Epilepsy

PREPARED & PRESENTED
BY
RICHARD OPOKUASARE
COLLEGE OF NURSING, NTOTROSO
SCHOOL OFALLIED HEALTH SCIENCES-UDS,TAMALE
EPILEPSY
1 asareor@yahoo.com © 2011

INTRODUCTION
asareor@yahoo.com © 2011
2
The terms seizure disorder and convulsion disorder are
used interchangeably. Seizures (convulsions) represent
abnormal motor, sensory, or psychic activity. The
abnormal activity may occur alone or in combination as a
result of abnormal electrical charges in one or more
specific areas of the cerebral cortex of the brain. If the
electrical discharges involve the entire brain, a general
seizure occurs.

INTRODUCTION – cont’d
3
Epilepsy (from the Ancient Greek (epilēpsía) — “to seize”) is a
common chronic neurological disorder characterized by
recurrent unprovoked seizures. These seizures are transient
signs and/or symptoms of abnormal, excessive or synchronous
neuronal activity in the brain.
Epilepsy is a brain disorder in which the person has seizures.

DEFINITION
4
 Epilepsy is the occurrence of sporadic electrical storms in the
brain commonly called seizures. These storms cause behavioral
manifestations (such as staring) and/or involuntary movements
(such as grand mal seizures). Thus epilepsy is a permanent,
recurrent seizure disorder.
 It is characterised by disturbance of brain function for a short
time leading to a characteristic electrical discharge. Depending
on the location and number of these discharges, a seizure may
cause unconsciousness, convulsive movements, or behavioural
abnormalities.

DEFINITION – cont’d
Epilepsy is a chronic disorder characterized by
paroxysmal brain dysfunction due to excessive
neuronal discharge, and usually associated with
some alteration of consciousness.
5

UNDERSTANDING SEIZURE
6
Just because someone has a seizure does not necessarily mean that
person has epilepsy, though. Seizures can be triggered in anyone
under certain conditions, such as life-threatening dehydration or
high temperature. But when a person experiences repeated
seizures for no obvious reason, that person is said to have
epilepsy. People with epilepsy can and do live normal lives.
Epilepsy is not contagious. You cannot catch it from someone who
has it. Epilepsy is not passed down through families (inherited) in
the same way that blue eyes or brown hair are. But a person who
has a close relative with epilepsy has a slightly higher risk for
epilepsy than somebody with no family history of seizures.

UNDERSTANDING SEIZURE – cont’d
7
The fact that someone has epilepsy does not mean that
individual is crazy. Epilepsy is not a psychiatric
condition. It is a medical condition. In Ghana, it is
treated as a psychiatric condition because of its
associated bizarre behaviour after an attack. The patient
becomes confuse and exhibits bizarre behaviour. People
therefore associate the behaviour as mental disorder. In
fact, it is a neurological disorder. However, the
condition can co-exist with a psychiatric condition – a
situation known as epileptic psychosis.

DIFFERENCE BETWEEN SEIZURE
AND CONVULSION
Seizures happen because of some abnormalities in the brain’s
electrical impulses, normally stemming from too many
neural discharges. The impulses stemming from the
abnormal discharges can happen in several areas of the
brain.
Convulsion, which is a symptom of seizure, manifests as a
series of extreme jerky movements of the muscles that
repeatedly contract and then relax. In convulsion episode,
the muscles contract abnormally because of rapid firing or
brain activity that usually transpires during a seizure
episode.
8

DIFFERENCE BETWEEN SEIZURE
AND CONVULSION
In sum, When a person is having a seizure, it is not always true that
s/he will experience convulsions. The same is true when a
person is experiencing convulsions wherein it is not always the
case that he is having seizures.
Seizures involve the abnormal or rapid neuronal activity of the
brain while convulsions are characterised by abnormal or
involuntary muscle contractions or jerky muscle movements.
A convulsion is often the first diagnosis given to a patient until the
time that a seizure disorder has been established.
It absolutely wrong to have the notion that adults rather experience
seizures and children experience convulsions.
9

CAUSES OF EPILEPSY
10
2 main causes of epilepsy:
Idiopathic – The actual cause is unknown, i.e., no other
condition has been implicated as the cause of the epilepsy.
Acquired and symptomatic – These are things that can make
a person more likely to develop epilepsy.
Cryptogenic means there is a likely cause, but it has not been
identified.

CAUSES OF EPILEPSY – cont’d
11
 A brain injury, such as from a car crash or bike accident, or forceps delivery
 An infection or illness that affected the developing brain of a foetus during
pregnancy
 Lack of oxygen to an infant’s brain during childbirth
 Meningitis, encephalitis, or any other type of infection that affects the brain
 Brain tumors or strokes
 Poisoning, such as lead or alcohol poisoning
 Metabolic disorders (hypoglycaemia)
 Degenerative diseases
 Genetic predisposition, i.e., a person who has a close relative with epilepsy
has a slightly higher risk for epilepsy than somebody with no family history
of seizures

TRIGGERS
12
 Flashing or bright lights
 A lack of sleep
 Stress, e.g., boredom, fatigue, overexcitement, etc.
 Overstimulation, i.e., like staring at a computer screen or
playing video games for too long.
 Fever
 Certain medications
 Hyperventilation, i.e., breathing too fast or too deeply.
 Sexual activity (rare)
 Seeing a large crowd of people

TYPES OF EPILEPSY
13
two broad categories:
 Generalized seizure – produced by electrical impulses from
throughout the entire brain, i.e., seizures are distributed through
the entire brain.
 Partial seizure (also called local or focal) – produced by electrical
impulses in a relatively small part of the brain. The part of the brain
generating the seizures is sometimes called the focus.
A partial seizure may spread within the brain – a process known as
secondary generalization.

SUB-TYPES OF GENERALIZED SEIZURE
14
1. Generalized convulsion, also called the grand-mal
seizure. In this type of seizure, the patient loses
consciousness and usually collapses. The loss of
consciousness is followed by generalized body stiffening
(called the “tonic” phase of the seizure) for 30 to 60
seconds, then by violent jerking (the “clonic” phase) for 30
to 60 seconds, after which the patient goes into a deep
sleep (the “postictal” or after-seizure phase). During
grand-mal seizures, injuries and accidents may occur, such
as tongue biting and urinary incontinence.

– cont’d
15
2. Absence seizures cause a short loss of consciousness (just a few
seconds) with few or no symptoms. The patient typically
interrupts an activity and stares blankly. These seizures begin
and end abruptly and may occur several times a day. Patients are
usually not aware that they are having a seizure, except that they
may be aware of “losing time.” Absence seizure is also known as
petit mal or lapse seizure.
3. Myoclonic seizures consist of sporadic jerks, usually on both
sides of the body. Patients sometimes describe the jerks as brief
electrical shocks.When violent, these seizures may result in
dropping or involuntarily throwing objects. Myoclonic seizure is
also referred to as astatic seizure.

– cont’d
16
4. Clonic seizures are repetitive, rhythmic jerks that involve
both sides of the body at the same time.
5. Tonic seizures are characterized by stiffening of the
muscles.
6. Atonic seizures or “drop attacks” consist of a sudden and
general loss of muscle tone, particularly in the arms and legs,
which often results in a fall.

TONIC-CLONIC SEIZURES
17

ABSENCE SEIZURE
18

MYOCLONIC SEIZURES
19

ATONIC SEIZURE
20

PARTIAL SEIZURES
21
TYPES
1. Simple partial seizures
2. Complex partial seizures
3. Partial seizure with secondary generalization
The difference between simple and complex seizures is that
during simple partial seizures, patients retain awareness;
during complex partial seizures, they lose awareness.

Sub-types of simple partial seizures
22
Simple partial seizures are further subdivided into four
categories according to the nature of their symptoms: motor,
autonomic, sensory, or psychological.
• Motor symptoms include movements such as jerking and
stiffening.
• Sensory symptoms caused by seizures involve unusual
sensations affecting any of the five senses (vision, hearing,
smell, taste, or touch). When simple partial seizures cause
sensory symptoms only (and not motor symptoms), they are
called “auras.”

Sub-types of simple partial seizures –
cont’d
23
 Autonomic symptoms affect the autonomic nervous system,
which is the group of nerves that control the functions of our
organs, like the heart, stomach, bladder, intestines.Therefore
autonomic symptoms are things like racing heart beat,
stomach upset, diarrhea, loss of bladder control.The only
common autonomic symptom is a peculiar sensation in the
stomach that is experienced by some patients with a type of
epilepsy called temporal lobe epilepsy.
 Psychological symptoms are characterized by various
experiences involving memory (the sensation of deja-vu),
emotions (such as fear or pleasure), or other complex
psychological phenomena.

COMPLEX PARTIAL SEIZURES
24
Complex partial seizures, by definition, include impairment of
awareness (i.e., loss of consciousness). Patients seem to be “out of touch,”
“out of it,” or “staring into space” during these seizures.
A complex partial seizure starts in one hemisphere of the brain, and can
spread to areas that involve consciousness. When there is an altered state
of consciousness at the onset of the event, the patient may experience a
change in awareness and may seem confused.
There may also be some “complex” symptoms called automatisms.
Automatisms consist of involuntary but coordinated movements that tend
to be purposeless and repetitive.
Common automatisms include lip smacking, chewing, fidgeting, walking,
and tugging at clothing; the patient may seem conscious but it is
important to remember that s/he is completely unaware of their actions.

COMPLEX PARTIAL SEIZURES – cont’d
25
Jacksonian seizure
This a form of epilepsy involving brief alteration in movement, sensation
or nerve function caused by abnormal electrical activity in a localized
area of the brain. Jacksonian seizures are a form of simple complex
seizures in which the abnormal electrical activity is localized to one
region in the brain. Seizures of this type typically cause no change in
awareness or alertness.They are transient, fleeting, and ephemeral.
Jacksonian seizures are extremely varied and may involve, for example,
apparently purposeful movements such as turning the head, eye
movements, smacking the lips, mouth movements, drooling, rhythmic
muscle contractions in a part of the body, abnormal numbness,
tingling, and a crawling sensation over the skin.

Partial seizure with secondary
generalization
26
The third kind of partial seizure is one that begins as a focal
seizure and evolves into a generalized convulsive (“grand-
mal”) seizure.
Most patients with partial seizures have simple partial, complex
partial and secondarily generalized seizures.
In about two-thirds of patients with partial epilepsy, seizures
can be controlled with medications. Partial seizures that
cannot be treated with drugs can often be treated surgically.

SIMPLE PARTIAL SEIZURES
27

COMPLEX PARTIAL SEIZURES
28

DIFFERENCES BETWEEN HYSTERICAL FIT AND GRAND MAL SEIZURE
FEATURE HYSTERICAL/CONVERSION
FIT
GRAND MAL
SEIZURE
Onset Gradual Sudden
Cause Psychogenic/emotional factors Idiopathic/secondary
Occurrence Occurs in presence of
onlookers
Occurs at any time of
the day
Duration Prolonged/lengthy Brief and seconds
Course/Stages Absence of stages Presence of stages (i.e.,
aura, tonic, clonic,
coma, and recovery)
29

FIT
GRAND MAL
SEIZURE
Sleep Does not occur during sleep May occur during sleep
Treatment Psychotherapy/abreaction Anticonvulsants used.
Reflexes Corneal, pupillary deep reflexes are
present
Corneal, pupillary deep
reflexes are absent
Babinski sign Negative Positive
Shrill cry Absent Present (i.e., at tonic stage)
30

FIT
GRAND MAL
SEIZURE
Incontinence of
urine
Absent Present (rarely faeces)
Injury Absent Present (i.e., injury at the
head, tongue, etc.)
On awakening up
after episode
Client exhibits hysterical laugh Client is embarrassed
Orientation Well orientated Disorientated after the fit
Termination of fit Absence of cognitive impairment Presence of post-epileptic
automation
31

32
FEATURE HYSTERICAL/CONVERSION FIT GRAND MAL SEIZURE
Consciousness Present Absent (i.e., unconscious)
Movement Histrionic Sequential
Breathing Variable Stertorous
Incontinence of
urine
Absent Present (rarely faeces)
Injury Absent Present (i.e., injury at the
head, tongue, etc.)
On awakening up
after episode
Client exhibits hysterical laugh Client is embarrassed

STAGES OF GRAND MAL SEIZURE
Aura (warning) Phase: This lasts for few
seconds. The patient experiences something
which warns him/her and soon after that the
seizure starts. The aura takes the form of the
five senses. It is not present in all cases; but its
nature is easily recognised by the patient who
experiences it such as the unpleasant taste in
the mouth, unpleasant smell, or a flash of light.
33

STAGES OF GRAND MAL SEIZURE – cont’d
Tonic Phase: This follows the aura and starts with
loss of consciousness. The patient suddenly falls down
and may hurt him/herself. The muscle become rigid
and stiff with the hands and teeth is clenched.
Breathing is obstructed by the contraction of the
respiratory muscles, leading to patient becoming
cyanosed with the veins becoming engorged. There is
‘epileptic cry’ at this phase as a result of the last few
stridulous inspirations. The eyes roll upwards. The
phase last between 25-30 seconds.
34

Clonic phase: There is repetitive, jerking
movements of the muscles as they sharply relax and
contract leading to the convulsion of the whole
body. The clonic twitching of the body also
produces arched back (opisthotonos). Patient
produces froth (foam) at the mouth which is a
mixture of air and saliva at this phase. Patient may
seriously bite his tongue at this phase and
experiences incontinence of urine and faeces. The
twitching last between 2-3 minutes.
35

Coma Phase: When the spasm ceases, the
patient may fall into a deep sleep or coma
lasting for about 45 minutes. At this phase
the muscles relax and the colour of the face
returns to normal. Breathing is stertorous
for a while and gradually subsides to
normal.
36

Sequel/Recovery Phase: When the patient
regains his/her consciousness, s/he may be
confused, restless, disoriented and may be
roaming around without purpose, or exhibit
other forms of automatic or bizarre behaviour.
S/he may not remember what has happened. This
form of behaviour is often mistaken for a
psychiatric illness. Patient may complain of
headache, fatigue and other physical symptoms.
37

OTHER STAGES OF SEIZURE
 The prodome may precede the actual seizure by
hours or days. It is characterized by a change in
mood or behavior. Some may experience headaches,
insomnia or feelings about the impending seizure.
 The aura signals the start of the seizure. Signs
include restlessness, nervousness, whining,
trembling, salivation, affection, wandering, hiding,
hysterical running, and apprehension.
38

OTHER STAGES OF SEIZURE – cont’d
 The ictus is the actual seizure, characterized by
sudden increase in tone of all muscle groups. The
ictus is either tonic or tonic-clonic, generally lasting
from 1-3 minutes.
 The postictus may be minutes to days after the
seizure, the individual may be
confused, disoriented, restless, or unresponsive, or
may wander or suffer from transient blindness.
39

MANAGEMENT OF A CLIENT DURING AND AFTER A TONIC-CLONIC SEIZURE
During the Seizure
 Stay calm, do not panic or run away leaving the client alone.
 Turn the client on the side to keep the airway patent and to prevent aspiration of
saliva and vomitus.
 Remove oral secretions by suctioning, if possible.
 Remove objects that could obstruct breathing, such as pillows, bedding, clothing.
 Pad client’s head to avoid injury.
 Loosen restrictive clothing, if possible.
 Protect the client from injury.
 Time the seizure.
 Do not forcibly restrain the arms, legs, or head.
 Ensure enough space and ventilation for the client by asking bystanders and
onlookers to move away.
 Stay with the client.
40

MANAGEMENT OF A CLIENT DURING AND AFTER A TONIC-CLONIC SEIZURE – cont’d
Observations during the Seizure
 Take note of the parts of the body involve in the seizure.
 Take note of the duration and frequency of seizure.
 Observe consciousness.
 Give attention to epileptic cry, or sharp loud noise.
 Observe frothing, i.e., pharyngeal secretions or frothy salivation (foam).
 Observe spasm and twitching movements of the limbs.
 Take note of lip and tongue biting.
 Observe for changes in breathing pattern.
 If there is cyanosis or change in colour of the skin, observe.
 Rolling of the eyes upwards should be observed.
 Give attention to any form of incontinence, such as urine or faecal matter.
 Give attention to any form of injury, such as head injury, bruises on the body, etc.
41

After the Seizure
 Keep the bed flat.
 Turn the client on the side until the client is awake and responding.
 Keep room lighting dim and noise to a minimum.
 Loosen restrictive clothing if this was not done during seizure.
 Take vital signs immediately and every 30 minutes until the client is awake.
 Inspect the lips, tongue, and oral cavity for signs of injury, give first aid measures.
 Change bedding if incontinence has occurred.
 Document seizure in epileptic chart (if client is already hospitalised).
 Draw attention of physician for further management.
 Help bring client to the nearest hospital/clinic for assessment, if seizure occurred
at home, school, or any other environment.
42

Do not do the following during a seizure
 Do not put anything in the mouth.
 Do not try to hold the client down.
 Do not give mouth-to-mouth resuscitation until the seizure
is over.
 Do not call an ambulance during a typical seizure – For a lot
of people, the first response to seeing a seizure is to call the
ambulance service. But for the vast majority of seizures, that
is not necessary. It is also frightening for a client to spend
time in the hospital unnecessarily.
43

Situations needing Medical Help
 If the client is injured during the seizure.
 If a seizure lasts more than five minutes, or if it
seems like one seizure is immediately following the
previous one (i.e., repeated seizures).
 If client is unconscious for a long time.
 If client has difficulty in breathing.
 If it is the first attack ever experienced by the client,
especially after 40 years of age.
44

Patient Counselling/Precautionary Measures
 Take medication daily to maintain constant blood levels that control seizure.
 Client should not stop drug abruptly.
 Avoid alcohol.
 Avoid activities that needs alertness, such as driving, operating a machine, sitting by screens
watchingTV or playing computer games for too long time, etc.
 Avoid heights.
 Do not swim alone, or avoid swimming at all.
 Do not use the bath tub when full of water.
 Seek early medical treatment for fevers.
 Drive with safety belts.
 Ride with safety helmets.
 Carry a personal identification card with name and drug being used wherever client goes.
45

Pharmacologic Treatment of Epilepsy
 Carbamazepine (Tegretol)
 Clonazepam (Klonopin)
 Ethosuximide (Zarontin)
 Phenobarbital (Luminal)
 Phenytoin (Dilantin, Epanutin)
 Valproate semisodium (Depakote)
 ValproicAcid (Depakene)
Other drugs commonly used to abort an active seizure or interrupt a
seizure flurry include:
 Diazepam (Valium, Diastat)
 Lorazepam (Ativan)
46

Thank you
47

Epilepsy

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