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- 1. Kingdom of Cambodia Nation Religion King សាកលវ ិទ្យាល័យបញ្ញា សាស្រ្ត កម្ព ុជា PAÑÑĀSĀSTRA UNIVERSITY OF CAMBODIA Subject: Health Education Prof: Leng Kuoy Session: Evening Group: 8 Present About: Seizure
- 2. GROUP MEMBER 2 No Name Sex ID Phone Number Email Remark 1 Hour Leelee M 126093 066 78 92 22 hour.leelee@gmail.com Team Leader 2 Lang Vandy M 195011 070 82 64 74 langvandy@hotmail.com Member 3 Mao Leaksmeewatei F 129077 092 222 047 maoleaksmeewatei@gmail.com Member 4 Thor Soriya M 122593 081 77 23 83 thorsoriya10@gmail.com Member 5 Roen Sovandy M 94327 098 46 12 13 sovandyroeun@gmail.com Member
- 3. I. Definition II. CAUSES III. SYMPTOMS IV. SIGNS V. INVESTIGATIONS VI. TREATMENT VII.EPILEPSY VIII.EPILEPSY 3 Contents
- 4. Introduction A seizure is a clinical event caused by a transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain. If these episodes are recurrent over several months or years without an identifiable cause, they are commonly described as epilepsy. The term status epilepticus is used for repeated seizures which occur without the patient regaining consciousness between attacks. A detailed description by a witness is key. Patients may sometimes describe the warning signals (termed a prodrome or aura) which they experienced before the event. 4
- 5. CAUSES • Congenital, prenatal/perinatal injury • Fevers, especially in children (aged 6 months to 6 years) • Cerebral malaria • Infections e.g. meningitis, TB, HIV, abscesses in the brain • Metabolic causes: hypoglycaemia, hypocalcaemia, hyponatraemia, hyperosmolar diabetic state, uraemia, hepatic failure • Idiopathic epilepsy • Eclampsia • Vascular diseases: Hypertensive encephalopathy, Stroke • Space occupying lesions: Tumour or malformations of the brain • Head Injury/Trauma • Drugs and toxins: - alcohol, antidepressants, metronidazole, drug and alcohol withdrawal • Degenerative diseases e.g. Dementia later in life Psychogenic: (see section on Psychogenic Seizures) 5
- 6. SYMPTOMS • Loss of consciousness • Tongue biting • Foaming at the mouth • Incontinence of stool and/or urine • Aura (may include a strange gut feeling, somatosensory manifestations- visual, olfactory, gustatory or auditory e.g. strange smells/flashing lights) • After a seizure, the patient may sleep for some time. 6
- 7. SIGNS 7 • A prodrome/aura with automatism (lip smacking, picking at items • Muscle twitching and movements which may be focal or generalized • Post-ictal sleep • Post-ictal confusion • Todd’s paralysis (stroke-like weakness) may rarely occur • Examine carefully for evidence of neurological localizing signs, tongue laceration and evidence of trauma to the face or other parts of the body.
- 8. INVESTIGATIONS • FBC, ESR • Blood glucose • BUE • Calcium • LFTs • Chest X-ray, skull X-ray • Electroencephalogram (EEG) • CT scan (head) 8
- 9. TREATMENT 9 Treatment objectives To stop the seizure To treat underlying cause
- 10. Non-pharmacological treatment • Ensure that the patient does not harm himself (moving person away • from sharp objects etc), clothing about the neck should be loosened • Ensure the airway is clear, remove any secretions or vomitus from the mouth or nose. Don't force a spoon or tongue depressor into mouth! • Remove false teeth if present • After convulsions cease, turn the patient into semi-prone position by turning the patient on the side, with one leg bent and the other leg straight • Monitor fits (fits chart) Immediate emergency measures: If patient is seen convulsing:
- 11. 11 Pharmacological treatment (Evidence rating: A) Immediate emergency measures: If patient is seen convulsing: • Oxygen, intranasal or by face mask, high concentration, to offset cerebral hypoxia • Diazepam, IV, Adults 10 mg slowly over 23 minutes (approximately 2.5 mg every 30 seconds) Children 200-300 microgram/kg slowly over 23 minutes or if not possible then give the same injectable form (directly from the syringe) into the rectum after removing the needle. This may be repeated 10 minutes later if the fit continues.
- 12. 12 EPILEPSY Epilepsy is a disorder of the central nervous system (CNS) which is characterized by spontaneous recurrent seizures or the tendency to have seizures.
- 13. 13 Epileptic seizures may be classified as follows: • Generalized seizures • Grand mal (tonic-clonic) seizures • Petit mal (absence) seizures • Other types (atonic, myoclonic) • Partial or focal seizures • Simple partial (consciousness not impaired) • Complex partial (consciousness impaired) eg temporal lobe seizures • Partial seizures with secondary generalization • Status epilepticus
- 14. 14 Anticonvulsant drug therapy: Traditionally, a single seizure has been regarded as an indication for investigation and assessment, but not for drug treatment unless a second attack follows closely or based on the circumstances of the seizure. Drug treatment should certainly be considered after two seizures and the type of drug depends on the type of seizure. The underlying abnormality must also be corrected if possible.
- 15. 15 Guidelines for Use of Anti-epileptic drugs • Begin with a single drug at the lowest dosage range • If seizures not controlled, increase dose to upper limit of dosage range or until side-effects appear. • If seizures are poorly controlled, change to a different drug by gradually reducing dose of initial agent while simultaneously introducing the new one. This usually takes 3-4 weeks. • Try 3 single drugs before resorting to drug combinations, which help in only a minority of cases. • Treatment can be stopped only after 2 years seizure free and after a full evaluation and discussion with patient.
- 16. 16 Note DON'TS FOR EPILEPTIC PATIENTS • Driving of a vehicle if not certified to be seizure free • Swimming alone • Working at heights • Excessive alcohol ingestion • Machine operation • Cooking by open fire alone
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