Title: Seizure-Related Emergencies
1Seizure-Related Emergencies
- Status Epilepticus and SUDEP
Evan Fertig MD, Northeast Regional Epilepsy Group
2I think I will call myself BRAIN
3Outline
- Status Epilepticus
- SUDEP
- Causes
- Prevention
- Devices
- Seizure Safety
4Case 1
- Edward is a 12 year old child with absence
seizures (staring and blinking episodes) and
grand mal (GTC) seizures who takes Depakote - His friend texts him and ask him to stay over
- Mom picks him up Sunday PM and he doesnt seem
right. He responds intermittently and is
blinking frequently. His uncle says that he has
been like this since lunch like he is in a
stupor. - EEG in ER reveals he is in absence status
epilepticus
5Status Epilepticus
TIME IS BRAIN
- A medical and neurologic emergency
- 55,000 deaths in U.S. per year
- Early recognition and treatment are essential
6Why is Status Different than Usual Seizures?
Lowenstein Epilepsia 199940120-2
7Not all Status Epilepticus is Created Equal
8Why is Status Epilepticus Dangerous?
9Treatment of Status Epilepticus
10Questions, questions, questions
- Why did Edward go into Status Epilepticus?
- How could it have been prevented?
11Causes of Status Epilepticus
- Medication Non-adherence with Known Epilepsy
- Can occur even with good medical adherence!
- No Epilepsy
- Alcohol Withdrawal
- Meningitis (Brain Infection)
- Stroke
- Head trauma
- Lack of Oxygen after Cardiac Event
12Case Continued
- The neurologist on call gives Edward ativan and
he immediately recovers - Bloodwork Low depakote level
- Seizure Action Plan/Diastat prescribed
- Neurologist and Mom talk and the conversation
comes around to worst case scenarios
13What is SUDEP?
- SUDEP stands for Sudden Unexpected Death in
Epilepsy - May be the cause of death when
- A healthy person with epilepsy dies suddenly
without drowning or trauma - The person may or may not have had a seizure
before death - No other reason for death is found upon exam
after death - Person was not using illegal drugs (example
cocaine) - Person did not have a heart attack
14What causes SUDEP?
- The exact cause is not yet known
- Some common theories causing SUDEP include
- Heart arrhythmias (abnormal heart rhythms)
- Breathing trouble
- Lack of protective brain chemicals
- A combination of causes
15Who is at risk for SUDEP?
- 1 out of 1,000 patients with epilepsy die
unexpectedly each year - In those with uncontrolled epilepsy, risk
increases to 1 out of every 150 people - Risk of SUDEP increases when
- Seizures are not well controlled (treatment
resistant epilepsy) - Treatment resistant epilepsy failure of 2
medication trials - A patient suffers from generalized tonic-clonic
(grand mal) seizures, esp at night when the
person is sleeping
16Seizure Control
17Risks in Perspective
- Overall risk of SUDEP in patients with epilepsy
- 1 in 1,000 (0.10) per year
- Risk of SUDEP in patients without seizure
control - 1 in 150 (0.66) per year
- Lifetime probability of dying in car accident
- 1 in 83 (1.2)
- 1 in 6500 chance each year
-
18Why wasnt I told about SUDEP?
- Some doctors dont know about SUDEP
- Doctors that do know about SUDEP may not discuss
it because - Not much is known about the cause or prevention
of SUDEP - No proof that one can prevent it except to
control seizures as much as possible - Some doctors feel that talking about SUDEP would
be unnecessarily frightening to some patients - Time in the office visit is short this time is
better spent making sure seizures are under
control - Not everyones risk of SUDEP is the same
19How can I reduce the risk of SUDEP?
- Reduce number of seizures
- Medication control
- Avoid triggers alcohol, sleep deprivation,
missed medications - Consider having an evaluation at an Epilepsy
Center if you have persistent seizures despite
treatment or cannot tolerate your medication - Practice good seizure safety when seizures do
happen - TRUST
- Seizure safety tips
- When to call 911
20Medication Control
- Take your medicine as instructed by your doctor
- Use pill box, alarms, reminders, etc
- Have a method to determine whether or not you
already took your dose (e.g., weekly pill box) - Do not change or stop medications without talking
to your doctor first - Call for refills long before you run out of
medicine - Each time you get your meds
- Make sure the med name, instructions, and dose
are the same - Make sure they are from the same manufacturer
- If your medicine label is different when you pick
up your meds, ask the pharmacist or call your
doctor
21Avoid Seizure Triggers
- Take your medicine. Low drug levels number 1
cause - Get enough sleep
- Avoid alcohol in excess
- Avoid specific seizure triggers if you have any
22Where Can I Find Specialist Care?
- Poor seizure control? Too many side effects?
Consider seeing a specialist at a comprehensive
epilepsy center - www.efnj.com/content/info/epilepsy_centers.htm
- Epilepsyfoundation.org
- Find closest local affiliate
- National Association of Epilepsy Centers
- www.naecepilepsy.org/find.htm
23Seizure Safety
24Seizure Safety
- What should I do if someone is having a seizure?
- TRUST
- Turn person on his or her side (especially head
at end of seizure) - Remove all objects around person (glasses, sharp
objects, etc.) - Use something soft under the persons head (but
NOT a pillow!) - Stay calm and stay with the person
- Time the length of the seizure
- Never place anything in the persons mouth!
- Do not try to restrain the person during a seizure
25When should I call 911?
- If this is the persons first seizure
- The person is pregnant or diabetic
- If the person was injured during the seizure or
does not wake up properly - If the person is having trouble breathing
- If the seizure lasts more than 5 minutes
26Seizure Safety Tips
- Never swim or bathe alone if you have
uncontrolled seizures (if you have a child, do
not bathe the child alone either) - Keep shower drains unclogged
- Do not lock bathroom door
- If possible, cook with someone else around
- Use rear burners
- Limit clutter and sharp objects in your home
- If you live alone, have routine check ins with
family or neighbors - Stop all dangerous activities if you have an aura
(stop driving if your doctor has allowed you to
drive, turn off power tools you are using, etc).
27Safety Devices to Prevent SUDEP
- There is no device proven to prevent SUDEP
- Several devices are marketed but have not been
studied - Some devices are currently under study
- Speak to your MD before purchase
28SmartWatch by SmartMonitor
29Emfit Movement Monitor (outside US and Canada
Emfit Tonic-Clonic Seizure Monitor
30Aremco
31Neurovista
32NeuroPace
33High Tech?
34Where can I learn more about SUDEP?
- Here are a list of websites with more information
on SUDEP - Epilepsy Foundation www.epilepsyfoundation.org/a
bout/SUDEP/faqs.cfm - Epilepsy. com
- www.epilepsy.com/EPILEPSY/sudep_epilepsy
- SUDEP Aware
- www.sudepaware.com
- Epilepsy Bereaved
- www.sudep.org
35Where can I get support?
- Contact your local Epilepsy Foundation for
support groups - For NJ residents www.efnj.com
- For other states, find your local Epilepsy
Foundation using - www.epilepsyfoundation.org
- Contact your local hospital for bereavement
groups - If you need to speak with a healthcare
professional in private, call your physician
36What is being done to help prevent SUDEP or
determine its cause?
- More than ever before
- Many international meetings
- Combined Epilepsy Foundation and American
Epilepsy Society Task Force (done) - National Institutes of Health multidisciplinary
2.5 day workshop (done) - Creation of the SUDEP Coalition
- EFA, AES, CURE, SUDEP Aware, Epilepsy Therapy
Project - 3 day joint meeting for scientists and consumers
being planned - June 21-24, 2012 (location to be announced)
- NIH SUDEP Center Without Walls grant
- Center for Disease Control registry?
- Areas of active research
- Animal models, devices, seizure monitoring
equipment, etc
37A Special Thanks
- A special thank you for the research and
development of the content of this presentation
and the coordination of this project done in
conjunction with EFNJ - Amy Schmelzer, MS, MPH, CTTS
- Contributors to this presentation
- Lawrence Hirsch, MD
- Evan Fertig, MD
- Eric Geller, MD
- Madeline Fields, MD
-