Presentation Epilepsy

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PRESENTATION

ON
EPILEPSY Prsented by :- Aafrin
M.Sc. Nursing 1 s t year ( medical and surgical nursing )
INTRODUCTION

Seizures ( also known as epileptic seizure and , if recurrent , epilepsy ) are


defined as a sudden alteration in normal brain activity distinct in behaviour and
body function.
DEFINITION
 Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity
(or a combination of these) resulting from sudden excessive discharge from
cerebral neurons.
 A part or all of the brain may be involved.
 Most seizures are sudden and transient.

 Epilepsy is a group of syndromes characterized by recurring seizures. Epileptic


syndromes are classified by specific patterns of clinical features, including age of
onset, family history, and seizure type.
ETIOLOGY OR RISK FACTOR

 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

 The international classification of seizures differentiates between two main types:


partial seizures that begin in one part of the brain, and generalized seizures that
involve electrical discharges in the whole brain.

 The underlying cause is an electrical disturbance (dysrhythmia) in the nerve cells in


one section of the brain, causing them to emit abnormal, recurring, uncontrolled
electrical discharges. The characteristic seizure is a manifestation of this excessive
neuronal discharge.
 There may be associated loss of consciousness, excess movement or loss of muscle
tone or movement, and disturbances of behavior, mood, sensation, and perception.
CLASSIFICATION
CLINICAL MANIFESTATIONS
 Depending on the location of the discharging neurons, seizures may range from a simple
staring episode to prolonged convulsive movements with loss of consciousness.
 Seizures have been classified according to the area of the brain involved and have been
identified as partial, generalized, and unclassified
 Partial seizures are focal in origin and affect only part of the brain.
 Generalized seizures are nonspecific in origin and affect the entire brain simultaneously.
 Unclassified seizures are so termed because of incomplete data.
In simple partial seizures
 Only a finger or hand may shake, or the mouth may jerk uncontrollably. The person may
talk unintelligibly, may be dizzy, and may experience unusual or unpleasant sights,
sounds, odors, or tastes, but without loss of consciousness.

In complex partial seizures


 the person either remains motionless or moves automatically but
inappropriately for time and place, or may experience excessive emotions
of fear, anger, elation, or irritability.
 Whatever the manifestations, the person does not remember the episode
when it is over.
Generalized seizures
 previously referred to as grand mal seizures, involve both hemispheres of the brain, causing both sides of
the body to react.
 There may be intense rigidity of the entire body followed by alternating muscle relaxation and
contraction (generalized tonic–clonic contraction).
 The simultaneous contractions of the diaphragm and chest muscles may produce a characteristic
epileptic cry.
 The tongue is often chewed, and the patient is incontinent of urine and stool.
 After 1 or 2 minutes, the convulsive movements begin to subside; the patient relaxes and lies in deep
coma, breathing noisily.
 The respirations at this point are chiefly abdominal.
 In the postictal state (after the seizure), the patient is often confused and hard to arouse and may sleep for
hours.

 Many patients complain of headache, sore muscles, fatigue, and depression.


A developmental history is taken, including events of pregnancy and childbirth, to seek evidence of pre-
existing injury. The patient is also questioned about illnesses or head injuries that may have affected the
brain.

Physical and Neurologic evaluations.

Biochemical, Hematologic, and Serologic studies.

MRI is used to detect lesions in the brain, focal abnormalities, cerebrovascular


abnormalities, and cerebral degenerative changes.

Electroencephalogram (EEG)

Single Photon Emission Computed Tomography (SPECT)


PREVENTION
 The risk for congenital fetal anomaly is two to three times higher in
mothers with epilepsy. The effects of maternal seizures, antiseizure
medications, and genetic predisposition are all mechanisms that contribute
to possible malformation. High-risk mothers (teenagers, women with
histories of difficult deliveries, drug use, patients with diabetes or
hypertension) should be identified and monitored closely during
pregnancy.

 Head injury is one of the main causes of epilepsy that can be prevented.
MEDICAL MANAGEMENT

 The management of epilepsy or seizure is individualized


to meet the needs of each patient and not just to manage
and prevent seizures.
 Management differs from patient to patient , because some
forms of epilepsy arise from brain damage and others from
altered brain chemistry.
PHARMACOLOGIC THERAPY
 Many medications are available to control seizures, although the mechanisms of their actions are still
unknown. The objective is to achieve seizure control with minimal side effects. Medication therapy
controls rather than cures seizures.
 Treatment is usually started with a single medication. The starting dose and the rate at which the dosage
is increased depend on the occurrence of side effects.
 Changing to another medication may be necessary if seizure control is not achieved or if toxicity makes
it impossible to increase the dosage. Sudden withdrawal of these medications can cause seizures to occur
with greater frequency or can precipitatethe development of status epilepticus
 Side effects of antiseizure agents may be divided into three groups: (1) idiosyncratic or allergic
disorders, which present primarily as skin reactions; (2) acute toxicity, which may occur when the
medication is initially prescribed; or (3) chronic toxicity, which occurs late in the course of therapy.
 The manifestations of drug toxicity are variable, and any organ system may be involved. Gingival
hyperplasia (swollen and tender gums) can be associated with long-term use of phenytoin (Dilantin).
SURGICAL MANAGEMENT
 Surgery is indicated for patients whose epilepsy results from intracranial tumors,
abscess, cysts, or vascular anomalies.
 As an adjunct to medication and surgery in adolescents and adults with partial
seizures, a generator may be implanted under the clavicle. The device is connected to
the vagus nerve in the cervical area, where it delivers electrical signals to the brain to
control and reduce seizure.

 Surgery – resective and palliative operations ( temporal lobectomy , extratemporal


resection , corpus , hemispherectomy)
NURSING MANAGEMENT
NURSING MANAGEMENT DURING A SEIZURE
A major responsibility of the nurse is to observe and record the sequence of symptoms. The nature of the seizure usually
indicates the type of treatment that is required before and during a seizure, the following are assessed and documented:

 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).

 The patient is at risk for hypoxia, vomiting, and pulmonary aspiration.


 To prevent complications, the patient is placed in the side-lying position to facilitate drainage
of oral secretions and is suctioned, if needed, to maintain a patent airway and prevent
aspiration.
 The bed is placed in a low position with side rails up and padded if necessary to prevent patient
injury.
 The patient may be drowsy and may wish to sleep after the seizure; he or she may not
remember events leading up to the seizure and for a short time thereafter.
Assessment
 The nurse elicits information about the seizure history.
 The patient is asked about the factors or events that may precipitate the seizures.
Alcohol intake is documented.
 The nurse determines if the patient has an aura (a premonitory or warning
sensation) before an epileptic seizure, which may indicate the origin of the
seizure (eg, seeing a flashing light may indicate the seizure originated in the
occipital lobe).
NURSING DIAGNOSIS

Ineffective Tissue Perfusion (cerebral)


related to seizure activity

Risk for Injury related to seizure activity

Ineffective Coping related to


psychosocial and economic consequences
of epilepsy
NURSING INTERVENTIONS
1. Maintaining Cerebral Tissue Perfusion
 Maintain a patent airway until the patient is fully awake after a
seizure.
 Provide oxygen during the seizure if color change occurs.
 Stress the importance of taking medications regularly.
 Monitor serum levels for therapeutic range of medications. Monitor
the patient for toxic adverse effects of medications.
 Monitor platelet and liver functions for toxicity due to medications.
Continue…
2. Preventing Injury
 Provide a safe environment by padding side rails and removing clutter.
 Place the bed in a low position.
 Do not restrain the patient during a seizure.
 Do not put anything in the patient's mouth during a seizure.
 Place the patient on his side during a seizure to prevent aspiration.
 Protect the patient's head during a seizure.
 Stay with the patient who is ambulating or who is in a confused state during
seizure.
Continue……..
3. Strengthening Coping
 Teach stress reduction techniques that will fit into the
patient's lifestyle.
 Initiate appropriate consultation for management of
behaviors.
 Answer questions related to use of computerized video
EEG monitoring and surgery for epilepsy management.
PATIENT EDUCATION
 Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental
care are essential to prevent or control gingival hyperplasia in patients receiving
phenytoin.
 The patient is also educated to inform all health care providers of the medication being
taken, because of the possibility of drug interactions.
 An individualized comprehensive education plan is needed to assist the patient and
family to adjust to this chronic disorder.
 Avoid activities that require alertness and coordination ( driving , operating machine )
until after the effects of the medication have been evaluated.
 Exercise in moderation in a controlled environment to avoid excessive heat.
Continue….
 Keep a medication and seizure record , noting when medications are taken and any
seizure activity.
 Notify the primary provider if the patient cannot take medications due to illness.
 Take showers rather than tub baths to avoid drowning if seizure occurs ; never swim
alone.
 Develop regular sleep patterns to minimize fatique and insomnia.
 Because epilepsy can be lifelong, the use of costly medications can create a significant
financial burden.

 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

 Brunner & Siddharth, Textbook of Medical surgical


nursing', Volume 2, 13th edition, Wolters Kluwer
publication, New Delhi 2009, pg. 1959-1966.

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