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Epilepsy - Research Paper - Final

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1. Epilepsy Sharlene Toirac Panther ID: 3001622 Florida International University HSC 4553 – Fundamentals of Pathology November 13, 2016 2. Toirac 2 Epilepsy is a…
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  • 1. Epilepsy Sharlene Toirac Panther ID: 3001622 Florida International University HSC 4553 – Fundamentals of Pathology November 13, 2016
  • 2. Toirac 2 Epilepsy is a neurological condition which affects the nervous system and causes seizures (Sirven, M.D. & Shafer, RN, MN, 2014). Seizures are a sudden surge of electrical activity between neurons in the brain, caused by chemical changes in the nerve cells. Brain cells can either provoke or impede cells from sending information. Normally, brain cells should send information that balance neurological activity; however, during a seizure, there may be too much or too little cell activity, causing an imbalance of information sent to the brain (Sirven, M.D. , Schachter, M.D., & Shafer, RN, MN, 2014). It is believed that seizures are not a disease; instead, they are symptoms of various brain disorders (Sirven, M.D. , Schachter, M.D., & Shafer, RN, MN, 2014). Many things can happen while experiencing a seizure, along with anything the brain and body can do regularly. It can take many forms, and affect individuals in different ways. Normally, there are 3 phases individuals experience: aura, ictal, and postictal. The aura phase is considered a warning sign; and although not everyone experiences this, it is the first phase of a seizure. Some symptoms correlated to the aura phase include: déjà vu, dizziness, headache, nausea, visual loss, etc. The ictal phase follows the aura phase; and during this phase, the imbalance of cell information occurs. Some symptoms related to this phase include: loss of awareness, confusion, feeling detached, difficulty speaking, unable to swallow, etc. Lastly, the postictal phase, which is the recovery phase. This phase varies from person to person, where some recover fast, while others may take minutes to hours to regain normality. Some symptoms of the postictal phase include: anxiety, memory loss, thirst, sleepiness, etc. (Schachter, MD , Shafer, RN, & Sirven, MD, What Happens During a Seizure? , 2014). It is estimated that 65 million people in the world suffer from epilepsy, of which 3 million are located in the United States (Sirven, M.D. & Shafer, RN, MN, 2014). In the United States, 150,000 people are diagnosed with epilepsy yearly. Over a person’s lifetime, it is estimated that 1 in every
  • 3. Toirac 3 26 individuals will develop epilepsy at some point in their lives (Shafer RN, MN & Sirven, MD, 2013). Epilepsy affects all ages, genders, and ethnicities. Regarding ethnicities, Hispanics are most likely to experience epilepsy. Additionally, it is more common for whites to experience active epilepsy than blacks, but more common for blacks to experience epilepsy over a lifetime than white individuals. Even though the causes for these differences are foreign, receiving the proper health care is vital. For example, individuals with a lower socioeconomic status have a greater chance at developing epilepsy (Schachter, MD, Shafer, RN, & Sirven, MD, Who Gets Epilepsy? , 2013). Epilepsy and seizures differentiate depending on the age group; such as, the diagnosis of the disorder, any concerns and issues that arise, and any psychosocial problems that individuals experience. New cases show that epilepsy happens more often in a child’s first year of life, and the chances of happening gradually decrease as the child reaches 10 years old. Common causes for epilepsy in newborns and infants are: lack of oxygen at birth, brain malformation, inborn errors in metabolism, fever, infections, etc. Additionally, common causes for epilepsy in older children and adults include head tumors, genetic factors, congenital conditions, and progressive brain disease (Schachter, MD, Shafer, RN, & Sirven, MD, 2013). Nearly 300,000 American children, under 14 years of age, have epilepsy. Although every individual has a different experience, for some it is a temporary issue and are able to control the seizures through medication, while others may suffer their entire life with this disorder (Sirven, MD & Shafer, RN, MN, For Youth, 2014). Lastly, there are 300,000 senior citizens in the United States with epilepsy, and they tend to blame their age for this disorder (Sirven, MD & Shafer, RN, MN, Epilepsy and the Senior Community, 2014). After the age 55, an increase in rates for new cases occurs because of Alzheimer’s, strokes,
  • 4. Toirac 4 and brain tumors (Schachter, MD, Shafer, RN, & Sirven, MD, Who Gets Epilepsy? , 2013). Because of the patient’s age and medications, epilepsy may cause other problems, such as: an increase for falls, broken bones, and loss of independence. Even though epilepsy isn’t life- threatening, it adds extra strain to an elder’s heart, while possibly depleting their oxygen. Luckily, a lot of seniors’ seizures can be controlled efficaciously (Sirven, MD & Shafer, RN, MN, Epilepsy and the Senior Community, 2014). Treatment and concerns for epilepsy also vary by gender. Throughout a woman’s lifetime, she experiences hormonal changes that give rise to the probability of becoming epileptic. For example, during pregnancy, an epileptic woman needs special attention so she can get the proper epilepsy treatment. The life stage of a woman (puberty, pregnancy or menopause) can trigger the start, stop or change of seizures. Caring for epileptic pregnant women requires special care to guarantee the health of the mother and baby; however, studies show that epileptic women can give birth to healthy babies. In order for this to occur, medication given to expecting mothers have to be altered to lower the risk of birth defects. It is imperative for epileptic women to plan ahead if they want to get pregnant (Shafer, RN, MN, Women and Epilepsy, 2014). Epilepsy can be related to a brain injury or be hereditary. Statistics vary depending on which parent, or if both parents, carry this disorder in their genes. The chances of someone, without epilepsy, having kids with this disorder are very low. If both parents are epileptic, the risk of the child being epileptic can be 15% to 20% higher. If the mother of the child is epileptic, the chances of the child being epileptic are slim: roughly around 5 out of 100 cases (Schachter, MD, Sirevn, MD, & Shafer, RN, MN, Is Epilepsy Inherited?, 2013). Lastly, studies have shown that children born from an epileptic father possess a 2.4% greater risk for epilepsy. Along with epilepsy, they
  • 5. Toirac 5 can also suffer from neurofibromatosis, tuberous sclerosis and juvenile myoclonic epilepsy (Sirven, MD & Shafer, RN, MN, Men and Epilepsy, 2014). In 6 out of 10 cases, where the root of the epilepsy is unknown, epilepsy is due to how genes function in the brain. It is difficult to understand the bond between genes and seizures; and sadly, genetic testing is not available for many types of epilepsy. In three out of ten individuals, the structure of the brain becomes altered causing electrical outbursts of seizures. Similarly, three out of ten children, within the autism spectrum, also experience seizures from unknown causes. Infections to the brain are also common with epilepsy, and often leave scarring of the brain causing future seizures after being treated with medication (Schachter, MD, Shafer, RN, & Sirven, MD, 2013). Although epileptics can live a full, healthy life, some cases end in death. Most of these deaths include accidents, suicide, brain tumors or infections. Epilepsy suicide has increased, ranging from 3.8 to 5.8 times higher than any other death caused by this disorder (Shafer, RN, MN & Sirven, MD, Suicide Risk , 2013). Conversely, the leading cause of death in adults with uncontrolled seizures is known as Sudden Unexpected Death in Epilepsy (SUDEP), where 1 out of 150 individuals are at risk; however, if the seizures are controlled, the death rate is 1 in a 1000 (Shafer, RN, MN , Mortality, 2013). SUDEP is a startling death of an epileptic who was otherwise known to be healthy. The person is often found dead, lying face down in bed, and without any signs of previous convulsions. Studies have shown that an epileptic can pass away by suffocating from impaired breathing, fluid in the lungs or being face down in bed. The best way to prevent this is to have epileptics’ seizures controlled, and by taking the proper medications regularly (Wright, 2013).
  • 6. Toirac 6 Unfortunately, epilepsy has been around for thousands of years, and only started to be understood within the past hundred years after the Babylonians mentioned it (History of Epilepsy). Throughout many cultures, such as Americans, Greeks, and Romans, it was believed that individuals, including children, with epilepsy were pariahs because they were demonically possessed. Many states had laws that prohibited marriage or required sterilization of individuals with this disorder (History of Epilepsy, n.d.). The father of medicine, Hippocrates, had a different take on this disorder. He believed it was a natural disorder and could be treated through natural methods. Different cultures viewed epilepsy differently, but it wasn’t until 1873 that John Hughlings Jackson became the first to explain the electrical theory of epilepsy. In the 1930’s, Hans Berger became the first person to test this theory by inventing the electroencephalogram (EEG). After this, a variety of drugs and treatments were developed. In the past, many companies refused to hire epileptics; but in the 1990’s the American’s with Disabilities Act prevented epileptics from being discriminated for a job position (History of Epilepsy). Despite the major achievements throughout the years, it is imperative to continue research in study, treatment, and the social view of epilepsy. Several tests are performed to determine the cause of seizure, which include: blood work, neurological exams, EEG, CT-scans, MRI’s, fMRI’s, PET-scan, and SPECT. Each of these exams pinpoint the location of the brain where seizures occur, which areas are affected, detect abnormalities, and allow the doctor to provide the patient with the best treatment possible (Epilepsy - Diagnosis, 2015). By using incidence and prevalence cases, researchers have been able to determine the rates for epilepsy. Incidence shows the number of new cases in a given year or time frame; for example, there are 150,000 patients with this disorder in the United States. While prevalence shows the number of individuals at any given point in time; for example, 1 in 26 people
  • 7. Toirac 7 develop this disorder throughout their lifetime. Furthermore, the number of prevalence cases ranges from 1.3 to 2.8 million individuals. Throughout their lifetime, 165 out of 10,000 people experience epilepsy some time throughout their lives. (Shafer RN, MN & Sirven, MD, 2013). “No seizures, no side effects”; an epileptics’ goal is to learn to control their seizures. It is imperative for the epileptics’ family members and friends to know what to do during and after a seizure occurs, because things could get complicated (Sirven, MD, Schachter, MD, & Shafer, RN, MN, Treating Seizures and Epilepsy, 2013). Sometimes, epileptics can get injured during convulsions, and the most common injuries include: cuts, bruises, and burns. However, head trauma, broken bones, choking, and drowning cannot be ruled out. Other medical complications may arise due to pregnancy or thereafter; such as, pneumonia and head injuries (Sirven, MD, Schachter, MD, & Shafer, RN, MN, Injuries and Illnesses, 2013). During a seizure, one can protect the person from injuries by moving furniture or other objects away, preventing them from falling, and turning them to the side so that any body fluids can leak from their mouths. After a seizure, a person can be examined for injuries, loosen tight clothing around their neck and waist to allow them to breathe better, seek a safe area so the person can rest, and stay with the person until they are fully awake and aware of their surroundings (Seizures - Home Treatment, 2014). If an epileptic suffers from minor injuries, they may be treated at home; however, head injuries, trouble breathing, drowning, broken bones, or any other complication that may occur within hours or days of a seizure should be treated by professionals at a hospital (Sirven, MD, Schachter, MD, & Shafer, RN, MN, Injuries and Illnesses, 2013). It is also important to seek medical help if the individual suffers from a cluster of seizures and epilepticus of seizures, which is when seizures occur too often and last longer than usual (Sirven, MD, Schachter, MD, & Shafer, RN, MN, Seizure Emergencies, 2013).
  • 8. Toirac 8 Although there is no cure at the time, most seizures are controlled by medications prescribed depending on the severity and frequency of their seizures, the person’s age, their health status, and their medical history. Some medications include Carbamazepine, Diazepam, Phenobarbital, and Felbamate. It is estimated that 70% of patients can control their seizures after taking these medications. Nonetheless, every medication has side-effects that depend on the medication prescribed and the length of the treatment. Many patients start this treatment by receiving low dosages and gradually increasing to prevent side-effects, such as: double vision, fatigue, stomach upset, liver problems, skin rashes, low blood cell counts, gum swell, hair loss, and weight gain. The duration of epilepsy can vary between years to a lifetime. Although, patients who remain seizure-free for a given amount of time can be taken off medications. Another treatment for epilepsy includes a ketogenic diet; however, this treatment depends on the type of seizure the patient experiences. This diet is commonly used by children through careful planning and clear procedures. Therefore, it is not recommended for older children or adults. This treatment usually begins in a hospital setting and then upheld for two or three years thereafter (Lava, MD, 2016). In rare cases, a surgery is performed if two or three medications have failed to control the patient’s seizures. Just about 30% (more than 100,000 in the United Stated) of patients cannot control their seizures, but only 3,000 patients undergo this procedure in a year. Before this procedure takes place, patients have to have pre-surgical exams to make sure this procedure will not cause any damage to vital functions (speech and memory) and to make sure it will benefit the seizures. This exam entails tests, such as, an EEG-video monitoring that is used to identify the location of the damaged brain cells. Depending on the location of these brain cells, doctors can determine if the surgery can be performed and the procedure used. Furthermore, the eligibility for surgery to take place includes an acceptance from the neurosurgeon, neuroradiologist,
  • 9. Toirac 9 neuropsychologist, social worker, epileptologist and the patient after reviewing the risks and benefits of having the surgery (Lava, MD, 2016). Individuals with epilepsy have been shunned from the public, considered demonically possessed, and thought to be contagious. Throughout years, researchers have changed their point of view on epilepsy and have learned that it is uncontrollable. Medications and treatments have been produced to help epileptics gain control of their seizures, know when they’re most at risk, and know the symptoms leading up to the seizure. Epilepsy doesn’t only affect humans; it also affects animals. My dog has suffered from epilepsy for the past 4 years, he gets a cluster of seizures at least once a week. Like humans, he goes through phases and I am able to prepare him and myself for the seizures. Similar to human prescribed medications, he is taking Diazepam for his seizures; however, this has not fully controlled them. It is important for more extensive research to be performed to find a permanent cure for epilepsy. It is heartbreaking watching the ones you love go through this and possibly get hurt in the process.
  • 10. Toirac 10 References Epilepsy - Diagnosis. (2015, November 6). Retrieved from MayoClinic : http://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis- treatment/diagnosis/dxc-20117234 History of Epilepsy. (n.d.). Retrieved from Epilepsy Education Everywhere: http://epilepsyed.org/history-of-epilepsy/ History of Epilepsy. (n.d.). Retrieved from North Dakota State University: http://nawrot.psych.ndsu.nodak.edu/courses/465Projects05/epilepsy/History.htm Lava, MD, N. (2016, January 16). Treatment Options for Epilepsy. Retrieved from Webmd: http://www.webmd.com/epilepsy/guide/treating-epilepsy?page=3 Schachter, MD , S. C., Shafer, RN, P. O., & Sirven, MD, J. I. (2014, March). What Happens During a Seizure? . Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/epilepsy-101/what-happens-during-seizure Schachter, MD, S. C., Shafer, RN, P. O., & Sirven, MD, J. I. (2013, July). What Causes Epilepsy? Retrieved from Epilepsy Foundation : http://www.epilepsy.com/learn/epilepsy-101/what- causes-epilepsy-and-seizures Schachter, MD, S. C., Shafer, RN, P. O., & Sirven, MD, J. I. (2013, July). Who Gets Epilepsy? . Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/epilepsy-101/who- gets-epilepsy Schachter, MD, S. C., Sirevn, MD, J. I., & Shafer, RN, MN, P. O. (2013, July). Is Epilepsy Inherited? Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/epilepsy- 101/epilepsy-inherited Seizures - Home Treatment. (2014, November 14). Retrieved from Webmd: http://www.webmd.com/epilepsy/tc/seizures-home-treatment Shafer RN, MN, P. O., & Sirven, MD, J. I. (2013, October). Epilepsy Statistics. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/epilepsy-statistics Shafer, RN, MN , P. O. (2013, November). Mortality. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/impact/mortality Shafer, RN, MN , P. O., & Sirven, MD, J. I. (2013, November). Suicide Risk . Retrieved from Epilepsy Foundation : http://www.epilepsy.com/learn/impact/mortality/suicide-risk Shafer, RN, MN, P. O. (2014, July). Women and Epilepsy. Retrieved from Epilepsy Foundation : http://www.epilepsy.com/learn/gender-issues/women-and-epilepsy Sirven, M.D. , J. I., & Shafer, RN, MN, P. O. (2014, January). What is Epilepsy. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/epilepsy-101/what-epilepsy Sirven, M.D. , J. I., Schachter, M.D., S. C., & Shafer, RN, MN, P. O. (2014, March). What is a Seizure? Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/epilepsy- 101/what-seizure Sirven, MD , J. I., & Shafer, RN, MN, P. O. (2014, March). Epilepsy and the Senior Community. Retrieved from Epilepsy Foundation : http://www.epilepsy.com/learn/age- groups/epilepsy-and-senior-community Sirven, MD , J. I., & Shafer, RN, MN, P. O. (2014, March). For Youth. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/age-groups/youth Sirven, MD, J. I., & Shafer, RN, MN, P. O. (2014, March). Men and Epilepsy. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/gender-issues/men-and-epilepsy Sirven, MD, J. I., Schachter, MD, S. C., & Shafer, RN, MN, P. O. (2013, August). Injuries and Illnesses. Retrieved from http://www.epilepsy.com/learn/impact/injuries-and-illnesses
  • 11. Toirac 11 Sirven, MD, J. I., Schachter, MD, S. C., & Shafer, RN, MN, P. O. (2013, August). Seizure Emergencies. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/impact/seizure-emergencies Sirven, MD, J. I., Schachter, MD, S. C., & Shafer, RN, MN, P. O. (2013, July). Treating Seizures and Epilepsy. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/treating-seizures-and-epilepsy Wright, C. (2013, August). SUDEP. Retrieved from Epilepsy Foundation: http://www.epilepsy.com/learn/impact/mortality/sudep
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