As I’m approaching the end of my Master of Health studies journey, I’ve been thinking about the next steps I should take and how I should apply my new knowledge. Shortly after completing leadership focus courses, I was introduced to the new courses related to health promotion. I decided to pursue a dual focus since the health promotion courses, including MHST/NURS 631, will strengthen my connection between my education and making a difference within the healthcare industry going forward. Exploring the role of social determinants of health and ways to minimize health inequalities fits with my life purpose of helping others and impacting change initiatives that allow people to thrive. For MHST/NURS 631, I decided to focus on epilepsy awareness and a health promotion project that can help with seizure prevention. This health topic is close to my heart because of my lived experience of supporting a family member with epilepsy following a traumatic brain injury as well working as a Neurophysiology Technologist at Vancouver General Hospital.
My Current Knowledge about Health Promotion in Epilepsy
People with epilepsy have seizures that are disruptive and potentially harmful, especially if they are related to losing consciousness and accidents like falls that result in injuries. Seizures may be triggered by stress, alcohol or drug use (particularly abrupt cessation of alcohol causing withdrawal seizures), missing a dose of anti-epileptic medication (related to deliberate non-compliance or accidental non-adherence), flashing lights (such as light passing through trees at a fast frequency while driving), excessive screen time (such as playing video games), and inadequate sleep (Epilepsy Foundation, 2022). Sleep deprivation is one of the most common precipitating factors for a seizure as it significantly decreases the seizure threshold (Epilepsy Foundation, 2022). Prior to certain electroencephalogram (EEG) studies, a patient with epilepsy may be asked to sleep less than usual (typically at most 4 hours) to enhance an EEG abnormality.
In the Seizure Investigation Unit (SIU), it is very useful having video monitoring since this allows the technologist to determine if there is a clinical correlate associated with certain electrographic activity. Similarly, the video footage can help us see if a clinical feature is time-locked with abnormal brainwave activity indicative of seizure activity or if there’s no correlate then it can help with a diagnosis of psychogenic non-epileptic seizures (PNES). Long-term EEG monitoring at home (longer than a few days during an ambulatory study) is not realistic given the discomfort of wearing scalp electrodes for extended periods of time and the maintenance of electrodes and other equipment required for an artifact-free recording. There are invasive electrodes as well (i.e. placed directly on the brain following insertion in the operating room) but these are still not a good choice for chronic use at home due to risks of infection and other complications. Monitoring using either scalp or intracranial EEG, within the context of the SIU, is safe because of the trained staff and the services available to provide remedies if issues arise. Although ongoing EEG monitoring is not ideal at home, gathering video footage would be useful for the Neurophysiology Technologist and Epileptologist. Some people with epilepsy choose to have a camera in the bedroom to capture seizure activity, which is enhanced at night for some individuals. A video could provide information such as the duration of the seizure and even help with localization of a seizure focus (i.e. brain region that is initiating the seizure) based on the first clinical sign that is noted (e.g. head deviation to the left or right arm twitching etc.).
My Learning Goals
During this project, I would like to learn more about ways people can utilize technology to collect data for their healthcare team such as the video footage of a seizure. For example, the market for wearable devices is gaining popularity. These devices can detect significant rhythmical movements and send alerts to a caregiver that someone is likely to be having a seizure (Brinkmann et al., 2021). The role of technology in health promotion for people with epilepsy is what I’m most excited to learn about because of the fast-paced changes within this industry and potential benefits in seizure reduction.
I’m also looking forward to learning more about the social determinants of health; the link between socioeconomic status and seizure disorders is especially interesting since approximately half of the adults in the United States with active epilepsy have an annual family income of under $25,000 (US Centers for Disease Control and Prevention Epilepsy Program, 2016). The only SIU in British Columbia is in Vancouver, which may be difficult for certain people to access. In general, rural areas do not have access to epilepsy specialists (Duke et al., 2021); therefore, I’m interested in learning ways to minimize barriers for populations in remote or rural areas such as virtual care solutions. I want to explore the current work being done to minimize the stigma around epilepsy and explain how eliminating stigma improves health outcomes. Moreover, it is important to understand that people in certain regions, particularly rural areas or developing countries, are more likely to go untreated due to negative beliefs and attitudes towards epilepsy (Beghi, 2016).
Challenges with my Health Promotion Project
One challenge associated with a project about epilepsy is the constantly changing definitions within this field, especially regarding epileptic seizures versus PNES. A limitation for some studies may be related to misdiagnosis of organic epilepsy when in fact it is PNES (Beghi, 2016); in order to keep the scope of this project manageable, I do not want to include PNES as this is more in keeping with a psychiatric disorder and the treatment plan is different compared to epileptic activity triggered by abnormal electrical activity of the brain. Another challenge will be providing health promotion suggestions that are not overly broad. For example, recommending stress management is not useful to the average person unless there are details outlining appropriate relaxation techniques and tangible actions. The biggest challenge for a health promotion project related to this topic is the fact that there’s no one-size fits all approach to seizure reduction. There are complicated interactions and relationships that will vary from person to person. Therefore, I’ll need to make it clear that there’s no magic bullet and people with epilepsy will still need to engage in dialogue with their healthcare team about which of the suggestions are the most relevant for them. Overall, my guiding principles for this health promotion project will be improving the quality of life of patients with epilepsy and conveying a body of evidence for seizure management in a simplified way.
Beghi, E. (2016). Addressing the burden of epilepsy: Many unmet needs. Pharmacological Research, 107, 79-84. http://dx.doi.org/10.1016/j.phrs.2016.03.003
Brinkmann, B.H., Karolv, P., Nurse, E.S., Dumanis, S.B., Nasseri, M., Viana, P.F. Schulze-Bonhage, A., Freestone, D.R., Worrell, G., Richardson, M.P. & Cook, M.J. (2016). Seizure diaries and forecasting with wearables: Epilepsy monitoring outside the clinic. Frontiers in Neurology, 12, 1-14. https://doi.org/10.3389/fneur.2021.690404
Duke, S.M., Gonzalea Otarula, K.A., Canales, T., Lu, E., Stout, A., Ghearing, G.R., Sajatovic, M. (2021). A systematic literature review of health disparities among rural people with epilepsy (RPWE) in the United States and Canada. Epilepsy & Behavior, 122, 181-186. https://doi.org/10.1016/j.yebeh.2021.108181
Epilepsy Foundation (2022). Seizure triggers. Epilepsy Foundation. Retrieved January 28, 2023 from https://www.epilepsy.com/what-is-epilepsy/seizure-triggers
US Centers for Disease Control and Prevention Epilepsy Program (2016). About one-half of adults with active epilepsy and seizures have annual family incomes under $25,000: The 2010 and 2013 US National Health Interview Surveys. Epilepsy & Behavior, 58, 33-34. https://doi.org/10.1016/j.yebeh.2016.02.024
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