There are at least seven alternative (some of them are complementary) treatment for epilepsy:
1. Drug treatment
2. Ketogenic Diet
3. Vagus Nerve Stimulation
4. Brain Surgery
5. Traditional Chinese Medicines
6. Aromatherapy
7. Yoga
Drug treatment and Ketogenic Diet are the most popular alternatives.
Thursday, July 26, 2007
Wednesday, July 25, 2007
The Seizure Attack Triggers
For most cases, avoid:
1. Alcohol
2. Lack of sleep
3. Stress (ie depression, low mood & low moral)
4. Fever
For fewer cases, this might become triggers:
1. Hearing particular pieces of music
2. Reading
3. Hot showers
4. Seeing certain patterns
For a very few cases, these might become triggers:
1. Flashing lights (photosensitivity)
2. Sunlight reflecting off water
3. Passing a line of trees through which the sun is shining
4. Stroboscopic lights
Seizures are rarely triggered by movie films and high frequency computer screen.
To avoid television-induced seizures:
1. View the TV in a well-lit room
2. View the TV from an angle
3. Sit at least 2.5 metres from the TV set
4. Change the channels with a remote control rather than manually
5. Cover one eye and/or use high frequency (100 Hz) televisions
1. Alcohol
2. Lack of sleep
3. Stress (ie depression, low mood & low moral)
4. Fever
For fewer cases, this might become triggers:
1. Hearing particular pieces of music
2. Reading
3. Hot showers
4. Seeing certain patterns
For a very few cases, these might become triggers:
1. Flashing lights (photosensitivity)
2. Sunlight reflecting off water
3. Passing a line of trees through which the sun is shining
4. Stroboscopic lights
Seizures are rarely triggered by movie films and high frequency computer screen.
To avoid television-induced seizures:
1. View the TV in a well-lit room
2. View the TV from an angle
3. Sit at least 2.5 metres from the TV set
4. Change the channels with a remote control rather than manually
5. Cover one eye and/or use high frequency (100 Hz) televisions
How to Help during Seizure Attack
Watching the seizure for the first time is obviously a frightening experience. Without adequate information, you, the observer might even take actions that would endanger the life of the person.
Here are things to do when you are watching and helping a person during seizure attack:
1. Don't be panic. In most cases, the proper emergency response to an attack is simply to prevent the person from self-injury by moving him away from any dangerous object and sharp edges, placing something soft beneath the head and carefully rolling them into the recovery position to avoid suffocation
2. During a seizure, objects should never be placed in a person's mouth as this could result in serious injury to either party. Despite common talk, it is not possible for a person to swallow their tongue during a seizure. However, it is more likely the person will bite their tongue, especially if an object is placed in the mouth
3. When the person is unconscious, never attempt to rouse them. Let the seizure take its full course
4. Should the person throw up, the material should be allowed to drip out the side of the person's mouth by itself.
5. After a seizure, the person may go into a deep sleep or remain disoriented and often unaware that they have just had a seizure. Keep the person under observation until complete recovery. Do not feed them anything until they have returned to normal. The epileptic should not be allowed to wander about unsupervised. Many patients will sleep deeply for a few hours after a seizure, others get headaches which respond to medications.
It is very important that you note how long and how severe the seizure was and any mannerisms displayed during the seizure. This information will help the doctor in diagnosing the type of seizure the person gets.
It is only when a seizure lasts longer than five minutes, or if the seizures begin coming in 'waves' (one after another), then you need to rush the patient to hospital immediately.
Here are things to do when you are watching and helping a person during seizure attack:
1. Don't be panic. In most cases, the proper emergency response to an attack is simply to prevent the person from self-injury by moving him away from any dangerous object and sharp edges, placing something soft beneath the head and carefully rolling them into the recovery position to avoid suffocation
2. During a seizure, objects should never be placed in a person's mouth as this could result in serious injury to either party. Despite common talk, it is not possible for a person to swallow their tongue during a seizure. However, it is more likely the person will bite their tongue, especially if an object is placed in the mouth
3. When the person is unconscious, never attempt to rouse them. Let the seizure take its full course
4. Should the person throw up, the material should be allowed to drip out the side of the person's mouth by itself.
5. After a seizure, the person may go into a deep sleep or remain disoriented and often unaware that they have just had a seizure. Keep the person under observation until complete recovery. Do not feed them anything until they have returned to normal. The epileptic should not be allowed to wander about unsupervised. Many patients will sleep deeply for a few hours after a seizure, others get headaches which respond to medications.
It is very important that you note how long and how severe the seizure was and any mannerisms displayed during the seizure. This information will help the doctor in diagnosing the type of seizure the person gets.
It is only when a seizure lasts longer than five minutes, or if the seizures begin coming in 'waves' (one after another), then you need to rush the patient to hospital immediately.
Tuesday, July 24, 2007
Mortality Risk in Epilepsy
SSEP is a scholarly textbook on epilepsy treatment based heavily on worldwide empirical researchs. I have read the two related chapters (2 and 3) on epilepsy mortality. There are two key practical insights from those chapters:
1. Epilepsy is related with higher mortality risk. The risk arises mostly from the underlying causes of epilepsy, and also from the seizures. (L. Forsgren in "Epidemiology and Prognosis of Epilepsy and its Treatment" (Chapter 2 in SSEP p. 37): "Overall it is reasonable to conclude that epilepsy doubles or triples mortality in people with epilepsy mainly due to the underlying causes of epilepsy and less often as a direct result of seizures. Thus, the potential to reduce mortality in epilepsy through reduction or elimination of seizures may be limited in the general epilepsy population but substantial in adolescents and younger adults with intractable epilepsy where SUDEP most often occurs [141,150]." and also L. Nashef and Y. Langan in "Sudden Death in Epilepsy" (Chapter 3 in SSEP p. 43): "Mortality is increased in epilepsy. Overall standardized mortality ratios (SMRs)1 in population-based cohorts are 2-3 times that of the general population [1—4]. Much of the excess mortality is due to associated or underlying disease, but there is also a small excess due to epilepsy itself.")
Nashef and Langan further wrote that (p. 43) "Causes of death in epilepsy are listed in Table 3.1; those that are epilepsy related are to some extent preventable. Sudden unexpected death in epilepsy (SUDEP), where an otherwise well person with epilepsy dies unexpectedly with no cause found at autopsy, is the single most important category of epilepsy related deaths [5-9]......As discussed below, the evidence suggests that most, but probably not all, SUDEP deaths are related to epileptic convulsions."
The causes of deaths listed in table 3.1 are "Death from underlying/associated disease; status epilepticus; trauma, burns or drowning consequent to a seizure; deaths in a seizure with severe aspiration/airway obstruction by food, etc.; deaths provoked by habitual seizures due to coexisting cardiorespiratory disease; Deaths due to medical or surgical treatment of epilepsy; Suicide".
2. To a certain extent, the mortality risk can be managed and minimised. For the mortality risk associated with epilepsy, especially for SUDEP, Nashef and Langan recommended the following prevention strategies: Prevention of convulsions, Avoiding abrupt medication changes/non-compliance, Ensuring prompt response to seizures, and Reversing treatment interventions that worsen epilepsy control.
Those prevention strategies are currently the best we can do for the patients. This is because the causes of epilepsy remain unidentified for most patients (see Forgren in SSEP p. 26: "The cause of epilepsy is unknown in the majority of patients"), so there is almost nothing we can do for the mortality risk associated with the causes of epilepsy.
1. Epilepsy is related with higher mortality risk. The risk arises mostly from the underlying causes of epilepsy, and also from the seizures. (L. Forsgren in "Epidemiology and Prognosis of Epilepsy and its Treatment" (Chapter 2 in SSEP p. 37): "Overall it is reasonable to conclude that epilepsy doubles or triples mortality in people with epilepsy mainly due to the underlying causes of epilepsy and less often as a direct result of seizures. Thus, the potential to reduce mortality in epilepsy through reduction or elimination of seizures may be limited in the general epilepsy population but substantial in adolescents and younger adults with intractable epilepsy where SUDEP most often occurs [141,150]." and also L. Nashef and Y. Langan in "Sudden Death in Epilepsy" (Chapter 3 in SSEP p. 43): "Mortality is increased in epilepsy. Overall standardized mortality ratios (SMRs)1 in population-based cohorts are 2-3 times that of the general population [1—4]. Much of the excess mortality is due to associated or underlying disease, but there is also a small excess due to epilepsy itself.")
Nashef and Langan further wrote that (p. 43) "Causes of death in epilepsy are listed in Table 3.1; those that are epilepsy related are to some extent preventable. Sudden unexpected death in epilepsy (SUDEP), where an otherwise well person with epilepsy dies unexpectedly with no cause found at autopsy, is the single most important category of epilepsy related deaths [5-9]......As discussed below, the evidence suggests that most, but probably not all, SUDEP deaths are related to epileptic convulsions."
The causes of deaths listed in table 3.1 are "Death from underlying/associated disease; status epilepticus; trauma, burns or drowning consequent to a seizure; deaths in a seizure with severe aspiration/airway obstruction by food, etc.; deaths provoked by habitual seizures due to coexisting cardiorespiratory disease; Deaths due to medical or surgical treatment of epilepsy; Suicide".
2. To a certain extent, the mortality risk can be managed and minimised. For the mortality risk associated with epilepsy, especially for SUDEP, Nashef and Langan recommended the following prevention strategies: Prevention of convulsions, Avoiding abrupt medication changes/non-compliance, Ensuring prompt response to seizures, and Reversing treatment interventions that worsen epilepsy control.
Those prevention strategies are currently the best we can do for the patients. This is because the causes of epilepsy remain unidentified for most patients (see Forgren in SSEP p. 26: "The cause of epilepsy is unknown in the majority of patients"), so there is almost nothing we can do for the mortality risk associated with the causes of epilepsy.
Monday, July 23, 2007
The Three Most Important Questions
As soon as you or someone you love is diagnosed with epilepsy, you must immediately start to answer these three questions:
1. What should you do to help the person in seizure?
2. What should you do to prevent or minimize further seizures?
3. Is it really epilepsy?
Why should not we answer the third question first? There are four reasons. First, because the third question is much more difficult and take more time to answer --false diagnosis is very common for epilepsy. Second, epilepsy might worsen as time goes by and the probability for remission decreases as number and frequency of seizures increases. Third, risk of death in epilepsy is imminent and must be managed immediately. Fourth, very few people know how to help the person in seizure during the attack, and they even may do some mistakes that might endanger the person's life. Therefore, it is immediately important to assume that you or the person you love has been really hit with epilepsy, and hence knowledge about how to help during seizure attack dan prevention or minimization of further seizures are top priority.
That is why I put the third question as the third question, not as the first or second question.
In the next post, I will briefly review the risk of death in epilepsy. After that, I will explain how we can help the person during seizure attack.
1. What should you do to help the person in seizure?
2. What should you do to prevent or minimize further seizures?
3. Is it really epilepsy?
Why should not we answer the third question first? There are four reasons. First, because the third question is much more difficult and take more time to answer --false diagnosis is very common for epilepsy. Second, epilepsy might worsen as time goes by and the probability for remission decreases as number and frequency of seizures increases. Third, risk of death in epilepsy is imminent and must be managed immediately. Fourth, very few people know how to help the person in seizure during the attack, and they even may do some mistakes that might endanger the person's life. Therefore, it is immediately important to assume that you or the person you love has been really hit with epilepsy, and hence knowledge about how to help during seizure attack dan prevention or minimization of further seizures are top priority.
That is why I put the third question as the third question, not as the first or second question.
In the next post, I will briefly review the risk of death in epilepsy. After that, I will explain how we can help the person during seizure attack.
Sunday, July 22, 2007
References
These are the books I will cite, review and use for discussion in this blog (the list will be updated as I read new books or articles):
Simon Shorvon, Emilio Perucca, David Fish and Edwin Dodson (eds), The Treatment of Epilepsy, 2nd Edition, Massachusetts: Blackwell Science Ltd (will be referred as SSEP)
Eric J. L. Griez, Carlo Faravelli, David Nutt, & Joseph Zohar (Editors), Anxiety Disorders--An Introduction to Clinical Management and Research, West Sussex: John Wiley & Sons, 2001 (EJLG)
Dr. Matthew Walker & Prof. Simon D. Shorvon, The British Medical Association Family Doctor Guide to Epilepsy, London: Dorling Kindersley, 1999 (MWSS)
Dieter Schmidt and Steven C. Schachter (Editors), 110 Puzzling Cases of Epilepsy, London: Martin Dunitz, 2002 (DSSS)
John M. Freeman, M.D., Eric H. Kossoff, M.D., Jennifer B. Freeman and Millicent T. Kelly, R.D., The Ketogenic Diet--A Treatment for Children and Others with Epilepsy, 4th Edition, New York: Demos Medical Publishing, 2007 (JFEK)
World Health Organization, The Atlas--Epilepsy Care in the World 2005, Geneva: World Health Organization, 2005 (WHO)
Jim Robbins, A Symphony in the Brain-The Evolution of the New Brain Wave Biofeedback, New York: Grove Press, 2000 (JR)
Barbara Jason Cohen BA, MEd, Medical Terminology: An Illustrated Guide, 4th Edition. Lippincott Williams & Wilkins, 2004 (BJC)
Stevanie Levin-Gervasi, Smart Guide to Yoga, New York: Cader Company Inc (John Wiley & Sons), 1999 (SLG)
James N. Parker MD, and Philip M. Parker PhD (Editors), The Official Patient's Source Book on Seizures and Epilepsy, San Diego: Icon Group International, 2003 (JNP)
Simon Shorvon, Emilio Perucca, David Fish and Edwin Dodson (eds), The Treatment of Epilepsy, 2nd Edition, Massachusetts: Blackwell Science Ltd (will be referred as SSEP)
Eric J. L. Griez, Carlo Faravelli, David Nutt, & Joseph Zohar (Editors), Anxiety Disorders--An Introduction to Clinical Management and Research, West Sussex: John Wiley & Sons, 2001 (EJLG)
Dr. Matthew Walker & Prof. Simon D. Shorvon, The British Medical Association Family Doctor Guide to Epilepsy, London: Dorling Kindersley, 1999 (MWSS)
Dieter Schmidt and Steven C. Schachter (Editors), 110 Puzzling Cases of Epilepsy, London: Martin Dunitz, 2002 (DSSS)
John M. Freeman, M.D., Eric H. Kossoff, M.D., Jennifer B. Freeman and Millicent T. Kelly, R.D., The Ketogenic Diet--A Treatment for Children and Others with Epilepsy, 4th Edition, New York: Demos Medical Publishing, 2007 (JFEK)
World Health Organization, The Atlas--Epilepsy Care in the World 2005, Geneva: World Health Organization, 2005 (WHO)
Jim Robbins, A Symphony in the Brain-The Evolution of the New Brain Wave Biofeedback, New York: Grove Press, 2000 (JR)
Barbara Jason Cohen BA, MEd, Medical Terminology: An Illustrated Guide, 4th Edition. Lippincott Williams & Wilkins, 2004 (BJC)
Stevanie Levin-Gervasi, Smart Guide to Yoga, New York: Cader Company Inc (John Wiley & Sons), 1999 (SLG)
James N. Parker MD, and Philip M. Parker PhD (Editors), The Official Patient's Source Book on Seizures and Epilepsy, San Diego: Icon Group International, 2003 (JNP)
Subscribe to:
Posts (Atom)