2. THE EPILEPSIES
Epilepsy is a group of syndromes characterized by recurring seizures.
Types of epilepsies
Can be differentiated by how the seizure activity manifests into
generalized seizures
Simple partial-onset seizures (no impaired consciousness)
Complex partial seizure (Impaired consciousness)
According to cause into
primary (idiopathic)
secondary, when the cause is known and the epilepsy is a symptom of another
underlying condition such as a brain tumor.
3. Clinical Manifestation of
simple partial seizure
only a finger or hand may shake.
the mouthmay jerk uncontrollably.
The person may talk unintelligibly.
may be dizzy
may experience unusual or unpleasant sights, sounds, odors, or
tastes
No loss of consciousness.
4. Clinical Manifestation of
complex partial seizure
In complex partial seizures
The person either remains motionless or moves automatically
but inappropriately for time and place
The person may experience excessive emotions of fear, anger,
elation, or irritability.
Whatever the manifestations, the person does not remember the
episode when it is over.
5. Clinical Manifestation of
generalized seizure
Generalized seizures, previously referred to as grand mal seizures
There may be intense rigidity of the entire body followed by alternating
muscle relaxation and contraction.
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.
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.
6. Prevention
Pregnant women with epilepsy need careful monitoring,
including blood studies to detect the level of antiseizure
medications taken throughout pregnancy
Head injury is one of the main causes of epilepsy that can be
prevented. Through highway safety programs and
occupational safety precautions
Avoid injuries to new babies at the time of delivery .
7. STATUS EPILEPTICUS
Status epilepticus (acute prolonged seizure activity) is a
series of generalized seizures that occur without full
recovery of consciousness between attacks It is considered
a medical emergency.
Precipitating factors:-
• withdrawal of antiseizure medication
• Fever
• concurrent infection.
8. Signs and symptoms
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.
9. Medical Management
An airway and adequate oxygenation are established.
If unconscious a cuffed endotracheal tube is inserted.
Intravenous diazepam (Valium), lorazepam (Ativan) is given slowly in an
attempt to halt seizures immediately.
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 may be useful in determining the nature of seizure.
Vital signs and neurologic signs are monitored on a continuing basis.
An intravenous infusion of dextrose is given if the seizure is due to
hypoglycemia.
10. SURGICAL MANAGEMENT
• Surgery is indicated for patients whose epilepsy results
from intracranial tumors, abscess, cysts, or vascular
anomalies.
• If the seizures originate in a reasonably well-circumscribed
area of the brain that can be excised without producing
significant neurologic deficits, the removal of the area
generating the seizures may produce long-term control and
improvement.
• 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 an
reduce seizure activity .
11. Nursing management
The nurse should assess and document the following carefully:-
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.
These information gives clues to the location of the seizure origin in the
brain.
12. Nursing management of patient
with seizure
Provide privacy and protect the patient from curious on-lookers. (The
patient who has an aura [warning of an impending seizure] may have time
to seek a safe, private place.)
Ease the patient to the floor, if possible.
Protect the head with a pad to prevent injury.
Loosen constrictive clothing.
Push aside any furniture that may injure the patient during the seizure.
If the patient is in bed, remove pillows and raise side rails.
If an aura precedes the seizure, insert an oral airway to reduce the
possibility of the tongue or cheek being bitten.
13. Nursing management of patient
with seizure
Do not attempt to pry open jaws that are clenched in a spasm to insert
anything. Broken teeth and injury to the lips and tongue may result from
such an action.
No attempt should be made to restrain the patient during the seizure
because muscular contractions are strong and restraint can produce injury.
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
mucus.
If suction is available, use it if necessary to clear secretions.
14. Nursing Care After the Seizure
Keep the patient on one side to prevent aspiration.
Make sure the airway is patent.
There is usually a period of confusion after a grand mal seizure.
A short apneic period may occur during or immediately after a
generalized seizure.
The patient, should be reoriented to the environment.
If the patient becomes agitated after a seizure (postictal), use calm
persuasion and gentle restraint.
15.
16. Patient and family education
The nurse should educate patient and family on the following:-
Take medications daily as prescribed to keep the drug level constant to
prevent seizures.
never discontinue medications, even when there is no seizure activity.
Keep a medication and seizure chart, noting when medications are taken
and any seizure activity.
Notify the physician if patient cannot take medications due to illness.
Check anti seizure serum levels regularly before taking morning dose in
the test day
17. Patient and family education
The nurse should educate patient and family on the following:-
Avoid activities that require alertness and coordination (driving,
operating machinery) until after the effects of the medication have been
evaluated.
Report signs of toxicity so dosage can be adjusted. Common signs include
drowsiness, lethargy, dizziness.
Difficulty walking, hyperactivity, confusion, inappropriate sleep, and
visual disturbances.
Avoid over-the-counter medications unless approved by the patient’s
physician.
18. Patient and family education
The nurse should instruct patient and family on the following:-
Carry a medical alert bracelet or identification card specifying the name of
the patient’s antiseizure medication and physician.
Avoid seizure triggers, such as alcoholic beverages, electrical shocks, stress,
caffeine, constipation, fever, hyperventilation, hypoglycemia.
Take showers rather than tub baths to avoid drowning if seizure occurs;
never swim alone.
Exercise in moderation in a temperature-controlled environment to avoid
excessive heat.
Develop regular sleep patterns to minimize fatigue and insomnia.
