Posts Tagged grand mal
Epilepsy discrimination is illegal, but it’s important to know your rights.
Dealing with the auras in her job as a lawyer with the U.S. Attorney’s Office was difficult but doable. Every so often Labby would experience a heightened sense of smell, the inability to swallow, and an overwhelming sense of déjà vu.
But after the grand mal seizure, Labby’s life changed. Because she could no longerdrive herself to work, Labby’s boss approved a transfer to a branch office in Erie, Penn., near Labby’s family. She telecommuted from home, and when necessary a family member drove her to the office. After epilepsy surgery, which ended the seizures but affected some of her short-term memory, she was reassigned to a job where she could write legal briefs but no longer deliver oral arguments, which are now beyond her capabilities.Labby received all these concessions because they are guaranteed to her by the Americans with Disabilities Act (ADA). She also got them because she knew the law and demanded that her employer follow it to the letter, which is something she suggests all people with epilepsy must do. “You have to learn to put your feet in the ground and protect yourself,” Labby says.
How the ADA Works
The ADA outlaws employers from discriminating against a qualified individual on the basis of disability. In other words, you cannot be denied a job or fired from one because you have epilepsy. In addition, an employer of more than 15 people is required to “make reasonable accommodation for a known disability unless to do so would impose an undue burden on the employer,” according to the Epilepsy Foundation. Exact accommodations required are unique to each person with epilepsy, but some examples from the Epilepsy Foundation include:
- A person experiencing memory problems can ask that assignments be given in writing instead of orally.
- Someone at risk of breakthrough seizures may need flexible hours or a short break at work if a seizure occurs.
“Employers need to understand that epilepsy is a disease deserving of an accommodation,” Labby says. “I was vocal about what I was capable of doing and what I was not capable of doing. My employer, at times, needed to be reminded of it, but did prove to be understanding.”
Discrimination Despite the ADA
Despite the number of people with epilepsy — 3 million Americans are affected — Labby’s case is too often the exception rather than the rule, say epilepsy experts. Employment discrimination against people with epilepsy is so rampant that neurologist Eduardo Locatelli, MD, advises his patients to keep their status secret unless disclosure is absolutely necessary.
“The issue of stigma is still very big,” says Dr. Locatelli, medical director of the Florida Neurosciene Center in Fort Lauderdale, Fla. “So what I say is, don’t announce that you have epilepsy. But from a safety perspective, if you’ve got a friend at work or you have a good relationship with your manager explain that if there is a seizure this is what you do.
”Should You Tell?
The ADA protects you if you want to keep your epilepsy a secret. But Labby found that by telling her co-workers, she was able to dispel many of the myths surrounding epilepsy.
“When you have epilepsy, people are very inquisitive about it,” Labby says. “It’s a disease that they just don’t understand. You feel like, on some level, you need to defend it.”
But by defending it, you are also proving that disability is not synonymous with inability. And that can help not just you but those with epilepsy who come after you as well.
Types of Seizures
Expert: Robert S. Fisher, M.D. Professor of Neurology Stanford University »
Seizures is a medical condition that is divided into two types. Watch our video to learn in detail about the different types of seizures and how to manage them.
The word “seizure” is used to describe the medical condition in which too many brain cells become excited simultaneously, but there are actually so many that neurologists are still updating how to classify them. Usually, they classify seizures into two main types, partial seizures and primary generalized seizures.
The difference between these types is in how they begin: Partial seizures, which begin in a single part of the brain, are further described by two additional criteria.
- The first is whether awareness, memory, and consciousness are preserved during the seizure. If they all are preserved, then a seizure is called “simple partial.”
- However, if any are impaired then the seizure is called “complex partial.”
The impact of a partial seizure depends on where in the brain it originates, and how it spreads. Partial seizures sometimes have an aura, which is a warning that bigger seizures may follow. An aura usually occurs seconds to minutes before seizure, but some patients can have periods of warning lasting a day or longer. Technically, the aura is itself a small simple partial seizure. There are many different ways in which people experience an aura. The start of a seizure in one of the temporal lobes can produce unusual feelings, like abnormal sensation or forced thinking. The onset of a complex partial seizure may be heralded by deja vu, a familiar feeling, or jamai vu, an unfamiliar feeling. Some patients have auras of sounds, tastes, distorted vision, racing thoughts, or smells, like burning rubber. Physical sensations occurring as auras are dizziness, headache, lightheadedness, and numbness. An upset stomach is a particularly common phsycial symptom. Auras can include a sense of tingling rising up the body or other strange feelings difficult to describe. Distorted emotions, like fear or panic, can also be a seizure warning. However, some complex partial seizures occur without any remembered warning. Primarily generalized seizures begin with a widespread electrical discharge that involves both sides of the brain at once. Partial seizures begin with an electrical discharge in one limited area of the brain. All generalized seizures begin with synchronous electrical activity throughout the brain accompanied by sudden generalized movements or loss of consciousness.
However, there are still many different types of generalized seizure. A tonic-clonic seizure, once called a “grand mal,” is what most people think of when they hear the word “seizure.” When someone experiences a tonic-clonic seizure, first they stiffen and lose consciousness, which is the “tonic” phase. Then, they begin jerking, which lasts for several minutes and is called the “clonic” phase.
Sometimes seizures don’t have a tonic stiffening and clonic jerking sequence, but are just tonic seizures or clonic seizures.
- Other types of generalized seizure include absence seizures, when the sufferer “disconnects” from the world for a few seconds,
- myoclonic seizures, which cause jerking, but just for a second or two,
- and atonic seizures, which cause people to lose all muscle tone and drop to the ground.
Understanding the different types of seizures can be helpful, but many people want more detailed information. The next two videos in this series provide an in-depth look at the effect of partial seizures on different parts of the brain and the different types of generalized seizures. “The movies in this series can be viewed in any order. If you wish to watch these clips in their original sequence, the next clip is, “Understanding the Different Types of Partial Seizures.”
…Much of the stigma associated with the condition could be alleviated if people could anticipate their seizures and take necessary steps to make themselves safe, and modify their environment. Conceivably having accurate seizure prediction strategies could also permit administration of acutely acting anticonvulsant therapies. Seizure prediction systems may allow new insights into the natural history of the condition, and associated co-morbidities…
The Epilepsy Center at UC San Diego Neurological Institute is the only nationally designated epilepsy center in the region. We handle the most complex epilepsy cases in Southern California.
UC San Diego offers the latest technological advances in diagnostics, medical therapies, surgical procedures and clinical trials. Our epilepsy team includes EEG technologists, clinical nurse specialists, clinical trial specialists, neurologists, epileptologists, neuropathologists, neuropsychologists, neuroradiologists, neurosurgeons and psychiatrists.
[WEB SITE] Keppra (Levetiracetam) Drug Information: Description, User Reviews, Drug Side Effects, Interactions
KEPPRA is an antiepileptic drug available as 250 mg (blue), 500 mg (yellow), 750 mg (orange), and 1000 mg (white) tablets and as a clear, colorless, grape-flavored liquid (100 mg/mL) for oral administration…
Epilepsy is a group of related disorders characterized by a tendency for recurrent seizures. There are different types of epilepsy and seizures. Epilepsy drugs are prescribed to control seizures, and rarely surgery is necessary if medications are ineffective.
…Fetal exposure to anti-epileptic drugs (AEDs) appears to carry risks beyond those congenital defects currently listed on the products’ labels, a researcher said here…
…Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems. Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence…
One of the problems that can occur after a traumatic brain injury (TBI) is seizures. Although most people who have a brain injury will never have a seizure, it is good to understand what a seizure is and what to do if you have one. Most seizures happen in the first several days or weeks after a brain injury. Some may occur months or years after the injury. About 70-80% of people who have seizures are helped by medications and can return to most activities. Rarely, seizures can make you much worse or even cause death.
What are seizures?
Seizures happen in 1 of every 10 people who have a TBI that required hospitalization. The seizure usually happens where there is a scar in the brain as a consequence of the injury.
During a seizure there is a sudden abnormal electrical disturbance in the brain that results in one or more of the following symptoms:
- Strange movement of your head, body, arms, legs, or eyes, such as stiffening or shaking.
- Unresponsiveness and staring.
- Chewing, lip smacking, or fumbling movements.
- Strange smell, sound, feeling, taste, or visual images.
- Sudden tiredness or dizziness.
- Not being able to speak or understand others.
Symptoms of a seizure happen suddenly, and you are unable to control them. Seizures usually last only a few seconds or minutes, but sometimes continue for 5 to 10 minutes. You may have a bladder or bowel accident or bite your tongue or the inside of your mouth during a seizure. After the seizure, you may be drowsy, weak, confused or have a hard time talking to or understanding others. After a severe seizure, one that lasts longer than 2 minutes, it may be harder for you to stand, walk or take care of yourself for a few days or even longer.
Conditions that could increase the risk of having a seizure include:
- High fever.
- Loss of sleep and extreme fatigue.
- Drug and alcohol use.
- Chemical changes in the body such as low sodium or magnesium, or high calcium.
Seizures and TBI
- Early post-traumatic seizures: A seizure in the first week after a brain injury is called an early post-traumatic seizure. About 25% of people who have an early post-traumatic seizure will have another seizure months or years later.
- Late post-traumatic seizures: A seizure more than seven days after a brain injury is called a late post-traumatic seizure. About 80% of people who have a late post-traumatic seizure will have another seizure (epilepsy).
- Epilepsy: Having more than one seizure is called epilepsy. More than half the people with epilepsy will have this problem for their whole lives.
The cause of your brain injury can help doctors figure out how likely you are to have seizures.
- 65% of people with brain injuries caused by bullet wounds have seizures.
- 20% of people with ‘closed head injuries’ that cause bleeding between the brain and the skull experience seizures. A ‘closed head injury’ means the skull and brain contents were not penetrated in the injury.
- Over 35% of people who need 2 or more brain surgeries after a brain injury experience late post-traumatic seizures.
Medications to treat seizures
Medications that are used to control seizures are called antiepileptic drugs (AEDs). These drugs may be used for other problems, such as chronic pain, restlessness, or mood instability. You and your doctor will decide on which drug to use based on your type of seizures, your age, how healthy you are, and if you get any side effects from the medications. Side effects of AEDs usually improve after you’ve been taking the medication for 3-5 days.
Some common side effects of AEDs are:
- Sleepiness or fatigue.
- Worsening of balance.
- Lightheadedness or dizziness.
- Double vision.
Blood tests may be needed to make sure you are getting enough of the medication and to make sure the drug isn’t causing other problems. Although these drugs rarely cause birth defects in newborns, tell your doctor if you are pregnant or may become pregnant.
Sometimes your doctor will prescribe two or more of these medications to stop your seizures. Some common AEDs are:
- Carbamazepine (also known as Tegretol).
- Lamotrigine (also known as Lamictal).
- Levitiracetam (also known as Keppra).
- Gabapentin (also known as Neurontin).
- Oxcarbazepine (also known as Trileptal).
- Phenytoin/ fosphenytoin (also known as Dilantin).
- Pregabalain (also known as Lyrica).
- Topiramate (also known as Topamax).
- Valproic acid or valproate (also known as Depakene or Depakote).
- Zonisamide (also known as Zonegran).
What if the medications do not work?
If your seizures continue even after trying medications, your doctor may refer you to a comprehensive Epilepsy Center for more tests and to be seen by special seizure doctors called epileptologists or neurologists specializing in epilepsy. At the comprehensive Epilepsy Center the doctors may do brain wave tests and take a video of you during one of your seizures to help figure out what is causing the problems. This may help your doctor decide what drug will work best, and to see if other types of treatment will help with the problems you are having.
In most states, if you have had a seizure you cannot drive and you must notify the department of motor vehicles (DMV). Usually you won’t be able to return to driving for a period of time, or until your seizures have been completely stopped. Laws vary from state to state regarding how long after a seizure you must not drive.
Other things you should do to stay safe if your seizures have not stopped:
- Always have someone with you if you are in water (pool, lake, ocean, bath tub).
- Don’t climb on ladders, trees, roofs or other tall objects.
- Let people you eat with know what to do in case you have a seizure and start choking.
What your caregiver should do if you are having a seizure
Family members or caregivers should watch closely to see what happens during a seizure so they can explain it to medical professionals. They should make a diary describing the date, time of day, length of time, and description of each seizure. Your doctor will need this information about your seizures and the drugs you are taking to control them.
The majority of seizures are short and do not result in significant injuries. However, it is important for your caregivers to know what to do to keep you from hurting yourself.
What to do for someone having a seizure:
- Loosen tight clothing, especially around the neck.
- Make sure the person does not fall. Hold the person steady if he or she is in a chair, couch or bed. If the person is standing, get him or her to the ground safely.
- Turn the person and his or her head to the side so that anything in the mouth, even spit, does not block the throat.
- It can be dangerous to put anything in the mouth as you can get bitten.
- If you know CPR, check the heart beat in the neck. Start CPR if there is no pulse. Call 911.
- Listen for breathing at the mouth and extend the neck if breathing is difficult. If there is no breathing, start CPR by sealing your lips over the person’s mouth and breathing 2 quick breaths. Continue breathing every 5 seconds unless the person starts breathing without help. Call 911.
- If this is the first seizure after TBI, call the person’s doctor for advice.
- If the seizure does not stop after 3 minutes, call 911.
- If the seizure stops within 3 minutes, call the person’s doctor.
- If the person does not return to normal within 20 minutes after the seizure, call 911.
For More Information
The Epilepsy Foundation of America
Brain Injury Association of America
- Diaz-Arrastia R, Agostini MA, Frol AB et al, Neurophysiologic and neuradiologic features of intractable epilepsy after traumatic brain injury in adults. Arch Neurol 2000; 57:1611-6.
- Englander J, Bushnik T, Duong TT et al, Analyzing risk factors for late posttraumtic seizures: a prospective, mulitcenter investigation. Arch Phys Med Rehabil 2003; 84: 365-373.
- Yablon SA, Dostrow VG. Post-traumatic seizures and epilepsy in Zasler ND, Katz DI, Zafonte RD, Brain Injury Medicine: Priciples and Practice. Demos, New York, 2007.
- Brain Trauma Foundation and American Association of Neurological Surgeons: Management and prognosis of severe traumatic brain injury 2000; pp 159-165.
This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.
Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model System directors.
Continue –> Seizures and Traumatic Brain Injury.