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PSY 634 Southern New Hampshire University Myoclonic Seizure Discussion

PSY 634

Southern New Hampshire University

PSY

Question Description

I’m studying for my Psychology class and need an explanation.

Describe one type of seizure common in childhood or adolescence, focusing on possible causes, how the seizure manifests, and possible treatments. How could uncontrolled seizures negatively affect development? What are the risks and benefits of the various treatments for the seizure you selected? When responding to your peers, think about any reservations you would have if your child were presented with the various treatment options for a seizure disorder.

To complete this assignment, review the Discussion Rubric document.

Please respond to the initial post with a minimum of 300 words, and to each of the below student responses with a minimum of 150 words EACH!


AFTER RESPONDING TO THE INITIAL POST, PLEASE ALSO RESPOND TO THE FOLLOWING TWO STUDENT RESPONSES REGARDING THE SAME TOPIC!


STUDENT ONE:

One seizure disorder that occurs in childhood is epilepsy. Epilepsy is a general seizure disorder that has many sub components to it. Epilepsy is made up of about 40 different types of seizures that last anywhere from a few seconds to a few minutes and has multiple different causes (Soloman & McHale 2013). Soloman and McHale (2013) report that actually 60% of epilepsy cases have unknown causes. The causes of epilepsy are broken up into three main categories which are idiopathic, or genetic, symptomatic, or as a result of another condition, and cryptogenic, or unknown. The specific causes could include brain damage from injury, deprivation of oxygen at birth, infection, malformation of brain, brain tumors, low blood glucose or calcium, or drugs (Soloman & McHale 2013). Some of the more common types of seizures that an individual with epilepsy may have are tonic-clonic (which are characterized by muscle stiffness and jerking motions), tonic (muscle stiffening, no jerking), atonic (muscle tone lost), myoclonic (muscle jerk, shortly after going to bed/waking up), absence (occurs many times throughout the day, mistaken for not paying attention), and focal (comes from one part of the brain) (Soloman & McHale 2013). Possible treatments for seizure disorders may include the use of one or multiple anti-epileptic drugs. These do not cure epilepsy or seizures, but are intended to prevent seizures and reduce the number of seizures an individual has. Anti-epileptic drugs can have unpleasant side effects like any medication. Certain drugs tend to work better with certain types of seizures although there is no surefire way to determine which medication will work best for a particular individual. Thus, it is often the case that multiple drugs are tried until one is successful or it ends up that a combination of anti-epileptic drugs are used on any given patient. Another less common treatment that Soloman and McHale (2013) mention is the keto diet. We've all heard of this diet for loosing weight, especially since it is actually pretty trendy at the moment. Apparently in some cases the keto diet has shown proven effects in reducing seizure activity in individuals. The exact method of success is unknown at this time, but the ketogenic bodies that are produced through the diet fuel the brain and are said to be the cause of seizure reduction. There is still research being done to determine if seizures themselves have a negative affect on development and/or the brain itself. Currently research points to the damage of the brain coming from head injuries that occur during a seizure such as when an individual is standing at the onset of a seizure and falls to the ground, hitting their head or when they bang their head repeatedly on the floor during a seizure. If witnesses are present during a seizure they are advised to either place something soft beneath the individuals head or hold their head in their hands for the duration of the seizure in order to prevent further brain damage.

Soloman, N. & McHale, K. (2012). An overview of epilepsy in children and young people. Learning Disability Practice, 15(6): 30-38.

STUDENT TWO:

Describe one type of seizure common in childhood or adolescence, focusing on possible causes, how the seizure manifests, and possible treatments.

A seizure is a period of sudden excessive activity of cerebral neurons that sometimes cause convulsions (Carlson & Birkett, 2017). One type of seizure that is common in children is known as absence seizures. During this seizure, the child will stop what they are doing in the middle and zone off and begin staring off into space. They may blink their eyes at a face pace. Seizures can be caused by scarring which can be the result of injuries, strokes, a growing tumor and abnormal development (Carlson & Birkett, 2017). Possible treatment options for a seizure are medication that are anticonvulsant drugs and brain surgery.

How could uncontrolled seizures negatively affect development?

After a seizure has occurred, especially the first one, it is important for the child to be seen by a doctor. A series of brain test are completed checking on things such as vision, muscle strength, reflexes and cognitive development (Kutscher, 2006). When these tests are done it is to make sure the child is not faced with as many developmental problems. The vision test is completed to ensure the pupils are functioning correctly. The areas of the brain that control the frontal lobe are also checked to see the strength. The continuous development of the body parts can be affected after the seizure and one might not develop as those of their peers.

What are the risks and benefits of the various treatments for the seizure you selected?

Benefits of treatment can slow down and reduce the number of seizures one can have. One risk of the different treatment options is a change in the child’s behavior of intellect. The medication aspect can cause moodiness and irritability in some children. It is important for the parent to make an appointment with their child’s doctor once this has been noticed. Of course, whenever surgery is involved there is always a risk of something going wrong during the procedure. This is with any surgery. One must do their research whether it be medication or surgery to see what the best possible outcome would be.

References

Carlson, N.R. & Birkett, M.A. (2017). Physiology of Behavior (12th ed). Boston, MA: Pearson.

Kutscher, M. L. (2006). Children with Seizures: A Guide for parents, teachers, and other professionals. Jessica Kingsley Publishers

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Continuing professional development An overview of epilepsy in children and young people LDP99 Solomon N, McHale K (2012) An overview of epilepsy in children and young people. Date of acceptance: March 3 2012. Updated: June 6 2012. Correspondence nsolomon@youngepilepsy.org.uk Abstract Nina Solomon is an epilepsy specialist nurse The role of the nurse is vital in the management of childhood epilepsy. Nurses play a key role in supporting the child and the family and ensuring that important relevant and accurate information is identified, recorded and reported to the team responsible for the medical management. This article aims to give readers an overview of epilepsy and its management in children and young people. After reading this article and completing the time out activities you should be able to: ■■ List the different types of seizures and describe their presentation. ■■ Describe the relevant information about any seizures that you observe to aid accurate diagnosis. ■■ Manage seizures effectively and recognise potential emergency situations. ■■ Discuss the different treatment options available for epilepsy. ■■ Evaluate the impact having epilepsy may have on a child and his or her family. Introduction Epilepsy is a chronic neurological condition that affects 63,400 people in the UK aged 18 and under (Joint Epilepsy Council (JEC) 2011). It is characterised by recurrent epileptic seizures originating in the brain. An epileptic seizure is a transient occurrence of signs and/or symptoms resulting from abnormal, excessive or synchronous neuronal activity in the brain (Fisher et al 2005). This activity results in an alteration in motor activity, sensation, behaviour or consciousness. There are more than 40 different types of seizure (JEC 2011). Seizures usually last from a few seconds to a few minutes and are self-limiting. Causes of epilepsy In approximately 60 per cent of cases, the cause of epilepsy is not known (Epilepsy Research UK 2011). 30 July 2012 | Volume 15 | Number 6 Both at Young Epilepsy National Services, Lingfield, Surrey The types of epilepsy fall into three categories: those with a genetic cause (idiopathic epilepsy); those where epilepsy is the secondary result of a separate structural or metabolic condition (symptomatic epilepsy); and those where the cause is unknown (cryptogenic epilepsy) (Berg and Scheffer 2011). Causes of epilepsy include damage to the brain as a result of injury, deprivation of oxygen at birth, infections such as encephalitis or meningitis, malformation or degeneration of the brain and brain tumours. Metabolic causes include low blood glucose, calcium and drugs (including alcohol). Genetic conditions such as tuberous sclerosis may also be a cause. Now do time out 1. 1 Defining epilepsy Time out Aims and intended learning outcomes Kirsten McHale is lead nurse for practice development In 2005 the International League Against Epilepsy and the International Bureau for Epilepsy defined epilepsy as a brain disorder ‘characterised by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological and social consequences of this condition’. With this in mind, explain why you think epilepsy is more than just a health condition? Conflict of interest None declared Keywords Epilepsy, neurology, seizures, status epilepticus These keywords are based on the subject headings from the British Nursing Index. This article has been subject to open review and checked using antiplagiarism software. For related articles visit our online archive and search using the keywords Different types of seizures Classifying which seizure type(s) a child has experienced is important for the future management and outcome of the child’s epilepsy. Seizure types fall into two main categories: generalised seizures and focal (partial) seizures (Figure 1). LEARNING DISABILITY PRACTICE Figure 1 Areas of electrical activity in focal and generalised seizures Seizures Generalised seizures Focal seizures Tonic Person goes stiff and falls, no repetitive jerking Temporal lobe epilepsy Temporal lobe epilepsy is shown above, but electrical activity can also occur in other lobes, causing: ■■ Frontal lobe epilepsy ■■ Parietal lobe epilepsy ■■ Occipital lobe epilepsy Atonic Person drops to the ground When a focal seizure progresses into a generalised seizure it is called a bilateral convulsive seizure Tonic-clonic Person goes stiff and falls, and has repetitive jerking Absence Person stares blankly for a few seconds Myoclonic Person has short jerky movements Areas of electrical activity (Adapted from Solomon 2010) Tonic-clonic seizures Tonic-clonic seizures usually start with a cry and a loss of consciousness, resulting in the child going stiff and falling to the ground. The ‘tonic’ or stiff phase then leads to a ‘clonic’ or jerking phase. Finally there may be confusion, often followed by sleep. The child may be incontinent of urine. Tonic seizures In tonic seizures the muscles stiffen and, if standing, the child will fall heavily, usually backwards, and will often receive injuries to the back of the head. There is no jerking. Atonic seizures In atonic seizures the muscle tone is lost, causing the child to flop and fall heavily to the ground and, although recovery is swift, the child will often experience a head or facial injury. Myoclonic seizures Myoclonic seizures usually occur shortly after waking or before retiring to bed when the child is tired. The muscles jerk rather as if the child has had some sort of electric shock. There is a brief, and hardly noticeable, loss of consciousness. These seizures may occur in clusters in which numerous seizures can occur over a few minutes, or even a couple of hours. LEARNING DISABILITY PRACTICE Absence seizures Absence seizures usually begin in childhood or adolescence and may occur many times a day and provoke a brief ‘trance-like’ state. The child will stare blankly and be unresponsive for usually five to ten seconds. Recovery is immediate and these episodes may go unnoticed. The child’s failure to respond when being spoken to during a seizure often results in the child being told off for not paying attention. Focal (partial) seizures Focal refers to the seizure coming from one area of the brain. Symptoms that occur during a focal seizure depend on where in the brain the abnormal burst of electrical activity occurs and the function for which that area is responsible (Figure 2, page 32). Consciousness may be impaired and, in contrast to absence seizures, children may experience a state of confusion following the seizure. Now do time out 2. 2 Defining symptoms Time out Generalised seizures In generalised seizures the whole brain is affected by changed electrical activity and the child becomes unconscious of their surroundings. The following are some examples of generalised seizures. Describe how you think seizures may present in temporal lobe epilepsy and parietal lobe epilepsy. Which symptoms might they have in common, what factors will be significantly different and which do you think may help in making an accurate diagnosis? What is important to remember in interpreting a witness account of someone having a seizure? July 2012 | Volume 15 | Number 6 31 Continuing professional development Figure 2 The functions of the lobes of the brain Frontal lobe Responsible for: emotional behaviour, personality, planning, problem solving. Parietal lobe Responsible for: sensory information (touch, temperature, pressure, pain), orientation, artistic and musical appreciation. Occipital lobe Processes: images from the eyes, recognises shapes and colours. Temporal lobe Processes: language and short-term memory, distinguishes one smell and sound from another, visual memory (pictures and faces), verbal memory (words and names), recognises auditory stimuli. (Adapted from Solomon 2011) Temporal lobe epilepsy Temporal lobe epilepsy can start in children of any age. The child will have a warning such as epigastric sensations (butterflies in the stomach), an odd smell or taste, fear or confusion afterwards. Because the temporal lobes are responsible for feelings, emotions and memory, children experiencing this form of epilepsy may experience a variety of feelings or emotions, including déjà vu and jamais vu. Children may also experience seizures that, on occasion, may generalise into tonic-clonic seizures. Most children will respond well to antiepileptic drugs. For those who do not respond to medication, treatment in the form of surgical resection has a good success rate (Azrimanoglou et al 2002). Frontal lobe epilepsy Although the symptoms associated with seizures arising from the frontal lobe will vary in nature depending on which part of the frontal lobe is involved (for example, seizures involving the motor areas of the brain can produce strange movements that occur on the opposite side of the body from the abnormality), the seizures usually occur in clusters with many brief seizures occurring per night that start and end abruptly. They may also produce weakness in certain muscles including those used in speech, which can last from minutes to hours following the seizure. These seizures usually occur during sleep and can present in a strange and dramatic manner involving head turning, thrashing around or cycling movements of the legs. 32 July 2012 | Volume 15 | Number 6 Occipital lobe epilepsy Seizures occurring in the occipital lobe usually present with sight-related symptoms, such as rapid eye blinking, seeing patterns, flashing lights or colours. Seizures can spread from the occipital lobe to the temporal or frontal lobes of the brain, which changes the characteristics of the seizure, making it hard to recognise as occipital lobe epilepsy. These seizures may also spread, causing generalised tonic-clonic seizures. Parietal lobe epilepsy Seizures coming from the parietal area are usually sensory and result in strange sensations such as tingling or warmness. They often occur down one side of the body and some people report that their limbs feel bigger or smaller than usual. There may also be areas of numbness of the body during the seizure. Seizure triggers For some children certain situations, such as failing to take medication, or taking alcohol or recreational drugs, may increase the chance of a seizure occurring. Other triggers may include illness, fever, tiredness, stress, excitement or menstruation. Flickering/flashing lights (photosensitivity) is a trigger in only 3 per cent of children with epilepsy (JEC 2011). Seizure triggers can occur in all types of epilepsy, but are more of a feature in particular epilepsy syndromes. Managing convulsive seizures Many people say that when they first witnessed a child having a tonic-clonic seizure they found it a LEARNING DISABILITY PRACTICE Parent’s experience Think back to situations where you have helped a parent make sense of witnessing seizures in their child. Why was it important to help them express their full range of emotions? What followed next? Was this a process of developing explanations that they could share with others, and who might they usefully share this with? 4 Emergency treatment Time out If the child is aware of an impending seizure, they should be encouraged to sit or lie down to reduce the risk of injury. The child should be protected from any danger, such as sharp edges, hot pipes, traffic and so on. If possible, the child should remain where they are and any problematic objects should be moved out of the way instead. Placing something soft under their head or cradling their head in your hands will protect it from banging. The child’s dignity and privacy should be maintained as much as possible by shielding them from the view of onlookers. When a seizure is taking place it is important to note the time the seizure starts and ends. The child’s movements should not be restrained but, if possible, any tight clothing around their neck should be loosened. Nothing should be placed in the child’s mouth. A seizure cannot be stopped but should simply be left to run its course. Once any jerking has stopped, the child should be placed in the recovery position. Now do time out 4. Write down a list of the circumstances that would prompt you to call an ambulance to a child having a seizure. Describe what information will need to be given to the paramedics and how this might influence the child’s treatment during and after a seizure. If the seizure occurs outside a hospital environment, an ambulance need only be called if the seizure lasts for five minutes (or for two minutes longer than is usual for the child), if the child has repetitive seizures without regaining consciousness in between, or if there is an injury, breathing problems or recovery is slow (Reuber et al 2009). LEARNING DISABILITY PRACTICE Box 1 Eyewitness information needed for epilepsy diagnosis Before the event: ■■ Where did the event take place? ■■ What was the child doing immediately before the event? ■■ Did they complain of any symptoms before the event occurring? ■■ Did they have a fever? ■■ Were they sitting, standing or lying down? ■■ Were they awake or asleep? During the event: ■■ When did it begin? ■■ What happened first? ■■ Was there a fall, if so, did they fall backwards or forwards? ■■ Were they stiff or floppy? ■■ Was there a change in their breathing or colour? ■■ What movements did they make? Were they trembling, making rapid movements of the arms or legs, or were the limbs jerking rhythmically? ■■ What level of awareness or responsiveness did they have? ■■ Was there tongue biting or other injury? ■■ Was there any urinary incontinence? ■■ How long did the event last? ■■ What did their eyes do? ■■ Did they lose awareness? After the event: ■■ What level of alertness did the child have? ■■ Were they confused? ■■ Were they sleepy following the event and, if so, for how long? ■■ Was there any weakness following the episode? Diagnosis The medical team will need to ascertain whether the event was an epileptic seizure, if it was, what type of seizure occurred and whether the child has an epilepsy syndrome identifiable on the basis of age of onset, seizure type and specific electroencephalogram (EEG) characteristics and other features (National Institute for Health and Clinical Excellence (NICE) 2012). Once these questions have been addressed, further discussion will allow the doctor to make a differential diagnosis. If not epilepsy, this could be a behavioural outburst, faint, tic, movement disorder and/or night terrors. Now do time out 5. 5 Diagnosis of epilepsy Time out 3 Time out terrifying experience and that they thought the child was going to die. Perhaps the most difficult thing for an observer is the fact there is little that they can, or should do. Now do time out 3. Using the NICE outline care algorithm for children and young people (www.nice. org.uk/nicemedia/live/13635/57619/57619. pdf), list the key actions that need to be taken before a diagnosis of epilepsy should be made. July 2012 | Volume 15 | Number 6 33 Continuing professional development Comparison of scans Compare the advantages and disadvantages of MRI and CT scans. Which scan do you think is better in aiding the diagnosis of epilepsy? When, and why, would each type of scanning be used? Treatment Antiepileptic drugs Whether to treat epilepsy with antiepileptic drugs will depend on a number of factors, such as the type of seizures that the child has experienced, how often they occur and, if established, the epilepsy syndrome. A syndrome is a group of characteristic signs and symptoms, such as age at onset of seizures, seizure types, developmental history and EEG findings which, if they occur together, can suggest a particular syndrome. The impact of having seizures will vary dramatically, depending on the age of the child. For example, a toddler is less likely to be left unattended than an older child who may want to climb, swim and ride a bike. The consequences of an adolescent losing a driving licence could have a major impact on the young person’s independence issues and self-esteem. Although antiepileptic medication will not cure epilepsy, it is designed to prevent seizures from occurring. The main aim of treatment is to stop all seizures while minimising side effects. Nevertheless, 34 July 2012 | Volume 15 | Number 6 Box 2 The most common side effects associated with antiepileptic drugs ■■ Memory, learning and attention problems. ■■ Drowsiness and lethargy. ■■ Dizziness or unsteadiness. ■■ Double vision. ■■ Changes in mood or behaviour. ■■ Increase or decrease in appetite. 15-25 per cent of children with epilepsy will have medically intractable epilepsy (Terra-Bustamante et al 2005). Where seizures cannot be stopped without side effects, the aim is to minimise the number of seizures and any adverse effects of the treatment. Some medications work better for certain types of seizures than for others (Garnett et al 2009). Finding the right medication is sometimes a lengthy and frustrating process because the first drug to be tried may not prove to be the best option. There is no test to identify which drug will be best. The use of one antiepileptic drug at a time (monotherapy) is generally recommended, and adding more antiepileptic drugs (polytherapy) should only be considered when attempts at monotherapy have failed to result in freedom from seizures (NICE 2012). Commonly used antiepileptic drugs include: carbamazepine, sodium valproate, lamotrigine, phenytoin, oxcarbazepine, ethosuximide, gabapentin, levetiracetam, tiagabine, topiramate, phenobarbital, primidone, clonazepam, lacosamide, zonisamide, vigabatrin, retigabine and acetazolamide. Side effects Different antiepileptic drugs can have different side effects, some of which can be unpleasant. Only a small number of children experience side effects and these may subside after the initial introduction of the medication. The most common side effects include those listed in Box 2. Now do time out 7. 7 Antiepileptic drugs Time out 6 Time out Eyewitness account of a seizure The diagnosis of epilepsy almost entirely depends on the clinical history and the doctor’s interpretation of the events that have occurred. According to Chadwick (2002), an accurate eyewitness account of an event is essential because the results of an initial medical examination will often be normal. The results of any further investigations will be interpreted with reference to the description of the event. A diagnosis of epilepsy is incorrectly made in 20-31 per cent of cases and up to 40 per cent of children referred to a tertiary clinic do not have epilepsy (JEC 2011). An accurate clinical history is therefore vital and should include the information shown in Box 1 (page 31). An initial medical examination will often be normal and the results of any further investigations will be interpreted with reference to the description of the event. Further investigations may include an EEG (routine, ambulatory and/or videotelemetry) and neuroimaging (magnetic resonance imaging (MRI) and/or computerised tomography (CT)). Gaillard et al (2009) and NICE (2012) provide useful information on the different scanning methods. Now do time out 6. With more than 20 antiepileptic drugs available, what factors do you think will need to be taken into account when prescribing them? Can you envisage any situations when giving antiepileptic medication may not be the best option for a child with epilepsy? Diet The ketogenic diet is a high-fat, low-carbohydrate and controlled-protein diet, which may be considered for children whose seizures are not being controlled by medication (NICE 2012). This diet is not effec ...
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Final Answer

Attached.

Running Head: MYOCLONIC SEIZURE

1

Myoclonic Seizure

Name

Institution affiliation

Date

MYOCLONIC SEIZURE

2

Discussion

Myoclonic Seizure

A myoclonic seizure is defined as short-lived shocks like twitches of a muscle or some
muscles. Myoclonic seizure, in most cases, does not last for more than a second or two. One
seizure can occur, but in other cases, several can happen in a short period. It happens to children,
or it can manifest to the teens. The seizure can occur to healthy people or people with epilepsy.
Myoclonic seizures are initiated by electrical unusual brain activities that trigger the movement
of the myoclonic muscle. The seizures are worsened by alcohol, fevers, tiredness, stress, light
stimulation and infections (Werz, 2017).

One of the most common types of myoclonic epilepsy is JME, and other brands are rare
progressive neurological disorders. They are manifested in different forms. In Juvenile
myoclonic seizure, it involves the shoulder, upper arm, and the neck. It beg...

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