Epilepsy
Definition
o Is a seizure disorder
o A part or all of the brain involved
o Sudden uncontrolled excessive electrical discharges from cerebral neurones
o Resulting in abnormal motor, sensory, autonomic, or psychic activity.
o There may be associated
loss of consciousness
excess movement
loss of muscle tone or movement
disturbances of behaviour, mood, sensation, and perception
Aetiology: -
o Birth injury
o asphyxia neonatorum
o head injuries
o infectious diseases
o toxicity co and lead poisoning
o circulatory problems
o fever, metabolic and nutritional disorders
o drug or alcohol intoxication
o brain tumours abscesses and congenital malformations
o Mostly idiopathic
Clinical Manifestations
o Simple staring episode
o Convulsive movements
o Loss of consciousness
o In simple partial seizures, only a finger or hand may shake, or the mouth may jerk uncontrollably
o Pt may talk unintelligibly, may be dizzy and may experience unusual or unpleasant sights, sounds odors, or tastes, but without loss of consciousness
o May remain motionless, or moves automatically but inappropriately
o may experience excessive emotions of fear, anger, elation or irribability.
o Whatever the manifestations the person does not remember the episode when it is over
o Generalized seizures (grand mal seizures) involve both cerebral hemispheres.
International Classification of Seizures
Partial Seizures (seizures beginning locally)
Simple partial seizures (with elementary symptoms, generally without impairment of consciousness)
o With motor symptoms
o With special sensory or somatosensory symptoms
o With autonomic symptoms
o Compound forms
Complex partial seizures (with complex symptoms, generally with impairment of consciousness)
o With impairment of consciousness only
o With cognitive symptoms
o With affective symptoms
o With psychosensory symptoms
o With psychomotor symptoms (automatism)
o Compound forms
Generalized Seizures (convulsive or nonconvulsive, bilaterally symmetric, without local onset)
o Tonic-clonic seizures
o Tonic seizures
o Clonic seizures
o Absence seizures
o Atonic seizures
o Myoclonic seizures (bilaterally massive epileptic)
Nursing Management during a Seizure
o Observe and record the sequence of symptoms.
o Note the circumstances before the seizure (visual, auditory, or olfactory stimuli, tactile stimuli, emotional or psychological disturbances, sleep, hyperventilation)
o The occurrence of an aura (visual, auditory or olfactory
o The first thing a patient does in a seizure - where the movements start, conjugate gaze position, and the position of the head at the beginning of the seizure)
o The type of movements in the part of the body involved
o The areas of the body involved
o The size of both pupils. Are the eyes open? Did the eyes or head turn to one side?
o The presence or absence of automatisms (involuntary motor activity, such as lip smacking or repeated swallowing)
o Incontinence of urine or stool
o Duration of each phase of seizure
o Unconsciousness if present and its duration
o Any obvious paralysis or weakness of arms or legs after the seizure
o Inability to speak after seizure
o Movements at the end of the seizure
o Whether or not the patient sleeps afterward
o Cognitive status (confused or not confused) after the seizure
Nursing interventions
o Privacy
o Put him to floor
o Protect the head with a pad
o Loosen constrictive clothing
o Clear articles around
o If in bed remove pillows and raise rails
o If aura + provide oral airway
o Do not pry open the clenched jaws
o Do not restrain the convulsive movements
o If possible place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mcus. If suction is available use it if necessary to clear secretions
Major Antiseizure Medication
o Carbamazepine (tegretol)
o Clonazepam
o Ethosuximide
o Felbanate
o Gabapentin
o Lamotrigine
o Levetiracetam
o Oxacarbazepine
o Phenobarbital
o Phenytoin (dilantin)
o Primidone
o Tiagabine
o Topiramate
o Valproate
o zonisamide
Status Epilepticus
o Status epilepticus is a series of generalized seizures that occur without full recovery of consciousness between attacks
o lasting at least 30 minutes even without loss of consciousness
o A medical emergency
o Produces cumulative effects
o Metabolic demand
o Interferes with respiration
o Hypoxia of the brain
o Repeated epsodes of cerebral anoxia and oedema may lead to irreversible and fatal brain damage
o Withdrawal of antiseizure medication, fever and concurrent infection - may precipitate
Management
o Airway, cuffed endotracheal tube
o Oxygen
o Iv diazepam, lorazepam, or fosphenytoin
o Phenytoin and phenobarbital later
o IV line
o Sampling of blood
o EEG monitoring
