Epilepsy NZD.pptx

EPILEPSY
CHIPO JAMES MAINDA
Nurses Zone(documentary)

INTRODUCTION
• Epilepsy is one of the most common neurological disorders
affecting about 50 million people globally, it is a chronic
condition characterized by seizures (WHO, 2023).
• Seizure manifest when there is an imbalance between
excitatory and inhibitory neurotransmitters.
• A seizure is a paroxysmal uncontrolled electrical discharge of
neurons in the brain that interrupts normal function.

INTRODUCTION
• This condition is associated with a lot of myths,
misconceptions and stigma when in the actual sense it is a
non-contagious disease.
• Anyone can develop epilepsy. Epilepsy affects both males
and females of all races, ethnic backgrounds and ages.
Seizure symptoms can vary widely.
• Some people with epilepsy simply stare blankly for a few
seconds during a seizure, while others repeatedly twitch
their arms or legs.

INTRODUCTION
• Having a single seizure doesn’t mean you have epilepsy.
• At least two seizures without a known trigger (unprovoked
seizures) that happen 24 hours apart are generally required
for an epilepsy diagnosis.

GENERAL OBJECTIVE
• At the end of the lecture/discussion, students should be able
to demonstrate knowledge of epilepsy as a disorder of the
nervous system and apply such knowledge in the
management of a patient suffering from the condition.

SPECIFIC OBJECTIVES
At the end of the lesson, students should be able to:
• Define epilepsy
• Mention the causes of epilepsy
• State the predisposing factors of epilepsy
• Explain the pathophysiology of seizures
• Describe the classification of seizures
• State the factors that can trigger an epileptic seizure

SPECIFIC OBJECTIVES
• State the clinical manifestation of epilepsy
• Outline the medical management of epilepsy
• Describe the nursing management of epilepsy
• Outline the prevention measures of a seizure
• State the complications of epilepsy

DEFINITION
• Epilepsy is a chronic noncommunicable disease of the brain
characterized by recurrent seizures, which are brief episodes
of involuntary movement that may involve a part of the body
or the entire body and are sometimes accompanied by loss
of consciousness and control of bowel or bladder function
(WHO 2023).

DEFINITION
• Epilepsy is a chronic disorder of the central nervous system
affecting the brain in which there is abnormal, excessive and
uncontrolled electrical discharge of electrical impulses in the
brain, due to cranial injury or genetic predisposition,
characterized by seizures or unusual behavior, sensation and
sometimes alteration in consciousness (loss of awareness).
• Epilepsy is a disorder in which nerve cell activity in the brain
is disturbed, causing seizures.

DEFINITION
• Epilepsy is described in to two ways; the type of epilepsy and
the type of seizure.
• The type of epilepsy, which depends on the cause of epilepsy
(primary causes and secondary causes).
• The type of seizure, this depends on what happens to the
person during the seizure.

CAUSES OF EPILEPSY
Primary causes
• Here the cause is not known but it has a tendency to run in
families.
• This type accounts for about 70% of all cases.
Secondary causes
• These are due to residual structural or physiological defects
following cerebral or cranial injury or disease.
• It accounts for 30% of all cases.

PREDISPOSING FACTORS OF EPILEPSY
• Age. The onset of epilepsy is most common in children and
older adults, but the condition can occur at any age.
• Family history. Having a family history of epilepsy increase
the risk of developing a seizure disorder.
• Head injuries. Head injuries are responsible for some cases
of epilepsy because of brain damage.
• Brain tumor, abscess or hematoma in the brain due to brain
damage.

• Metabolic disorder such as hypocalcemia, hypoglycemia,
hyperglycemia.
• Central nervous system infections like meningitis and
encephalitis which causes inflammation in the brain or spinal
cord, can increase the risk.
• Cerebral edema due to cerebral infection can also increase
the risk of having epilepsy.
• Alcohol and drug abuse alter the function of neurons in the
brain.

• Cerebral hypoxia can lead to serious brain damage.

PATHOPHYSIOLOGY
• Epilepsy means seizure disorder, hence people with epilepsy
have recurring and unpredictable seizures.
• A seizure is a period where cells in the brain called neurons
are abnormally active (they are firing/sending electrical
signals relayed from neuron to neuron) when they are not
supposed to be.
• Normally, electrical signals are controlled by
neurotransmitters at the neuro junction.

PATHOPHYSIOLOGY
• Neurotransmitters will be released and binds to receptors
and tell the cells of the neuron either to open (excitatory
neurotransmitters-glutamate) so that electrical signal is
passed from one neuron to the other or close and stop the
electrical message called inhibitory neurotransmitters
(GABA).
• Neurotransmitters can be excitatory (glutamate,
epinephrine, acetylcholine etc.) or inhibitory (gamma-
aminobutyric acid, glycine, serotonin etc.).

PATHOPHYSIOLOGY
• Excitatory neurotransmitters excite/stimulate neurons to fire
action potentials and transmit electrical messages while
inhibitory neurotransmitters suppress this process
preventing excessive firing.
• A balance between excitation and inhibition is essential for
normal brain functions.

PATHOPHYSIOLOGY
• During a seizure, cluster of neurons in the brain become
temporarily impaired and start sending out sudden
excitatory signals over and over again.
• This is due to too much excitation or too little inhibition.
• Whether it is a decrease in inhibition or increase excitation,
groups of neurons starts firing simultaneously over and over.
• It is often noticed by others as outward signs like jerking,
moving and loosing consciousness.

PATHOPHYSIOLOGY
• It can also be subjective experience where only noticed by
the person experiencing it like fears, or strange smells.
• But it also depend on which neurons are affected.
• Left untreated epilepsy can lead to aspiration pneumonia
due to inhalation of saliva during a seizure, injuries due to
falls or self bites during a seizure, permanent brain damage
and status epilepticus.

CLASSIFICATION OF SEIZURES
• Partial (focal) seizures
• Generalized seizures

PARTIAL/FOCAL SEIZURES
• When the affected area is limited to one hemisphere or one
half the brain but sometimes a small area like a single lobe, is
called a partial or focal seizure.
• What happens during the seizure describe the part of the
brain that has been altered.
• Partial/focal seizures are subcategorized into;
• Simple partial seizures
• Complex partial seizures

Simple partial/focal seizures
• In simple partial seizures, a small part of one of the lobes of
the brain is affected.
• The person is conscious and will usually remember or know
that something is happening and will also remember the
seizure afterwards.

• This can involve the person experiencing strange sensations
like hearing or tasting something but can also involve jerking
movements to specific muscles if neurons controlling those
muscles are affected.
• Simple partial seizures are sometimes called ‘warning’ or
‘auras’ because for some people, may develop into another
type of seizure.

Complex partial/focal seizures
• This affect a bigger part of one hemisphere of the brain and
the person’s consciousness is affected, hence they may be
confused and might not remember exactly what happened
during a seizure.

GENERALIZED SEIZURES
• This affect both sides of the brain and the patient lose
consciousness briefly or for a longer period of time.
• Just like partial seizures, there are subcategories of
generalized seizures as well and these include;
• Tonic seizures
• Atonic seizures
• Clonic seizures
• Myoclonic seizures

• Absence seizures
• Tonic clonic seizures

Tonic seizures
• In tonic seizures, patient’s muscles all the sudden become
stiff or flexed and often the patient falls backwards.
• Tonic seizures causes sudden stiffness in the muscles in the
legs, arms, or trunk.
• Consciousness is impaired.

Atonic seizures
• In atonic seizures, the patient’s muscles sudden become
relaxed and cause the person to fall but this time forward.
OR
• There is a brief loss of muscle tone which may cause the
patient to fall or drop something hence also termed as the
drop attack/seizure.
• Here, consciousness is impaired for just a few seconds.

Clonic seizures
• Clonic seizures are characterized by repeated, jerky muscle
movements of the face, neck, and arms lasting a few seconds
to a minute.
• These movements can not be stopped by restraining or
repositioning the person.
• A clonic seizure may sometimes be hard to distinguish from a
myoclonic seizure. The jerking is more regular and sustained
during a clonic seizure.

Myoclonic seizures
• “Myo” means muscle and “clonus” means rapidly alternating
contraction and relaxation (jerking or twitching of a muscle).
• Therefore, myoclonic seizures are sudden brief shock-like
jerks or twitches of a muscle or a group of muscles.
• Usually they don’t last more than a second or two. Patients
typically reacts as if are hit by electricity.
• NOTE: muscle jerks are not always due to epilepsy.

• For example, hiccups or jerk while falling asleep.
Absence seizures
• Absence seizures tend to cause a short loss of awareness, a
blank stare, and may cause repetitive movements like lip
smacking or eye blinking.
• There is also a sudden stop in activity without falling.
• These seizures are formerly called petit mal, described as
blackout and are common in children than in adults.

Tonic clonic seizures
• Tonic-clonic seizures are the most common generalized
seizures.
• Formally called grand mal seizures.
• The person become unconscious and fall backward and the
body goes stiff.
• They may cry out, bite their tongue or cheeks.

• The breathing pattern is affected becoming difficult and
produce noisy sound.
• Here the seizure occur in well defined stages. It has four
stages;
• Prodromal stage
• Aural (warning/early ictal) stage
• Ictal stage
• Post-ictal stage

Prodromal stage
• This is the period hours or days before the actual seizure.
Aural stage
• It is reported that as many as 65% of people with epilepsy
experience auras.
• Not everyone with epilepsy has auras, though they are
common.

• This may take various forms in different people e.g.
numbness or tingling sensation in any area of the body,
bitter/acidic taste, dizziness, flickering vision etc.
Ictal stage
• This is the stage of the seizure that most people are familiar
with and would identify as a seizure.
• This stage manifests in different ways for each person with
epilepsy.

• Patient’s muscles all the sudden become stiff or flexed and
often the patient falls backwards.
• Patient losses consciousness here and fall to the ground with
an epileptic cry (due to air passing through a partially closed
glottis).
• There is violent jerking or convulsive movements of the body
and limbs.

• The jaw opens and closes and the tongue may be bitten
during this time.
Post-ictal stage
• The recovery period following a seizure is called the post-
ictal stage.
• The patient relaxes for a few minutes and passes into a deep
sleep.

• Patient may later wake up and may not be able to explain
what happened.
• If the patient continues in a fit for more than 30 minute or
patient goes into succession of fits without recovery, this is
called status epilepticus.
• Typical symptoms of post-ictal stage include; Arm or leg
weakness, Confusion, Feelings of fear, embarrassment, or
sadness, Memory loss, Headache, Thirst, etc.

FACTORS THAT CAN TRIGGER AN EPILEPTIC
SEIZURE

SEIZURE
• No two cases of epilepsy are exactly the same.
• One person’s seizure triggers may be completely different
than someone else’s triggers.
• But in general there are several well-known-and extremely
common triggers.
Missed medication

SEIZURE
• Missed medication is the number one reason why people
with controlled seizures have breakthrough ones (sudden,
unexpected seizures in a person who previously had control
over their seizures).
• Missing medication can cause seizures to occur more often
than usual or be more intense.
• They can even lead to status epilepticus, which is a medical
emergency that’s potentially life threatening if the seizures
aren’t stopped.

SEIZURE
Lack of sleep
• Getting a good night’s sleep is important for everyone, but
its especially important if you have epilepsy because there
are changes in the brain’s electrical and hormonal activity.
Stress
• Stress can bring on seizures.

SEIZURE
• The exact cause reason why this happens isn’t totally
understood, especially because stress is subjective and can
be different from person to person.
• One study did find that some people feel a loss of control
when they are stressed, and develop worry and fear
(anxiety).
• This can cause someone to hyperventilate (breathe rapidly
and deeply) which can increase abnormal brain activity and
provoke seizures.

SEIZURE
Alcohol
• In small amounts alcohol doesn’t typically cause seizures.
• However, binge drinking (having too much alcohol at once in
a short period of time) or having 3 or more drinks can be
triggers.
Menstruation
• About half of women of childbearing age with epilepsy have
increased seizures around their period.

SEIZURE
• This is most likely due to hormonal changes that occur during
menstrual cycle.

CLINICAL MANIFESTATION OF EPILEPSY
• Because epilepsy is caused by abnormal activity in the brain,
seizures can affect any process the brain coordinates.
• Seizure signs and symptoms may include;
• Temporary confusion
• A staring spell (periods of time when children ‘space out’)
• Stiff muscles
• Uncontrolled jerking movements of the arms and legs

CLINICAL MANIFESTATION OF EPILEPSY
• Loss of consciousness or awareness
• Psychological symptoms such as fear or anxiety
• Symptoms vary depending on the type of seizure.
• In most cases, a person with epilepsy will tend to have the
same type of seizure each time, so the symptoms will be
similar from episode to episode.

MEDICAL MANAGEMENT
Aims
• To relieve the signs and symptoms
• To control the seizures
Investigations
• History will reveal previous epileptic attacks.
• On physical examination previous burn scars may be seen or
patient may fit in your presence.

MEDICAL MANAGEMENT
• Electroencephalography will show increased electrical
activity.
• CT Scan may show a brain lesion.
• MRI: to rule out structural lesions.
• Lumbar puncture, to rule out meningitis
• Head X ray will show trauma to the head e.g. presence of a
fracture.
Treatment

MEDICAL MANAGEMENT
• Drugs are given to control the fits not to cure the condition.
The following anticonvulsants may be used;
• Barbiturates like phenobarbitone 20-320mg IM 6 hourly as
necessary.
• Phenytoin is an anti-epileptic drug. Loading dose: 10-
15mg/kg IV slowly. Maintenance dose: 100 mg IV every 6 to
8 hours.
• Carbamazepine 100-300mg orally od or bd.

MEDICAL MANAGEMENT
• In status epilepticus valium 10mg IV TDS.
• 5% dextrose may be given for energy 1 litre in 24hours.

NURSING MANAGEMENT
Aims
• To prevent injury to the patient
• To educate patient about his condition
• To control the symptoms
• To alley anxiety
• To prevent complications such as head injury

CARE BEFORE AN ATTACK
• Nurse the patient in a railed bed to prevent fall during an
attack.
• Nurse the patient in a padded railed bed to prevent injuries
during violent jerking movements.
• Remove anything that can injure patient during an attack
such as naked wires.
• Dress the patient in lose clothes to prevent strangulation
should an attack occur.

CARE BEFORE AN ATTACK
• Nurse the patient in a quiet environment to prevent stimulation
which can precipitate an attack.

CARE DURING AN ATTACK
• Don’t need to do anything during the seizure other than
making sure patient does not hurt himself and is in a safe
place.
• Do the following;
• Clear the area of hard or sharp objects.
• Place something soft and flat under the patients head.
• Don’t try to force the patient’s mouth open or put anything
in the mouth.

CARE DURING AN ATTACK
• Don’t give the patient anything to eat until fully alert.
• Stay with the patient until the seizure ends and the patient
has recovered fully.
• Observe the time of initiation, duration and source of the
seizure.
• Have a fit chart for monitoring the patient.
• Do not restrain the patient to avoid causing injury such as a
fracture. Administer IV drugs (if) the IV line is already
inserted.

CARE AFTER AN ATTACK
• Turn the patient’s head onto one side to promote airway
clearance.
• Suction mouth for secretions
• Change bed linen if the patient soiled the linen during an
attack to promote comfort.
• Change the patient’s clothes to promote comfort.
• Provide glucose to replace that which has been lost during
the convulsion.

CARE AFTER AN ATTACK
• Administer oxygen if patient is hypoxic.
• Observe for injuries such as bruises, abrasions, bleeding or
loss of function of a body part.
• Monitor urine for red or cola color which may signal
myoglobinuria from muscle damage.
• The patient on awakening should be reoriented to the
environment.
• Reassure the patient and check neurologic status and vitals.

PREVENTION MEASURES OF A SEIZURE
• Some people can prevent seizures by avoiding their triggers such
as;
• Flashing or flickering lights
• Lack of sleep
• Stress
• Alcohol
• Missing seizure medication doses
• As mentioned above, medication is effective at treating seizures in
60-70% of people.

COMPLICATIONS OF EPILEPSY
• Difficulties in learning
• Aspiration pneumonia due to inhalation of saliva during a
seizure
• Injuries due to falls, self-bites, driving during a seizure
• Permanent brain damage
• Psychosis
• Status epilepticus

CONCLUSION
• Epilepsy is a condition that can negatively impact a patient’s
quality of life and become very dangerous.
• Patient education is crucial so that patients stay adherent to
their pharmacotherapeutic regimens, preventing seizure
occurrences.

ASSIGNMENT
• Identify 5 nursing problems and nurse the patient using a
nursing care plan

REFERENCE
• Craven, H. (Ed.). (2019). Core Curriculum for Medical-Surgical
Nursing. (5th ed.). Pitman, NJ: Academy of Medical-Surgical
Nurses.
• De Wit, S.C., Stromberg, H. & Dallred, C. (2016). Medical-
surgical nursing: Concepts & practice. 8th Ed. Elsevier Health
Sciences.
• Hinkle, J.L. and Cheever, K.H., (2018). Brunner and
Suddarth’s textbook of medical-surgical nursing. 14th Ed.
Wolters Kluwer India Pvt Ltd.

REFERENCE
• Ignatavicius, D.D. and Workman, M.L. (2020). Medical-
Surgical Nursing-E-Book: 8th Ed. Patient-Centered
Collaborative Care. Elsevier Health Sciences.
• Stuart, G.W., (2022). Principles and practice of psychiatric
nursing-e-book. 8th Ed. Elsevier Health Sciences.

Epilepsy NZD.pptx

Recommended

Recommended

More Related Content

Similar to Epilepsy NZD.pptx

Similar to Epilepsy NZD.pptx (20)

Recently uploaded

Recently uploaded (20)

Epilepsy NZD.pptx