بسم الله الرحمن الرحيم

ع�ط�اء اب�ن اع�ن� ل�ى ال� ق� ال� ق� ب�اح� ر� ب�ىأ� ب�ن

ل�ت ق ن�ة� ال�ج� أ�ه�ل� م�ن� �أ�ة ر� ام� ر�يك�أ أ�ال� ع�ب�اس�

- الن�ب�ى�. �ت�ت� أ د�اء و� الس� أ�ة ر� ال�م� ذ�ه� ه� ال� ق� ب�ل�ىإ�ن,ى ال�ت� ق� عف� ر� ص�

الل�ه� أ اد�ع ف� ف �ت�ك�ش� أ �ن,ى إ و� ،  « إ�ن�. و� ن�ة ال�ج� ل�ك� و� ت� ب�ر� ص� ئ�ت� ش� إ�ن� ال� ق� ل�ى

أ�ن� الل�ه� د�ع�و�ت ئ�ت� ي�كش� . يع�اف� ب�ر «. ص�أ� ال�ت� ق� ف� �

، ف� �ت�ك�ش� أ ال� أ�ن� الل�ه� اد�ع ف� ف �ت�ك�ش� أ �ن,ى إ ال�ت� ق� ف�د�ع�ا . ف� : . باب السابع الجزء البخارى صحيح ا ل�ه�

70 : 555حديث.

By: Dr: Samir MM Al- Minshawy Lecturer of Neuropediatrics Minia University Egypt

Epilepsy and Modern life

We will discuss:

• Epilepsy awareness and knowledge

•Modern technology and epilepsy

•Exercise and epilepsy

•Stress and epilepsy

•Diet and epilepsy

•Others

Epilepsy in modern life gained much benefit from new technology regarding diagnostic procedures and therapeutic modalities including: epilepsy surgery, vagus nerve stimulation, gene therapy and alternative medicine approaches like: yoga, relaxation techniques, biofeedback, nutritional & herbal supplements , dietary measures and acupuncture.

On the other hand, modern life is still adding risk factors for epilepsy which presents multiple challenges to the clinicians.

Attitude, Awareness and Knowledge

Paradigm Shift ???

Although a revolution has been done in epilepsy research, recent technologies didn’t make this paradigm shift in perception and understanding of epilepsy in general population.

Epilepsy has frequently been portrayed in literary works, films and television (TV) series, often relating it with madness, evil, violent behaviors or possession by the divine or ghosts. This marks the awareness and knowledge people have about epilepsy and epileptic patients.

-

Epilepsy has been always stigmatized (and still).- History declared that much discrimination measures were taken against epileptics even in 20th century.- In old civilizations and beliefs misunderstanding about epilepsy and epileptic patients was the base, one of exceptions which was done by the pure sunnah in Islam.

NARRATED 'ATA BIN ABI RABAH: IBN 'ABBAS SAID TO ME, "SHALL I SHOW YOU A WOMAN OF THE PEOPLE OF PARADISE?" I SAID, "YES." HE SAID, "THIS BLACK LADY CAME TO THE PROPHET AND SAID, 'I GET ATTACKS OF EPILEPSY AND MY BODY BECOMES UNCOVERED; PLEASE INVOKE ALLAH FOR ME.' THE PROPHET SAID (TO HER), 'IF YOU WISH, BE PATIENT AND YOU WILL HAVE (ENTER) PARADISE; AND IF YOU WISH, I WILL INVOKE ALLAH TO CURE YOU.' SHE SAID, 'I WILL REMAIN PATIENT,' AND ADDED, 'BUT I BECOME UNCOVERED, SO PLEASE INVOKE ALLAH FOR ME THAT I MAY NOT BECOME UNCOVERED.' SO HE INVOKED ALLAH FOR HER.SAHIH BUKHARI" VOLUME 7, BOOK 70, NUMBER 555

ع�ط�اء اب�ن اع�ن� ل�ى ال� ق� ال� ق� ب�اح� ر� ب�ىأ� ب�ن

ل�ت ق ن�ة� ال�ج� أ�ه�ل� م�ن� �أ�ة ر� ام� ر�يك�أ أ�ال� ع�ب�اس�

- الن�ب�ى�. �ت�ت� أ د�اء و� الس� أ�ة ر� ال�م� ذ�ه� ه� ال� ق� ب�ل�ىإ�ن,ى ال�ت� ق� عف� ر� ص�

الل�ه� أ اد�ع ف� ف �ت�ك�ش� أ �ن,ى إ و� ،  « إ�ن�. و� ن�ة ال�ج� ل�ك� و� ت� ب�ر� ص� ئ�ت� ش� إ�ن� ال� ق� ل�ى

أ�ن� الل�ه� د�ع�و�ت ئ�ت� ي�كش� . يع�اف� ب�ر «. ص�أ� ال�ت� ق� ف� �

� ال أ�ن� الل�ه� اد�ع ف� ف �ت�ك�ش� أ �ن,ى إ ال�ت� ق� ف� ، ف� �ت�ك�ش� د�ع�اأ : ف� . الجزء البخارى صحيح ا ل�ه�

باب. : 70السابع 555حديث.

Modern Technology and Epilepsy

Photosensitive Epilepsy (PSE)

• It is a good example for effect of technology, it’s a form of reflex epilepsy in which seizures can be triggered by flickering or intermittent light stimulation, occurring in 1/4000 of the population, common in childhood and more in girls. With age, it can disappear but 75% stay photosensitive for life.

• Seizures vary from brief absence seizures to tonic–clonic seizures, May preceded by “aura” and this can serve as a warning. Flashing lights or rapidly changing or alternating images (as in clubs, around emergency vehicles, in action movies or television programs, cinema, theatre…….. etc.) are examples especially in luminance contrast. Red color is a good trigger. The photoparoxysmal response in EEG helps in diagnosis. Treatment remains the removal of the offending stimulus with drug therapy (as sodium valproate).

*Television is the most common source of seizures in PSE especially in a dark room, at close range and with flickering. Some patients self-induce seizures by waving their fingers in front of their eyes with TV watching.

*For protection:

• The room should be well-lit.

• light source is placed on top of or behind the TV to balance the screen brightness.

• Flat screen or LCD (liquid crystal display) units don’t flicker at all.

• Sitting away (2.5 meters).

• Use a remote control or cover one eye to reduce flickering.

• Take a five-minute break every 30 minutes.

• Seizures triggered by VGs were reported, not only in photosensitive, but also in nonphotosensitive epileptic children.....Preventive measures concerning the characteristics of images VGs (flash rate, choice of colours, patterns, and contrast).

• Playing video games on a LCD TV screen

• No playing with the feeling of tiredness

• Taking a 5-minute break away every 15 minutes

• Switching off immediately with dizziness , blurring of vision, muscle twitching and being uncomfortable in any way .

Computers

Computers

• It is recommended that computer screens have a refresher frequency of at least 73 Hz or use LCD screen, the computer screen should not show any glare, which can result in a flickering.

• The risk of a seizure depends on the material being viewed. Some software, especially games, cartoons and web designs contain flickering images.

• Use an anti-glare screen to reduce fatigue and discomfort• Take regular breaks away (5 minutes every 15 minutes).

Cinema and Theatre

Going to cinema and theatre is safe with epilepsy. Films with special effects (including laser and flashing lights) could potentially trigger seizures in people with photosensitive epilepsy. Think carefully about where is the seat.

Fluorescent Lighting

• It is more beneficial to use natural light or old-fashioned light bulbs. Energy-saving bulbs are small fluorescent tubes. Older strip fluorescent light tubes flicker more and should be exchanged regularly.

Mobile

Electromagnetic fields (EMFs) emitted by mobile phones had been shown to increase cortical excitability and modulate inter-hemispheric synchronization of temporal and frontal resting EEG rhythms.

Inhabitants living nearby mobile base stations are at risk for developing neuropsychiatric problems and some changes in the performance of neurobehavioral functions either by facilitation or inhibition.

Although that exposure wasn’t above accepted international guidelines, studies had reported increased prevalence of adverse neurobehavioral symptoms , such as headache, memory changes, dizziness, tremors, depression, sleep disturbances and more significant increases in the frequency of seizures in epileptic patients if living at distances <500 m from base stations which suggesting that current guidelines may be inadequate in protecting health. Other studies added the dose response relationship, duration exposure and other variables, such as sociodemographic data.

Future research should address critical and neglected issues such as investigation of repeated, intensive and chronic exposures, especially in in highly sensitive populations such as epileptic children to provide safe rules for the use of mobile

Finally, research related to the effects on health of using mobile phones is inconclusive. So until there is more evidence, it is sensible for everyone, whether they have epilepsy or not, to restrict their mobile phone use to short and essential calls only.

-People with epilepsy who use mobile phones often should carefully monitor their seizure frequency.

-Mobile phones should be kept away from vagus nerve stimulation devices.

-Children with epilepsy should be discouraged from using mobile phones.

Microwave Ovens

Although microwave ovens are recommended as a safe cooking alternative for epileptic patients but hand burns in complex partial seizures are reported. The use of gloves and heating foods (not boiling liquids) is recommended.

Stress

Both physical (work related) and mental stress are commonly believed to precipitate seizures in some patients with epilepsy. Stress itself may also be associated with other seizure-provoking factors such as sleep deprivation.

Stressful life events as wars can be provocative factors for the occurrence of seizures. Typical absence seizures are more likely to be provoked by stress then other types of seizures.

Sports

Epileptic patients have previously been discouraged from participation in sports dx- for fear of inducing seizures or increasing its frequency. Although there are rare cases of exercise-induced seizures, studies have shown that it improves both physical and psychosocial outcomes.

The majority of sports are safe provided adequate seizure control and preparation of family and trainers. Contact sports including football don’t induce seizures.

Water sports and swimming are safe if seizures are well controlled and direct supervision is present with exception for those who have bathing epilepsy or hot-water epilepsy.

Additional care must be taken in sports involving heights such as gymnastics, or horseback riding. Sports such as hang-gliding, diving are not recommended, given the risk of severe injury or death, if a seizure were to occur during the activity.

Generally, most sports are safe as long as patients avoid overexertion, dehydration and hypoglycemia. If a seizure occurs, it is most likely to be after the exercise (15 minutes to three hours later) and can occur suddenly without warning.

Travelling

• Travelling by cars and trains: Patients should sit away from watching fast moving or jerking shapes on roads, also light reflection on rapidly moving vehicles which can trigger seizures in PSE.

• Air travel increases seizures frequency. Provided that seizures are controlled with medication, epileptic Patients can travel by air.

• Epilepsy is thought to be one of the essential contraindication for driving a motor vehicle on public roads. There is a tendency toward a greater liberalization of driving standards for people with epilepsy.

Foods that thought to be seizure triggers in some patients include: artificial colors, preservatives especially Propionate in addition towheat, cows milk and cheese (but not sheep cheese), tomatoes, tea, grapes and other salicylate-containing foods; chocolate, pork, banana, amine-containing foods and other glutamate containing foods (Egger et al, 1989). ).

Others• Pollution

• Noise

• Smoking

• Radiation

Thank you

Warning