Sunday, May 24, 2020

Blog #118: MORE HELPFUL INFORMATION ON YOUR EPILEPSY AND SAFETY DURING COVID-19 PANDEMIC


My blog last month provided tips for people with epilepsy to stay safe in the context of the Covid-19 Pandemic (Tips: Your Epilepsy in Our New Covid-19world). The Epilepsy Society of the United Kingdom offers helpful tips for keeping people with epilepsy safe during the Covid-19 pandemic. This month I share their tips to help keep people who have epilepsy out of clinics and hospitals where contracting the virus can be a larger threat.

·        People with epilepsy are at no greater risk of contracting Covid-19 than anyone else unless you have an additional risk factor such as old age, immobility, respiratory disease, severe heart disease, diabetes mellitus, hypertension or are immunosuppressed. These same risk factors also apply to the general population without epilepsy.
·            Wash your hands frequently and do not touch your face.
·         Isolation from and avoiding contact with symptomatic individuals during this pandemic is paramount to staying healthy.
·         Wear a mask when others are nearby and keep at least 6 feet away from another person.
·         People who have epilepsy are generally experienced with their own condition and know what triggers their seizures, so do what you can to minimize this risk. Triggers may include: skipping/forgetting to take anti-seizure medication, lack of sleep, poor nutrition, recreational drugs and alcohol, etc. If you know flashing lights and computer games set your seizures off, avoid them as well.
·          Make sure you have an adequate supply of medications on-hand to avoid or at least limit contact with people in pharmacies and clinics where risk of exposure to the Covid-19 infection is greater. Familiarize yourself with obtaining medications through online pharmacies, where feasible.
·         To make compliance with medication easier, use pillboxes to increase accuracy and regularity of medication dosages during the day by using pillboxes or cell- phone alarms or phone apps.
·         During this health emergency, consultations with your caregiver should be available by telehealth internet mechanisms and telephone. Establish this communication system before they are needed in a panic-mode. Ask your health team in what situation you should go to the clinic or emergency department before you head out, to avoid unnecessary exposure or travel.
·         Your companion/caregiver needs to be included in your discussions with your neurologist/physician/nurse to determine what to do if you have multiple seizures over a short time-period, or if you have a prolonged convulsion lasting over 5 minutes. Also make plans what to do/should be done in a similar situation if your companions/care givers at times are not available. For this reason, it’s always a good idea to wear a Medi-alert bracelets/necklaces in case you ever need emergency care and are unable to communicate or provide information about your epilepsy to medical personnel or first responders.
·         To minimize the risk of injury during a seizure, only use the front burner when you are cooking. (I have seen severe burns in patients seizing and falling on flames/hot coils/hot pots while cooking on a front burner.) If possible, try to avoid taking a bath or shower when no one else is at home  and keep the bathroom door open for easier access by a companion. Shower drownings can occur, too, if you fall face-down and block the drain.
·         Avoid holding a baby over bathwater when bathing the child or holding the baby while cooking. If you have a seizure at these times, your baby is at risk, too.
·         Helplines are available through local epilepsy societies and support groups for people who would benefit from emotional support, such as for anxiety and depression. Epilepsy-service-dogs can be extremely supportive, too. (See my blogs #109, August 26, 2019; blog #72, July 26, 2016 and blog #9, December 14, 2011 that discuss service dogs at www.LanceFogan.com.)

Stay safe! The above suggestions can help you do that.


Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Saturday, April 25, 2020

Blog #117: TIPS: YOUR EPILEPSY IN OUR NEW COVID-19 WORLD


Now that we’re secluded in our homes do we live alone or with others?

Safety in dealing with the Corona Virus-19 starts with minimizing/avoiding close contact with other people as much as possible; wearing a face mask over both your nose and mouth to try to avoid spread of nasal/oral droplets and avoid contact with other people to minimize spreading the virus. Even if you are asymptomatic these actions should be done when around others and even more so if you believe you have mild cough, fever, aches and headaches. During this spring-time season, allergies usually cause running nose, itchy eyes but do not cause fevers. One tell-tale symptom of Covid-19 can be altered or loss of smell and taste; this is uncommon in other types of infections.

 
Fevers and viral infection syndromes commonly lower resistance to epileptic seizures. Spending more time in front of your computer screen exposed to flashing/flickering lights and geometric patterns such as checks or stripes in computer games can provoke seizures in up to 5% of those people who have epilepsy of the photosensitive epilepsy-type. Flickering overhead lights, sunlight through blinds and fast-moving figures on television screens may also trigger seizures in these people, too.

Tiredness and getting insufficient sleep are known triggers of seizures in people with epilepsy so be sure to get enough rest and take your anti-seizure medications as directed. Avoid drinking alcohol; alcohol can bring on seizures in epilepsy. Your doctor should be available for telephone consultations when desired if face-to-face meetings are not necessary during the Covid-19 pandemic.

As always, take precautions in your home. Be sure not to bathe/shower unless someone else is home with you whenever possible and keep the bathroom door open. I know of 17 patients who drowned in the bathtub (over a century ago Mark Twain’s adult daughter, Jean, had epilepsy and was found drowned in the bathtub) including 5 who fell face-down in the shower blocking the drain; they drowned in just 2 inches of water. Younger children bathing when mother can’t stay close should have the child sing. If singing stops mom should rush to check the child. When you cook, use only the rear burners to avoid falling on to hot coils, flames, and on to hot pots should you have a seizure at the stove.

You stay safe! The above suggestions can help you do that.


Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Wednesday, March 25, 2020

Blog #116: YOUR EPILEPSY AND YOUR SURVIVAL

 
Epilepsy affects 65 million people worldwide and over 3 million Americans. It places a major burden in seizure-related disability, mortality, co-morbidities, stigma, and costs. The lives of most people with epilepsy continue to be adversely affected by gaps in knowledge, diagnosis, treatment, advocacy, education, legislation, and research.
Epilepsy is associated with causes of death other than seizures, e.g., drowning, traffic accidents, accidents in the home, co-morbidities and suicide.
Life expectancy is reduced approximately two years when the cause of the epilepsy is unknown (idiopathic). Life expectancy is reduced even more—up to 10 years—when there are identifiable diseases such as brain tumors, infections, scars from strokes and scars from brain traumas. In a study conducted from 2005-2010, on 7,461 epilepsy patients, 29% died over that 5-year study period. For perspective, this death rate was five times higher in the epilepsy population than in the control population. 1
Recent reports from the United States and from the United Kingdom indicate epilepsy mortality may be rising. Possible explanations for this trend include: increase in Alzheimer’s as a risk for epilepsy; increased survival of patients with other neurological disorders, and inadequate prevention of otherwise preventable conditions such as heart disease, stroke, illegal-drug usage and alcohol. In their 2016 study, Greenlund et al reported a 47% increase in mortality in the US between 2005-2014 and a 33% increase in the UK between 2003-2014. However, these results are confounded by an increase in epilepsy prevalence worldwide.2  Furthermore, risk factors for stroke and ischemic heart disease are increased by use of antiepileptic drugs.3,4 
 Today, people who have epilepsy could contract COVID-19 an develop a severe illness.To minimize this risk follow CDC recommendations, i.e. frequent hand-washing, staying at least 6 feet away from others, etc. High fevers can trigger seizures.
SUDEP (sudden unexplained death in epilepsy) is another cause of death. SUDEP is more likely to occur when tonic-clonic seizures are poorly controlled. SUDEP affects 1 in 4500 children per year and 1 in 1000 adults per year. Risk factors for SUDEP include duration of epilepsy for over 30 years, experiencing more than 3 convulsions per year, using more than 2 antiepileptic drugs simultaneously, and an IQ below 70. Good seizure-control is strongly associated with decreased SUDEP risk. Factors that could minimize SUDEP occurrence include taking your medications as prescribed, getting adequate sleep, using “Baby Monitors” close to the bed to detect sounds of a convulsion for rescue attempts and supervision while asleep. Sleeping face down (the prone position) was observed in 73% of 253 SUDEP cases. The mechanisms seem to be impaired air exchange and dysfunction of the autonomic nervous system interfering with breathing. 5 Using a “Sleep Safe anti-suffocation pillow” could help. A “Smart Watch” detects shaking movements; it could send a text or phone alert to contacts to respond.
Another possible prevention for SUDEP is Epilepsy Surgery for excision of identified seizure foci. 6
Vagus Nerve Stimulation (VNS) involves a stimulator attached to the Vagus nerve in the neck to stimulate the brain.  VNS has been reported to reduce seizures and mortality in patients with refractory epilepsy. The exact mechanism how it reduces seizures is not known. 7 

  1.  Chen et al in Neurology 2016: 87, 718 
  2.  Greenlund et al in Epilepsy and Behavior 2017 
  3. Chen SC et al. "Patients with epilepsy are at an increased risk of subsequent stroke: A population-based cohort study." Seizure: volume 23, Issue 5, pages 327-410 (May 2014) 
  4. Mintzer S, et al. "Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein." Epilepsy Behavior. 58:127. Epub 2016. 
  5. Liebenthal JA, Wu S, et al. "Association of prone position with sudden unexpected death in epilepsy." Neurology. 2015; 84:703-709. 
  6. Sperling MR, et al. "A reappraisal of mortality after epilepsy surgery." Neurology. 86(21): May 24, 2016:1938-44. 
  7. Mayo Clinic. Vagus Nerve Stimulation 


Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.