Presentation Epilepsy
Presentation Epilepsy
Presentation Epilepsy
ON
EPILEPSY Prsented by :- Aafrin
M.Sc. Nursing 1 s t year ( medical and surgical nursing )
INTRODUCTION
Epilepsy can be primary (idiopathic) or secondary, when the cause is known and the epilepsy is a
symptom of another underlying condition such as a brain tumor.
Although there is evidence that susceptibility to some types of epilepsy may be inherited, the cause of
seizures in many people is unknown. Epilepsy can follow birth trauma, asphyxia neonatorum, head
injuries, some infectious diseases (bacterial, viral, parasitic), toxicity (carbon monoxide and lead
poisoning), circulatory problems, fever (childhood) and nutritional disorders, and drug or alcohol
intoxication. It is also associated with brain tumors, abscesses, and congenital malformations.
In most cases of epilepsy, the cause is unknown (idiopathic).
The improved treatment for cerebrovascular disorders, head injuries, brain tumors, meningitis, and
encephalitis has increased the number of patients at risk for seizures after recovery from these conditions.
CONTINUE…..
Cranial surgery
Metabolic disorders ( hypocalcemia , hypoglycemia / hyperglycemia , anoxia)
Drug toxicity
CNS infection
Circulatory disorders or Cerebrovascular disease is the leading cause of seizures in the
elderly.
Drug withdrawal states ( alcohol , barbiturates )
Congenital neurodegenerative disorders.
PATHOPHYSIOLOGY
Messages from the body are carried by the neurons (nerve cells) of the brain by means
of discharges of electrochemical energy that sweep along them.
These impulses occur in bursts whenever a nerve cell has a task to perform.
Sometimes, these cells or groups of cells continue firing after a task is finished.
During the period of unwanted discharges, parts of the body controlled by the errant
cells may perform erratically.
Resultant dysfunction ranges from mild to incapacitating and often causes
unconsciousness.
When these uncontrolled, abnormal discharges occur repeatedly, a person is said to have
an epileptic syndrome.
CLASSIFICATION
Electroencephalogram (EEG)
Head injury is one of the main causes of epilepsy that can be prevented.
MEDICAL MANAGEMENT
The circumstances before the seizure (visual, auditory, or olfactory stimuli, tactile stimuli, emotional or psychological
disturbances, sleep, hyperventilation)
The occurrence of an aura (visual, auditory, or olfactory).
The first thing the patient does in a seizure—where the movements or the stiffness starts, conjugate gaze position, and
the position of the head at the beginning of the seizure. This information gives clues to the location of the seizure
origin in the brain.
The type of movements in the part of the body involved
The areas of the body involved.
The size of both pupils. Are the eyes open? Did the eyes or head turn to one side?
Continue….
The presence or absence of automatisms (involuntary motor activity, such as lip smacking
or repeated swallowing)
Incontinence of urine or stool
Duration of each phase of the seizure
Unconsciousness, if present, and its duration
Any obvious paralysis or weakness of arms or legs after the seizure
Inability to speak after the seizure
Movements at the end of the seizure
Whether or not the patient sleeps afterward
Cognitive status (confused or not confused) after the seizure
NURSING MANAGEMENT AFTER A SEIZURE
After a patient has a seizure, the nurse’s role is to document the events leading to and occurring
during the seizure and to prevent complications (eg, aspiration, injury).
Use the epilepsy foundation of America ‘ special services , including help in obtaining
medications vocational rehabilitation , and coping with epilepsy.
COMPLICATIONS
1. Status epilepticus
2. Injuries due to falls , especially head injuries
STATUS EPILEPTICUS
Status epilepticus (acute prolonged seizure activity) is a series of generalized seizures that occur
without full recovery of consciousness between attacks.
The term has been broadened to include continuous clinical or electrical seizures lasting at least 30
minutes, even without impairment of consciousness.
It is considered a medical emergency.
Vigorous muscular contractions impose a heavy metabolic demand and can interfere with respirations.
There is some respiratory arrest at the height of each seizure that produces venous congestion and
hypoxia of the brain.
Repeated episodes of cerebral anoxia and edema may lead to irreversible and fatal brain damage.
Factors that precipitate status epilepticus include withdrawal of anti-seizure medication, fever, and
concurrent infection.
MEDICAL MANAGEMENT
An airway and adequate oxygenation are established.
If the patient remains unconscious and unresponsive, a cuffed endotracheal tube is inserted.
Intravenous diazepam (Valium), lorazepam (Ativan), or fosphenytoin (Cere- byx) is given slowly in an
attempt to halt seizures immediately.
Other medications (phenytoin, phenobarbital) are given later to maintain a seizure-free state.
An intravenous line is established, and blood samples are obtained to monitor serum electrolytes,
glucose, and phenytoin levels.
EEG monitoring
Vital signs and neurologic signs are monitored
An intravenous infusion of dextrose is given if the seizure is due to hypoglycemia.
If initial treatment is unsuccessful, general anesthesia with a short-acting barbiturate may be used.
NURSING MANAGEMENT
Assessment and monitoring of respiratory and cardiac function.
Monitoring and documenting the seizure activity and the patient’s responsiveness.
The patient is turned to a side-lying position. Suction equipment must be available because of
the risk for aspiration.
The intravenous line is closely monitored because it may become dislodged during seizures.
A person who has received long-term antiseizure therapy has a significant risk for fractures
resulting from bone disease (osteoporosis, osteomalacia, and hyperparathyroidism), a side
effect of therapy. Thus, during seizures, the patient should be protected from injury using
seizure precautions and monitored closely. No effort should be made to restrain movements.
SUMMARY
◦ Today we are discussed about the definition , etiology or risk factors
, pathophysiology, classification, clinical manifestations , medical
and surgical management, nursing management and complication.
COMPLICATION
◦ Epilepsy is a very complex medical condition. Many effective treatment
options are available. Epilepsy is a centeral nervous system (neurological )
disorder in which brain activity becomes abnormal causing seizure or periods
of unusual behavior , sensation and sometimes loss of awareness . Anyone can
develop epilepsy affects both males and females all races , ethnic backgrounds
and ages.
BIBLIOGRAPHY