Kevin Berner, Assistant Professor, Occupational Therapy, hopes future brings implantable devices to warn of impending seizures
November is National Epilepsy Awareness Month – a time to bring attention to one of the most common neurological disorders that affects nearly 3.4 million people in the United States. While the challenges of epilepsy are more commonly known, the disease is often stigmatized; advocates say a wider understanding of the realities of living with the condition is needed.
In this month’s “IHP Interview,” Kevin Berner, Assistant Professor of Occupational Therapy, dives deeper into the topic. The conversation below has been edited for brevity and clarity.
Give us a brief background on epilepsy.
Epilepsy is a medical condition where individuals experience seizures, or unusual electrical activity in the brain that may result in changes in consciousness, changes in responsiveness or abnormal movements. A seizure can result in impairments and disability.
What causes epilepsy?
Epilepsy can be caused by changes in the brain from medical conditions such as stroke, multiple sclerosis, traumatic brain injury, or infection. An individual may have epilepsy due to a family history or because of abnormal structures in their brain from birth. Other times, an individual may develop epilepsy without any known cause.
According to the Epilepsy Foundation, infections such as meningitis and encephalitis are the most common cause of the disease, but about half of people with epilepsy have an unknown cause.
How does epilepsy impact the way someone lives their life?
With epilepsy, seizures can be triggered by a number of things like lack of sleep, missed medication doses, flashing lights, physical exertion, or menstruation. Seizure onset can be unpredictable and can happen while engaging in activities such as biking, cooking, driving, or while at the movies. If someone becomes unresponsive or has movement changes from a seizure while engaging in activities like biking, cooking or driving, they can get hurt so they need to be more cautious than those without the disease.
How can epilepsy be managed?
Medication adherence and adjustment is essential. An individual’s interprofessional treatment team can work together to help the client monitor medications, establishing routines for medication adherence, and develop healthy lifestyle routines like healthy eating and sleep routines to minimize risk factors for seizures.
What are some misconceptions about epilepsy?
There are many different types of seizures, but oftentimes when people think about seizures, they think they are all noticeable.
While some seizures are obvious and result in a loss of consciousness paired with generalized, uncontrolled movements – known as tonic-clonic seizures – there are other forms too. Some generalized seizures are less obvious, leading to a change in responsiveness for only a few moments, otherwise known as absence seizures. Some seizures are categorized as “focal” in nature and do not result in loss of consciousness, and may result in tensing or twitching of muscles, changes in sensation, or changes in autonomic functions like temperature regulation. Seizure activity can be confirmed with an electroencephalogram test (EEG), which measures the electrical activity of the brain.
What do you want people to know about epilepsy?
Seizures may not be obvious in all individuals. If you notice changes in movements, awareness, consciousness, or cognition, this may be a seizure. It’s important at this point that individuals communicate these symptoms to their provider. From there, providers may seek additional testing to determine if it is seizure activity.
Getting treatment for epilepsy is essential. In addition to experiencing possible neurologic damage from the seizure itself, people with epilepsy can experience injuries during a seizure if they fall or are involved in some kind of accident. While medications are a primary treatment, maintaining healthy routines can further reduce seizure risk.
How do Occupational Therapists work with individuals who have epilepsy?
As occupational therapists, we work with individuals to help them engage in occupations and activities that are most meaningful to them. It’s no different for people with epilepsy.
For some with epilepsy, taking medication is essential for preventing seizures from happening. OTs may help create routines for taking and managing medications as prescribed by their provider. This may include entering and managing electronic medication reminders on smart phones or smart speakers and planning for meals and snacks so medication can be paired with food when necessary.
Individuals with epilepsy are more likely to have seizures when their body is under stress from hunger, fatigue, school or work stresses, or physical exertion. OTs help individuals with lifestyle redesign to lessen life stressors and reduce the overall risk of seizures.
It’s essential for everyone to participate in activities that are most meaningful to them. OTs can help find ways to engage in activities most meaningful while reducing risk of injury.
How did you get involved in epilepsy work?
I began my career working in a neurological rehab and inpatient rehabilitation hospital. Many of the individuals I worked with had new onset of epilepsy as a result of a brain injury from stroke or trauma. We engaged in patient and family education around epilepsy and discussed how epilepsy may impact recovery.
I later transitioned into working with adults in the community and children as a school-based occupational therapist. In these environments, we focused on health, well-being, and managing symptoms to promote participation in activities and occupations that the client/patient/student wanted to do or needed to do.
Years later, my child was diagnosed with epilepsy. We employ many of the strategies from my occupational therapy practice into our family routines to support participation in many of the meaningful activities of childhood including school, sports, and play.
How does the IHP prepare students work with patients with epilepsy?
In the entry-level occupational therapy doctoral coursework, we underscore the importance of supporting an individual in participating in the occupations that are most meaningful to them. Classes cover specific skills around helping individuals develop healthy habits and routines, engage in lifestyle change for improved wellness, remediate skills impacted by neurologic change, and adapt activities to improve independence and safety.
Where do you hope to see advancements in this space in the coming years?
We have been seeing improved reliability of wearable technology and mainstream devices in detecting significant medical events. I hope to see continued innovation for wearable devices that can be sensitive to detecting and alerting caregivers of different types of seizures. In the farther future, perhaps implanted devices can reliably detect electrical changes to predict onset of seizures before they happen, allowing an individual to activate emergency services and take necessary precautions.
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