, the person has more than one seizure without recovering in between, you know it is the persons first seizure, the person is injured or has breathing difficulties, or the person’s behavior after a seizure is unsafe.


Status epilepticus – is the name for any seizure that lasts longer than 30 minute, or a series of seizures where the person does not regain consciousness in between. This is a medical emergency and requires treatment as soon as possible. If you have been trained to treat this condition, you will usually have been advised to use diazepam administered rectally, or buccal administration of midazolam.4


HOW IS EPILEPSY TREATED? Treatment for epilepsy is used to control seizures, although not everyone with the condition will need to be treated. In some instances simply avoiding that person’s triggers can control their seizures. Anti-epileptic drugs (AEDs) are usually the first choice of treatment for epilepsy, and this leads to approximately 70% of people with the condition able to control their seizures. AEDs are normally commenced following a second seizure. The type of AED recommended for a patient will


depend on a number of factors, including the type of seizure they have, their age, if they are taking interacting medicines, and whether they are pregnant or breastfeeding. Examples of commonly used AEDs include sodium valproate, carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, ethosuximide, and topiramate. AED treatment regimens are often complex with the aim to achieve seizure control. It is important that patients are fully aware of the benefits and risks of taking AEDs, and also some of the key information as to how they should be taken, for example it is important that AEDs are not started or stopped suddenly, as this can result in causing a seizure. It is important that any over-the-counter medicines are checked for interactions with AEDs, as many herbal and alternative medicines can alter their effectiveness, which could result in a loss of seizure control, even after a significant period of being seizure free.5


Epilepsy is a complex condition, with many sub-classification of seizure, multiple treatment options, and many sources of information available to help patients manage their condition. Often a cross disciplinary approach is taken in order to help a person become seizure free, and as with many chronic conditions the community pharmacy is central to the dispensing of medicines, and the dissemination of information. It is essential that pharmacy staff are aware of common conditions such as epilepsy, and as such, willing and able to provide the necessary information.


REFERENCES


1. Epilepsy Scotland website. Available www.epilepsyscotland.org.uk. Accessed 30-08-15.


2. NHS Choices website, Epilepsy introduction. Available www.nhs. uk/Conditions/Epilepsy/Pages/ Introduction.aspx. Accessed 30-08-15.


3. Epilepsy society website. Available www.epilepsysociety.org.uk. Accessed 30-08-15.


4. NHS Choices website, Epilepsy symptoms. Available www.nhs.uk/ Conditions/Epilepsy/Pages/Symptoms. aspx. Accessed 30-08-15.


5. NICE guidelines and clinical summary pathways - The epilepsies in adults. Available pathways.nice.org.uk/ pathways/epilepsy. Accessed 30- 08-15.


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