With thanks to The National Institute for Health and Care Excellence (NICE)

provides national guidance and advice to improve health and social care.

The information below is courtesy of NICE

 

Guidance

The following guidance is based on the best available evidence. The full guideline gives details of the methods and the evidence used to develop the guidance.In this guideline, the term 'adults' is used to describe people who are aged 18 years and older, and 'children' those who are aged 28 days to 11 years. 'Young people' describes those who are aged 12 to 17 years. 'Older people' is used to describe people who are aged 65 years or older – this age range is based on evidence reviewed by the Guideline Development Group. However, it is recognised that there is a variable age range (15–19 years) at which care is transferred between child and adult health services by local healthcare trusts and primary care organisations.

1 Guidance

  • 1.1 Principle of decision making

  • 1.2 Coping with epilepsy

  • 1.3 Information

  • 1.4 Following a first seizure

  • 1.5 Diagnosis

  • 1.6 Investigations

  • 1.7 Classification

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  • 1.8 Management

  • 1.9 Pharmacological treatment

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  • 1.10 Referral for complex or refractory epilepsy

  • 1.11 Psychological interventions

  • 1.12 Ketogenic diet

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  • 1.13 Vagus nerve stimulation (VNS)

  • 1.14 Prolonged or repeated seizures and convulsive status epilepticus

  • 1.15 Women and girls with epilepsy

  • 1.16 Children, young people and adults with learning disabilities (see also sections 1.15 and 1.17)

  • 1.17 Young people with epilepsy (see also section 1.15)

  • 1.18 Older people with epilepsy

  • 1.19 Children, young people and adults from black and minority ethnic groups

  • 1.20 Review

  • Heat the danger

  • And it can trigger some pretty awful consequences.

  • An epileptology's explained that heat can trigger a seizure for some people because it’s firing up the neurons in the brain which can cause a seizure.

  • Examples:

  • Heat Exhaustion (“Heat Stroke”)

  • Heat exhaustion, commonly known as heat stroke, is a condition caused by the body’s inability to keep itself cool.

  • The body stays cool by perspiring (sweating), as the perspiration evaporates.

  • On days that are especially hot and humid, extra moisture in the air causes perspiration to evaporate more slowly, causing your body temperature to rise.

  • If left untreated, heat stroke can cause different symptoms.

  • Symptoms of Heat Stroke

  • The early symptoms of heat stroke are not terribly serious but should be considered a warning.

  • Earliest symptoms may include nausea and vomiting, fatigue and weakness, headaches, muscle cramps and dizziness.

  • As the condition worsens, you may experience not only seizures, but also high body temperature, the absence of sweating with very hot or flushed dry skin, a rapid pulse, difficulty breathing, odd behaviour, confusion, hallucinations and disorientation.

  • And you could become comatose.

  • Hot Weather and Epilepsy

  • There is no scientific evidence that heat itself causes seizures to occur in people suffering from epilepsy.

  • Becoming severely overheated can cause seizures, but an average hot day is not in itself the culprit.

  • It’s mainly changes in weather that trigger epileptic seizures.

  • For example, someone who keeps his house very cool in the summer may go out into the hot weather, and the change in temperature may trigger seizure activity.

  • Summertime mean thunderstorms, and the lightning produced during such storms can also be a trigger.

  • Going from a dark room into the bright sunshine can cause seizures, too.

  • Dehydration and Epilepsy

  • Make sure you have plenty of fluids in your system if you have epilepsy.

  • Too much perspiration and not enough fluid intake can cause a drop in sodium and sugar levels (hypoglycaemia), both of which have been known to cause seizures.

  • Also, sweating or urinating too much may cause too much of your seizure medication to be expelled from your body, lowering both your therapeutic medication levels and your threshold for seizures.

  • Anti-Seizure Medication Side-Effects

  • Certain anti-seizure medications, such as the drug Topamax, may cause side-effects that require more fluid intake.

  • For example, Topamax may cause decreased sweating and higher body temperature, which can prevent your body from cooling itself adequately.

  • Normally, the process of sweating and evaporation of sweat facilitates body cooling.

  • In extreme temperatures in excess of 90° F (32.2° C), the amount of heat produced, exceeds the cooling effect of sweat evaporation.

  • Likewise, if the humidity reaches 100%, evaporation of sweat is no longer possible, and your body loses its ability to dissipate heat.

  • Eventually, your body’s temperature rises, leading to severe dehydration, swelling of brain tissue, low blood pressure, organ damage, and possibly death.

  • What Should I Do if I Think I Have Heat Stroke?

  • Heat stroke traditionally is divided into three classic varieties:

  • Exertional heat stroke typically occurs in younger athletic individuals who exercise vigorously in the heat until the body’s normal thermoregulatory mechanisms are overwhelmed.

  • Classic heat stroke more commonly occurs in older individuals or in those with underlying illnesses who are exposed to extreme environmental temperatures and/or humidity.

  • Another less common type of heat stroke is sunstroke (heat stroke caused by direct exposure to the sun).

  • What Does the “Heat Index” Mean?

  • The heat index tells you how hot it feels outside in the shade.

  • It’s not the same as the outside temperature.

  • The heat index is a measurement of how hot it feels when relative humidity is combined with the effects of the air temperature.

  • When you’re standing in full sunshine, the heat index value is even higher.

  • A heat index of 90°F or higher is dangerous.

  • How Can I Prevent Heat Illness?

  • When the heat index is high, stay indoors in air-conditioned areas when possible.

  • If you must go outside, take the following precautions:

  • Wear lightweight, light-coloured, loose-fitting clothing.

  • Protect yourself from the sun by wearing a hat or using an umbrella.

  • Use sunscreen with a sun protection factor (SPF) of 15 or more.

  • Schedule vigorous outdoor activities for cooler times of the day — before 10:00 a.m. and after 6:00 p.m.

  • During an outdoor activity, take frequent breaks.

  • Drink water or other fluids every 15 to 20 minutes, even if you don’t feel thirsty.

  • If you have clear, pale urine, you are probably drinking enough fluids. Dark-coloured urine is an indication that you’re dehydrated.

  • Having heat exhaustion or heat stroke makes you more sensitive to hot conditions for about a week afterwards.

  • Your doctor can tell you when it is safe to return to your normal activities.

  • Heat-Related Illnesses and First Aid

  • Heat stroke is a medical emergency that may result in death! Call 999 immediately.

  • Heat exhaustion is the body’s response to loss of water and salt from heavy sweating.

  • Signs include headache, nausea, dizziness, weakness, irritability, thirst, and heavy sweating.

  • Heat cramps are caused by the loss of body salts and fluid during sweating.

  • Low salt levels in muscles cause painful cramps.

  • Tired muscles — those used for sport and outside work — are usually the ones most affected by cramps.

  • Heat rash, also known as prickly heat, is skin irritation caused by sweat that does not evaporate from the skin.

  • Bottom line: Try to stay out of the heat. Or if you must, take the proper precautions.

  • Human rights

  • People with epilepsy can experience reduced access to health and life insurance, withholding of the opportunity to obtain a driving license, and barriers to enter certain occupations. In many countries legislation reflects centuries of misunderstanding about epilepsy

  • . For example:

  • In both China and India, epilepsy is commonly viewed as a reason for prohibiting or annulling marriages.

  • In the United Kingdom, laws which permitted the annulment of a marriage on the grounds of epilepsy were not amended until 1971.

  • In the United States of America, until the 1970s, it was legal to deny people with seizures access to restaurants, theatres, recreational centres and other public buildings.

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  • Your responsibility

  • The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties..Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible

  • Updated Jan 2019

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