nursing student

1. Epilepsy

2. Epilepsy
Definition:
➢A neurological disorder marked by sudden recurrent
episodes of sensory disturbance, loss of consciousness,
or seizures, associated with abnormal electrical
activity in the brain.
➢Epilepsy is a brain disorder in which clusters of nerve
cells, or neurons, in the brain sometimes signal
abnormally.

3. Seizure Vs Epilepsy
◼ Seizures and epilepsy are not the same.
◼ Epilepsy is a diseases
◼ Seizure is a sign/symptom and may be caused by other
conditions. e.g. Febrile seizures, Eclampsia, Meningitis,
encephalitis, and Migraine headaches.
◼ Convulsion: One of the most common type of . This may be
called a "tonic clonic" or "grand mal" seizure. In this type of
seizure, a person may stiffen and have jerking muscle
movements; during the muscle-jerking, the person may bite
their tongue, causing bleeding or frothing at the mouth.

4. Pathophysiology
◼ There are excitatory and
InhibitoryNeuro transmitters.
◼ Excitatoryneurotransmitter:
Acetylcholine, amino acids
glutamate
◼ Inhibitoryneurotransmitters:
Gamma- aminobutyric acid
(GABA)
◼ Reduction in inhibitory system and
excessive excitation play a part in
the genesis of seizure activity.

6. Etiology
◼ Idiopathic.
◼ Genetic factors
◼ Acquired: brain injury during prenatal, perinatal or postnatalperiods or
traumatic accident.
◼ Alcohol,cocaine and others, low blood sugar, low oxygen, low blood
sodium or low blood calcium.
◼ Adverse Reactions to Drugs
◼ Infections which affect the brain such as meningitis, encephalitis
◼ The type of injury that can lead to a seizure is age‐dependent.
◼ Seizures in children: Birth traumas, infections, such as meningitis,
congenital abnormalities or high fevers.
◼ Seizures in the middle years: Head injuries, infections, alcohol,
stimulant drugs or medication side effects.
◼ In the elderly:Brain tumors and strokes

7. Classification of Epilepsy
1. Partial seizure
2. Generalized seizure
3. Absence Seizure

8. Partial Seizure
Simple
(Focalseizures without loss of consciousness)
Complex
(Focal seizures with loss of consciousness)

9. Simple Partial seizures
i. Simple partial seizures.
◼ No loss of consciousness.
◼ The clinical manifestations are considered relatively
simple.
◼ May alter emotions or change the way things look, smell,
feel, taste or sound.
◼ experiencing of unusual feelings or sensations.
◼ They may also result in involuntary jerking of a body
part, such as an arm or leg,
◼ Usually the event is remembered in detail
◼ How long do they last?
◼ Only a short time, usually less than 2 minutes

10. Complex partial seizure
◼ Characterized by:
◼ Period of altered behaviors, amnesia for event
◼ Inability to respond to environment
◼ Impaired consciousnessduring event
◼ Drowsiness or sleep follows seizure
◼ During a complex partial seizure, Person may perform repetitive
movements, such as hand rubbing, chewing, swallowing or walking in
circles.
Feeling of aura:
◼ Unpleasant odoror taste, complex auditoryor visual hallucination.
◼ Strong feeling of fear and anxiety. Small children may emit a cry or run
for help.
◼ May be confused

11. 2. Generalized seizures
A generalized seizure occurs when the epileptic activity
affects both halves of the brain. The person will usually lose
consciousness while the seizure is in progress.
A. Tonic- Clonic seizures (grand mal).
B. Atonic seizures
C. Myoclonic seizures

12. A. Tonic clonic Seizure (Grand mal Seizure)
◼ Cause loss of consciousness, body stiffness, and shaking.
Phases
i. Tonic phase-(10-20 sec), The body becomes stiffs and
breathing stops
Manifestation
◼ Eye roll upward,
◼ Immediate loss of consciousness,
◼ If standing, falls to ground,
◼ Generalized symmetric tonic contraction of entire body
◼ Arm flexed, head, leg and neck extended,
◼ may become cyanotic,
◼ increase salivation and
◼ loss of swallowing reflex.

13. ii. Clonic phase: rhythmic shaking
Manifestations:
◼ Violent jerking movement
◼ may foam at mouth,
◼ may incontinent of urine and faeces,
◼ gradual decrease of rhythmic movement and
cessation.

14. iii. Post seizure phase: depression, confusion, and
disorientation
Manifestation;
◼ Appear relax,
◼ Difficulty to arouse,
◼ May awaken in few minutes,
◼ May remain confused for several hours,
◼ Poor coordination
◼ Mild impairment of fine motor movement,
◼ Visual, speech difficulties.
◼ May have vomit,
◼ sleeps for several hours, headache, no recollection of entire
events.

15. B. Atonic and akinetic seizures (drop attacks)
Atonic= A loss of muscle tone causes the individual to drop
suddenly.
◼ Onset usually 2 to 5 years of age
◼ During an Atonic seizure, the muscles in body go floppy.
◼ If you have this type of seizure, you may fall forwards to the
ground.
Manifestation:
◼ Child fall in the floor violently,
◼ Unable to break fall by putting out hands,
◼ May incur a serious injury to the face, head, or shoulder,
◼ Momentary losses of consciousness.
Atonic seizure

16. Atonic seizures

17. C. Myoclonic seizure
◼ Leg, arm, head or body will jerk in this type of
seizure.
Characterized by:
◼ Sudden brief contracture of a muscle or group
of muscle, repetitively,
◼ may or may not include loss of consciousness.
Myoclonic seizure

18. 3. Absence seizure (petit mal seizure)
◼ Also known as petit mal seizure
◼ Onset usually between 4 and 12 years of age , may continue to
adulthood (common in girl).
◼ This kind of seizure doesn't involve falling down or
experiencing involuntary jerking movements.
◼ Involve short lapses of consciousness wherein the individual
appears to be staring off into space.( May look like the person
is merely staring into space for a few seconds)
◼ Lip smacking, eyelid twitching, slight movement of hands
(may).
Absence seizure

19. S/S of Epilepsy
◼ The main symptom of epilepsy is recurrent seizures. Others may include one or more
of the followings:
1. A convulsion with no fever
2. Short blackout or confused memory
3. Intermittent fainting during which they lose bowel or bladder control, frequently
followed by extreme tiredness
4. Temporary unresponsiveness to instructions or questions
5. Sudden stiffness for no apparent reason
6. Sudden falling for no apparent reason
7. Sudden bouts of blinking without apparent stimuli
8. Sudden bouts of chewing without any clear reason
9. Staring at a point
10. Involuntary repetitive movements
11. Fearfulness for no apparent reason
12. Peculiar changes in senses, such as smell, touch, and sound
◼ Jerking arms, legs, or body

20. Triggering factors for epileptic fits
1. Sleep deprivation
2. Missing meals
3. Flashing or flickering lights - this is photosensitive epilepsy
and affects less than one in 20 people with epilepsy
4. Stress
5. Hormonal changes, for example at certain times of the
menstrual cycle in women - this is called catamenialepilepsy
6. sudden loud noise, specific voices, song etc
7. Starting sudden movement.
8. Extreme or drastic change in temperature.
9. Dehydration,fatigue, hypoglycemia, hyperventilation
10. Ingestion of caffeine, insufficient protein diet

21. Diagnostic investigations:
Purpose of investigation:
◼ To ascertain the type of seizure
◼ To understand the cause of the events.

22. Diagnostic investigation
1. Complete accurate and detailed history from reliable and
knowledgeable informant. Specific questions:
◼ Events leading up to attack : sleep deprivation, drugs, alcohol
◼ Time of day or night
◼ Symptoms of aura, duration
◼ Abnormal movements
◼ Salivation , cyanosis
◼ Tongue biting
◼ Incontinence
◼ Postictal symptoms
2. Completephysical and neurological examination
3. Skull radiographs
4. CT scan
5. MRI
6. EEG

23. Therapeutic management
1. Self Help:
◼ If you know what triggers a seizure, you may be
able to find ways of avoiding the trigger to help to
control your seizures.
◼ For example, if stress is a trigger you may benefit
from relaxation and anti-stress exercises such as
yoga.
◼ Keeping a diary to record your seizures can help to
identify triggers.

24. 2. Drugs: Guidelines for anticonvulsant
therapy
◼ Start with 1st line drug.
◼ Start with low dose; gradually increase to effective
control of seizures or until side effects.
◼ Check compliance.
◼ If first drug fails, start 2nd line drug whilst gradually
withdrawing 1st.
◼ Do not use more than 2 drugs in combination at any 1
time.

25. Guidelines for choice of AED
Epilepsy type First-line Second-line Third-line
Partial and/or
secondary GTCS
Carbamazepine Lamotrigine
Sodium valproate
Gabapentin
Phenytoin
Phenobarbital
Acetazolamide
Primary GTCS Sodium valproate Lamotrigine
Carbamazepine
Phenytoin
Gabapentin
Absence Ethosuximide Sodium valproate Lamotrigine
Clonazepam
Myoclonic Sodium valproate Clonazepam Lamotrigine
Phenobarbital

26. Withdrawl of AED therapy:
◼ After complete control of seizures for 2-4 yrs,
withdrawl of medication may be considered.
◼ Withdrawl to be done slowly, reducing the
drug dose gradually over 6-12 months.

27. 3. Surgical treatment
◼ If seizure activity is determined to be caused by a
hematoma, tumor, or other progressive cerebral
lesion, surgical removal is the treatment.

28. 4. Diet
◼ Some children with particular forms of epilepsy are
recommended a ketogenic diet, which is high in fat and
low in carbohydrates.
◼ This is individually calculated for each child by a
dietician, so a certain amount of ketone bodies (produced
when fat is burned) build up in the body. These appear to
suppress seizures.

29. Nursing management
During seizure
1. Remain calm.
2. Watch time, duration of the event
3. Keep comfortable, harm free position
4. Loosen restrictive clothing , remove eye glasses
5. Clear any hazard or hard object from surroundings.
6. Allow seizure to end without interference.
7. If vomiting turn child to one side.
8. Stay with them until they feel well again
9. Do not
◼ Attempt to restrain child or use force.
◼ Put anything to child’s mouth.
◼ Don't try to move or restrain the person

30. After seizure
1. Check breathing, keep in lateral position
2. If no breathing, give rescue breathing, call emergency service.
3. Remain with child
4. Don’t give food or liquid until fully alert and swallowing
reflex has returned.
5. Check head and body for possible injuries.
6. Check either tongue or lips have been bitten.
Consult physician in following condition
◼ Stopped breathing.
◼ Seizure more than 5 minutes.
◼ Child vomits continuously after seizure.
◼ Child can’t awaken and is unresponsive of painful stimuli.
◼ Seizure in water.
◼ Evidence of injury.

31. Complications of epilepsy
◼ Status epilepticus
◼ Status epilepticus is defined as continues seizure that last
more than thirty minutes or recurrent seizure without regain
of pre morbid level of consciousness. It's a medical
emergency

32. Health education
Teach the patient or family the followings:
◼ Avoid activities that need concentrationsuch as driving, machinery
work, and dangerous work like swimming, fire work etc.
◼ If you have a seizure or suspected seizure at any time you must stop
driving.
◼ It's a good idea for you to carry a card or wear a bracelet which says that
you have epilepsy.
◼ Be sure to take your medication correctly.
◼ Don't take it upon yourself to adjust your dosage levels. Instead, talk to
your doctorif you feel something should be changed.
◼ It's also important to keep a detailed seizure record. Each time a seizure
occurs, write down the time, the type of seizure it was and how long it
lasted.

33. 8. Seek input from people who may observe your
seizures — including family, friends and co-
workers — so that you can record information you
may not know.
9. Sleep deprivation is a powerful trigger of seizures.
Be sure to get adequate rest every night, and make a
conscious effort to eat a balanced diet, exercise and
manage stress effectively.
10. Excessive alcohol consumption may trigger
seizures. If you have difficulty avoiding alcohol and
cigarettes, ask your doctor for help.

34. Thank You