Epilepsy

Introduction
Epilepsy is a group of syndromes characterized by recurring
seizures. Epilepsy syndromes are classified by specific pattern
of clinical features, family history & seizures type.Epilepsy is a
syndrome of another underlying condition such as tumor.
 DEFINITION
``Epilepsy is a reccurent seizure disorder characterized by
abnormal electrical discharge from brain, often in the cerebral
cortex’’.
Or
``Epilepsy is a recurrent episodic disturbance of the brain
function due to abnormal electrical activity of the neuron.it is
manifested as abnormal motor,sensory phenomenon often
with impaired or loss consciousness.’’
 INCIDENCE

Epilepsy is the most common neurological problem.An estimated

2-4 million people are affected in the US with epilepsy .
Approximately 50 million people are affected of all age group
globally by epilepsy. Nepal is the one of the poorest countries
in the world and it is not uncommom to see huge untreated
epilepsy patients in our country. The prevalance rate of
epilepsy in Nepal is 7.3 per 1000 population with the
treatment gap of over 80%.
 CAUSES
• In 30% cases cause can be determined .
• Rest (70%)are idiopathic.
• Determined causes:
a)Inherited genetic
b)Acquired : Trauma, neurosurgery,
inflammatory,metabolic,infection, tumor,toxic disorders,
drugs,etc.
c )Congenital: inborn error of metabolism.
d) Withdrawal of drugs: Alcohol,benzodiazepine,
barbiturates,other anti epileptics.c
 According to the age groups
Neonate Perinatal hypoxia and ischemia
(<1month) Intracranial hemorrhage and trauma
Acute CNS infection
Drug withdrawal
metabolic disturbances (hypoglycemia,hypocalcemia )

febrile seizures
genetic disorders (metabolic,degenerative ,primary epilepsy
syndromes)

Infantsand developmental disorders

children(> trauma
idiopathic
1month
And <12yrs )
Adolescents(12 Trauma, genetic disorders,infection, brain tum
- 18 years) or , illict drug use ,idiopathic

Young adults( 18- Trauma, alcohol withdrawal,brain tumor

35 years)

Older adults (>35 Cerebrovascular disease

Years) brain tumor
 PATHOPHYSIOLOGY
Genetic causes Na+,K+, Ca+ transport across the
neuron
Which cause excitatory neurotransmitters and neuron
depolarization(depolarization is a change within a cell , during which
the cell undergoes a shift in electrical charge disturbition).

Causing brain cells to

become overactive and discharge in a sudden violent disorderly
manner.
Which result
in( hypoglycemia, hypoxia,hypercapnia )
 CLASSIFICATION
SEIZURES
PARTIAL GENERALIZED
. Simple . Absence

. partial . Tonic-Clonic

. Complex Partial . Myoclonic

. Atonic

. Simple partial . Infantile spasms (hypsaarythmia)

or complex partial
seizures secondarily
generalized
A. PARTIAL SEIZURES:

1.Simple partial seizures(SPS,cortical focal epilepsy):

. Lasts ½ -1 min.
.Often secondary.
.Convulsions are confined to a group of muscles or
localized sensory disturbance depending on the
area of cortex involved in the seizure,
.without loss of consciousness.
2.Complex partial seizures(CPS,temporal lobe
epilepsy, psychomotor):
.Attacks of bizarre and confused behavior and
purposeless movements,
. Emotional changes lasting 1-2 min along with
impairement of consciousness.
.An aura often preceds and seizure focus is
located in the temporal lobe.
 FOCAL SEIZURES
A.FOCAL SEIZURES B. FOCAL SEIZURES WITH
WITHOUT DYSCONGITIVE DYSCONGITIVE FEATURES
FEATURES
. without impairement . Impairement of consciousness
. Fully consciousness patient
. Able to interact normally .Appears to be awake does
with the surroundings not interact or answers and

.SIMPLE PARTIAL SEIZURES questions

. COMPLEX PARTIAL SEIZURES

3. Simple partial or complex partial seizures
secondarily generalized:
.The partial seizure occurs first and evolves into
generalized tonic – clonic seizures with loss of
consciousness.
B.GENERALIZED SEIZURES:
.Focal symptoms may be prognostic in
generalized epilepsies
 1. Generalized tonic-clonic seizures(GTCS, major epilepsy,
GRAND MAL):
• Commonest,
• Lasts 1-2min
• The usual sequence is aura – cry- unconsciousness-
tonic spasm of all body muscles –clonic jerking
followed by prolonged sleep and depression of all
CNS function.
• Postictal phase/post seizure phase:
depression,confusion,and disorientation(for hours)
2.Absence seizures (minor epilepsy, PETIT MAL):
• Prevalent in children
• Lasts about ½ min
• Momentry loss of consciousness, patient
apparently freezes and stares in one direction,
no muscular componentor little bilateral jerking.
• EEG shows characteristics 3 cycles per second
spike and wave pattern.
3.Atonic seizures(Akinetic epilepsy or drop
attacks)
• Unconsiousness with relaxation of all muscles
due to excessive inhibitory discharges .
• Patient may fall.
• The seizures are brief – usually less than
fifteen seconds.
4. MYOCLONIC SEIZURES
• Shock – like momentary contraction of
muscles of a limb or the whole body.
5. Infantile Spasms ( Hypsarrhythmia)
• Seen in infants .
• Probably not a form of epilepsy .
• Intermittent muscle spasm and progressive
mental deterioration .
• Diffuse changes in the interseizure EEG are
noted.
• STATUS EPILEPTICUS
.Seizure activity occurs for >30 min, or to or more
seizures occur without recovery of
consciousness.
.Recurrent tonic- clonic convulsions with recovery
of consciousness in between is an emergency;
fits have to be controlled as quickly as possible
to prevent death and permanent brainn
damage.
 SIGN AND SYMPTOMS
• “Blackouts”or periods of confused memory
• Episodes of staring or unexplained period of unresponsiveness

• Involuntary movement arms and legs.

• “Fainting spells’’ with incontinence or followed by excessive
fatigue.
• Distored perceptions , or episodic feelings of fear that cannot
be explained.
• Strange sensations
• Visual hallucination
• Muscles spasms,convulsions
 DIAGNOSIS

• History of events during pregnancy& child

birth for eg:birth asphyxia,difficult labor&
trauma.
• Electroencephalogram
• Neurological imaging studies
1. Magnetic Resonance Imaging(MRI) to detect
lesion in brain,eg:abscess or tumor etc.
2. Computerized tomography(CT) to identify the
epilepto-genic zone.
3. Blood tests.
 TREATMENT
• MEDICAL MANAGEMENT
> It includes need for long term needs & immediate treatment of
epilepticus using medications. The usual treatment is a single – drug
therapy.
> Airway and oxygen administration & I/V line is established for giving
medications.
> I/V diazepam , lorazepam or phenytoin are administered slowly in an
attempt to halt the seizures.General anesthesia with a short – acting
barbitura te may be used if initial treatment is unsuccessful.
> To prevent further seizures , other medications (Phenytoin ,
phenobarbital) are prescribed after the initial seizure is treated.
• SURGICAL MANAGEMENT : It is indicated in
the following conditions:
 Anatomical lesion, e.g. brain tumor, hematoma&
abscess or cysts, etc.
 Surgical removal of the epileoptogenic focus is done
for seizure that originates in a well defined area of the
brain that can be excised without producing
significant neurologic defects.
 NURSING MANAGEMENT
Nursing assessment
>History : By analyzing the patients detailed clinical
history, also provides invaluable details about auras,
preservation of consciousness, and postictal states.
> Physical exam : Helps in the diagnosis of specific
epiletic syndromes that cause abnormal findings also,
patients who for years have had intractable
generalized tonic – clonic seizures are likely to have
suffered injuries requiring stitches.
Nursing diagnosis
• Risk for trauma or suffocation related to loss of large or
small muscle coordination.
• Risk for ineffective airway clearance.
• Deficient knowledge related to information
misinterpretation.
• Risk for injury related to weakness, balancing
difficulties,altered consciousness.
• Situational low self – esteem related to stigma
associated with the condition.
 Nursing intervention
> Prevent trauma / injury
• To determine and familiar warning signs and how to
care for patient during after seizure attack.
• Support head , place on soft area, or assist to floor if
out of bed.
• Do not attempt to restrain, turn head to side and
suction airway.
 > Promote airway clearance
• Maintain lying position,flat surface,turn head to side
during seizure activity.
• Loosen clothing from neck or chest and abdominal
areas; suction as needed.
• Supervise supplemental oxygen or bag ventilation as
needed postictally.
 > Improve self esteem
• Encourage activities , providing supervision and
monitoring when indicated .
• Help an individual realize that his or her feelings are
normal ; however ,guilt and blame are not helpful.
>Enforce education about the diseases
• Review pathology and prognosis of condition and
lifelong need for treatments as indicated.
• Discuss patients particular trigger factors ( flashing ,
lights, loud noises ,games, TV viewing).
• Review medication regimen, necessity of taking
drugs as ordered and not discontinuing therapy
without physicain order.
 > Evaluation
Goals are met as evidenced by:
• Identified actions or measures to take when seizure
activity.
• Identified and corrected potential risk factorsin the
environment.
• Maintained treatment regimen to control or eliminate
seizure activity.
• Maintained effective respiratory pattern with airway
patent or aspiration prevented.