Hi, In this ppt, made an attempt to understand the basic understanding of epilepsy and to improve knowledge among students about epileptic management.

1. MR.THIRIVIKKIRAMAN.Z
ASSISTANT PROFESSOR,
INDIRANI COLLEGE OF NURSING,
ARIYUR,PUDUCHERRY.

2. EPILEPSY
 DEFINITION
 Epilepsy refers to a group of disorders
characterized by excessive excitability of
neurons within the Central Nervous System
(CNS)

3.  The term seizure and convulsions are not
synonymous.
 Seizure is the general term that applies to all
types of epileptic events.
 In contrast CONVULSIONS has a limited
meaning applying only o jerking movements
that occur during aTonic-clonic (Grand Mal )
attack.

4.  Accordingly all Convulsions may be called
Seizures, it is not correct to call all Seizures as
Convulsions.
 For ex. Absence Seizures manifest as brief
periods of Unconsciousness, that may or may
not be accompanied by Involuntary
Movements.

5. SEIZURE –GENERATION
 Seizures are initiated by Synchronous,High-
Frequency discharge from a group of hyperexcitable
neurons called a FOCUS.
 A “FOCUS” may result from several causes,
including Congenital Defects, Hypoxia at birth,
HeadTrauma and Cancer.
 SEIZURES result when discharge from a FOCUS
spreads to other brain areas, thereby recruiting
normal neurons to discharge abnormally along with
the FOCUS.

6. KINDLING
 An Experimental procedure referred to as KINDLING
may explain how a focal discharge is eventually able
to generate a SEIZURE.
 Experimental KINDLING is performed by implanting
a small electrode into the brain of an animal.
 The electrode is used to deliver localized stimuli for
a brief interval once a day.
 When stimuli are first administered no SEIZURES
result.

7.  However after repeated once-a-day delivery, these
stimuli eventually elicit a SEIZURE.
 The process of KINDLING may tell us something
about SEIZURE development in humans.
 For eg., Kindling may account for the delay that
can take place between injury to the head and
eventual development of SEIZURES.

8. TYPES OF SEIZURES
 SEIZURES can be divided into two broad categories:
 PARTIAL (Focal) SEIZRES
 GENERALISED SEIZURES.
Partial Seizures – Seizures activity begins focally in the
cerebral cortex and usually undergoes limited
spread to adjacent cortical areas.
Generalized Seizures – Focal seizure activity is
conducted widely throughout both hemispheres.

9. PARTIAL SEIZURES
 PARTIAL SEIZURES fall into three groups:
 SIMPLE PARTIAL SEIZURES
 COMPLEX PARTIAL SEIZURES
 SECONDARILY GENERALISED SEIZURES

10. SIMPLE PATIAL SEIZURES
 These Seizures manifest with Discrete Symptoms that
are determined by the brain region involved.
Hence patient may experience :
 Discrete Motor Symptoms –TwitchingThumb
 Sensory Symptoms – Auditory,Visual ,or Olfactory
Hallucinations
 Autonomic Symptoms - Nausea, Flushing,
Salivation, Urinary Incontinence or Psychoillusory
Symptoms eg. Feeling of Unreality,Fear,or Depression
 This persist for 20 to 60 seconds

11. COMPLEX PARTIAL SEIZURES
 These seizures are characterized by:
(i) Impaired Consciosness
(ii) Loss of Consciousness
 The patient becomes Motionless and stares with a
Fixed Gaze during Seizure onset.
 It is followed by a period of “Automatism", which the
patient performs Repetitive, Purposeless movements,
such as lip smacking or Hand Wringing.
 This Seizures last for 45 to 90 Seconds.

12. SECONDARILY GENERALISED SEIZURES
 These Seizures begin as Simple or Complex partial
seizures.
 It evolves into GeneralizedTonic-Clonic seizures.
 Consciousness is lost.
 These seizures last for 1 to 2 minutes.

13. GENERALISED SEIZURES
 TONIC-CLONIC SEIZURES (GRAND MAL)
 ABSENCE SEIZURES (PETIT MAL)
 ATONIC SEIZURES
 MYOCLONIC SEIZURES
 STATUS EPLEPTICUS
 FEBRILE SEIZURES.

14. TONIC –CLONIC SEIZURES(GRAND
MAL)
 InTonic – Clonic seizures, neuronal discharge
spreads throughout the entire Cerebral Cortex.
 This manifest with a major convulsions,
characterized by a period of Muscle Rigidity(Tonic
phase) followed by synchronous muscle jerks(Clonic
phase).
 These seizures often cause Urination, but not
Defecation.

15.  Convulsions may be preceded by a loud cry, caused
by forceful expiration of air across theVocal cords.
 Tonic – Clonic seizures are accompanied by marked
impairment of consciousness and are followed by a
period of CNS depression, referred to as Postictal
State.
 This seizure lasts for 90 seconds or less.

16. ABSENCE SEIZURES (PETIT MAL)
 Absence seizures are characterized by
 Loss of consciousness (10 to 30 seconds)
 It usually involve Mild, Symmetric motor activity
(eg. Eye blinking) and also without motor activity.
 The patients may experience hundreds of absence
attacks a day.
 Absence seizures occur primarily in children and
usually cease during the early teens.

17. ATONIC SEIZURES
 These seizures are characterized by sudden loss of
muscle tone.
 If seizure activity is limited to the muscles of neck,
“HEAD DROP” occurs.
 If the muscles of the Limbs andTrunks are involved, a
“DROP ATTACK” can occur, causing the patient to
suddenly collapse.
 Atonic Seizures occur mainly in children

18. MYOCLONIC SEIZUES
 These seizures consists of sudden muscle
contractions that last for just 1 second.
 Seizure activity ma be limited to one limb(Focal
Myoclonus) or it may involve the entire
body(Massive Myoclonus)

19. STATUS EPILEPTICUS
 Status Epilepticus is defined as a seizure that
persists for 30 minutes or more.
 There are several types of Status Epilepticus,
including
 Generalized convulsive SE
 Absence SE
 Myoclonic SE

20. FEBRILE SEIZURES
 Fever-associated seizures are common among
children age 6 months to 5 years
 Febrile seizures typically manifest as generalizes
Tonic-Clonic convulsions of short duration.
 Children who experience those seizures are not at
high risk of developing epilepsy.

21. ANTILEPTIC DRUGS –HOW IT WORKS
 Anti Epileptic Drugs act through three basic
mechanisms:
1) Suppression of Sodium Influx
1) Suppression of Calcium Influx
1) Potentiation of Gamma-Aminobutryic Acid (GABA)

22. SEIZURE TYPE EFFECTIVE & WELL
TOLERATED
EFFECTIVE BUT LESSWELL
TOLERATED
PARTIAL SEIZURES
Simple Partial
Complex Partial Seizures
Secondarily Generalized
Carbamazepine
Oxcarbazepine
Phenytoin
ValproicAcid
Carbamazepine
Oxcarbazepine
Phenytoin
ValproicAcid
Carbamazepine
Oxcarbazepine
Phenytoin
ValproicAcid
Clorzepate
Phenobarbital
Primidone
Clorzepate
Phenobarbital
Primidone
Phenobarbital
Primidone

23. SEIZURE TYPE EFFECTIVE & WELL
TOLERATED
EFFECTIVE BUT LESS
TOLERATED
PRIMARY GENERALISED
SEIZURES
Tonic- Clonic (Grand Mal)
Absence (Petit Mal)
Myoclonic
Atonic
Carbamazepine
Oxcarbazepine
Phenytoin
Valproic Acid
Ethosuximide
Valproic Acid
Clonazepam
Valproic Acid
Clonazepam
Valproic Acid
Phenobarbital
Primidone
Clonazepam
Trimethadone

24. NURSING IMPLICATIONS
 PHENYTOIN – Oral Phenytoin is used to treat
Partial Seizures (Simple & Complex) andTonic-
Clonic Seizures.
 Intravenous Phenytoin is used to treat Convulsive
SE.
Identifying High Risk Patients
 Intravenous Phenytoin is Contraindicated for
patients with Sinus Bradycardia,SinoArtial
block,Second –or third degreeAtrioventricular
Block, or Stokes – Adams syndrome.

25.  ROUTES – Oral,IV & IM(rarely)
ORAL – Instruct patients to take Phenytoin exactly as
prescribed, Inform them that, once a safe and effective
dosage has been established, small deviations in
dosage can lead to toxicity or to loss of seizure control.
 Advise patients to take Phenytoin with meals to reduce
Gastric Discomfort.
 Instruct patients to shake the Phenytoin oral
suspension before dispensing in order to provide
consistent dosing.

26.  INTRAVENOUS –To minimize the risk of severe
reactions (e.g., Cardiovascular collapse), infuse
Phenytoin slowly (no faster than 50 mg/min).
 Do not mix Phenytoin solutions with other drugs.
 To minimizeVenous Inflammation at the site of
injection, flush the needle or catheter with saline
immediately after completing the Phenytoin
Infusion.

27. Minimizing Adverse Effects
 CNS Effects- Inform patients that excessive doses can
produce Sedation, Ataxia,Diplopia & Interference with
Cognitive Function. Notify Physician If these occur.
 Gingival Hyperplasia – Inform patients that
Phenytoin often promotes overgrowth of GumTissue.
To minimize harm & discomfort, instruct them in proper
techniques of brushing, flossing and gum massage.

28.  Use in Pregnancy – Phenytoin can cause Fetal
Hydantoin Syndrome and Bleeding Tendencies in the
Neonate.
The risk of bleeding can be decreased by giving the
mother Vitamin K for 1 month prior to delivery and
during delivery to the Infant immediately after delivery.
 Skin Rash – Inform patients that Phenytoin can cause a
Morbilliform (Measles-like) rash that may progress to a
more serious reaction. Use of Phenytoin should stop.
Notify Physician.
 Withdrawal Seizures – Abrupt discontinuation of
Phenytoin can trigger Convulsive SE. Warn patients
against abrupt cessation of treatment.

29. CARBAMAZEPINE
 Nursing Implications for Carbamazepine are as
follows.
• Therapeutic Goal – Carbamazepine is used to
treat Partial Seizures (Simple & Complex) &
Tonic-Clonic Seizures.
• Baseline data – Obtain complete blood counts
prior to treatment.
• Identifying High-risk patients – Carbamazepine is
Contra-Indicated for patients with a history of
Bone Marrow depression or adverse hematologic
reaction to other drugs.

30. Administration
 ORAL -Advise patients to administer
Carbamazepine with meals to decrease Gastric
Upset.
To minimize adverse CNS effects, use low initial
doses and give the largest portion of the daily
dose at bedtime.

31.  Minimizing Adverse Effects
CNS Effects – Carbamazepine can cause
Headache,Visual Disturbance (Nystagmus,
BlurredVision, Diplopia),Ataxia,Vertigo &
Unsteadiness.
To minimize these effects, initiate therapy with
low doses and have the patient take the largest
portion of the daily dose at bedtime.

32. HEMATOLOGIC EFFECTS
 Carbamazepine can cause Leukopenia,
Anemia,Thrombocytopenia and very rarely Fatal
Aplastic anemia.
 To reduce the risk of serious Hematologic effects.
1) Obtain complete blood counts prior to treatment
and periodically thereafter
1) Avoid carbamazepine in patients with pre-
existing hematologic abnormalities.

33. 3) Inform patients about manifestations of
hematologic abnormalities (Fever, Sore throat,
Pallor,Weakness, Infection,Easy bruising,
Petechiae).Notify physician if these occur.

34. THANKYOU…….