2. Demographic data
Name of the patient Mr Sabarinathan
Age/Sex 25 years/Male
Religion Hindu
Education Primary
Occupation Coolie
Marital Status Single
Family Income 40000/year
MRD Seq No N 896278
Address Nathakkattanoor village, Thoramangalam(PO),
Salem,Tamilnadu
Date of admission
Diagnosis
17/07/2019
Epilepsy
3. Present medical history:
• Patient admitted with the c/o seizures, jerks of upper and
lower extremities since 10 years, difficulty in holding
objects. Also reported 3-4 episode of seizures within
last 2 wks.Reported normal till 15 years of age.
• Had first episode of GTCS followed by occasional upper
limb dominant myoclonus at the age of 15 years.
Gradually increased frequency and had daily jerks. Had
dropped out school as he could not unite jerk
movements on action and walking.
• Currently on medication:Valproate,500mg BD, tab
Clonazepam,0.25mg HS,tab Amoxyclav,625mg BD,tab
Diclofenac 50mg BD, tab Rantac 150mg BD
4. Seizures Vs Epilepsy?
seizures
• abnormal, sudden,
excessive, uncontrolled
electrical discharge of
neurons within the brain
that may result in alteration
in consciousness, motor or
sensory ability, and/or
behavior.
• No known reason.
• Pathologic condition of
the brain.
epilepsy
• Is a chronic disorder
characterized by recurrent,
unprovoked seizure activity.
• Abnormality in electrical
neuronal activity.
• Imbalance in
neurotransmitters.
• Combination of both
5. Definition
Epilepsy is a chronic
disorder of abnormal,
recurrent, excessive
and self-terminating
discharge of electrical
impulses from
neurons (Hicky 2007).
10. How common is epilepsy?
• Most common serious neurological disorder
• Affects 1/200 people worldwide.
• Could be as much as 1/100 in developing
nations like India due to following reasons:
poor antenatal care and perinatal injury,
infections(tuberculosis,cysticercosis,road
traffic accidents)
14. Causes of Epilepsy by Age
• Infancy and Childhood
- Birth injury
- Inborn errors of metabolism
- Congenital malformations
• Childhood and Adolescence
- Idiopathic-Cryptogenic/genetic
- CNS infection
15. Causes of Epilepsy by Age
• Adolescence and Young Adult
- Head trauma
- Drug intoxication/withdrawal (acute seizure)
• Older Adult
- Stroke
- Brain tumor
- Acute metabolic disturbances (acute seizure)
16. Post-Traumatic Epilepsy
• Epilepsy arising as a result of head trauma
• Head trauma may be subtle or severe
• Extent & location of injury may increase
likelihood of developing seizures
– 2 types of seizures -early/acute & delayed
onset
• Early treatment with anti-epileptic drugs (AEDs)
may not affect the development of seizures later
on
17. Epilepsy Risk Factors
• Intellectual or other
developmental
disability
• Cerebral Palsy
• Anoxia
• Autism
• Stroke
• Major head trauma
• CNS hemorrhage
• CNS infection,
neurocystercosis
• Dementia
• Brain tumor, tubers
• Family history
• Birth injury
18. Seizure Triggers
• Non-adherence
• Sleep deprivation
• Stress (good or bad)
• Accident/injury
• Concurrent illness (fever)
• Menses or hormonal changes
• Alcohol/drugs
• Specific stimuli (photosensitivity, reflex epilepsy)
19. Mortality
• Risk of death higher in people with epilepsy
– 10 years of life lost for people with known cause of
seizures
– 2 years of life lost for those with unknown cause of
seizures
• Approximately 42,000 deaths are caused by epilepsy
annually
• Mortality rate associated with seizures lasting 30
minutes may be as high as 19%
– Vast majority of deaths occur in people with seizure
in the context of an acute brain insult, hypoxia,
trauma, etc.
.
20. Additional Causes of Death in Epilepsy
• Life-threatening injuries
• Drowning
• Status epilepticus
• Sudden unexplained death in epilepsy (SUDEP)
• Suicide
21. Sudden Death in Epilepsy (SUDEP)
• SUDEP
– applies to a sudden death in someone known to
have epilepsy, in the absence of an obvious cause
for the death
• Numbers vary
– 1 in 10,000 of newly diagnosed
– 9 of 1,000 candidates for epilepsy surgery
22. A Spectrum of Severity
Uncomplicated epilepsy,
Seizures controlled with
medication
Seizures not completely controlled by treatment;
Epilepsy lowers standard of living due to social,
emotional, and educational problems
Seizures refractory to
treatment; Epilepsy is disabling
due to frequent seizures
and other problems
Increase risk of SUDEP
27. Generalized seizures
Tonic-Clonic Seizure
• Last for 2-5 minutes.
• TONIC phase is characterized by stiffening or
rigidity on the muscles, particularly of the
arms and legs, and immediate loss of
consciousness.
• CLONIC phase or rhythmic jerking of all
extremeties follows it.
• Biting of tongue, incontinent urine or feces,
fatigue, confusion and lethargy.
28.
29.
30. Tonic Seizures
Characterized by an abrupt increase in muscle
tone, loss of consciousness, and loss of
autonomic signs lasting from 30 seconds to
several minutes.
32. Absence Seizure
• More common in
children and tends to be
hereditary.
• With brief periods of loss
of consciousness and
blank staring, as though
the person is
daydreaming.
• Returns to baseline
immediately after.
33. Myoclonic Seizure
• Characterized by brief
jerking or stiffening of
the extremeties, which
may occur singly or in
groups.
• May be symmetric or
asymmetric.
35. Partial seizures
• Known as focal or local seizures, begin in a
part of one cerebral hemisphere.
• Complex Partial Seizure
• Simple Partial Seizure
36. Complex Partial Seizures
• Cause loss of consciousness or “black out” for
1-3 minutes.
• Automatism may occur such as lip smacking,
patting, picking at clothes, amnesia.
• Affects the temporal lobe so also known
Psychomotor or temporal lobe seizure.
37.
38. Simple Partial Seizures
• Client remains conscious.
• Aura – “deja vu”, offensive smell, sudden
onset of pain.
• Unilateral movement of extremity, unusual
sensations, autonomic or psychic motors such
as changes in heart rate, skin flushing and
epigastric discomfort.
41. STATUS EPILEPTICUS
• Characterized by prolonged seizures lasting more
than 5 minutes or repeated seizures over the
course of 30 minutes.
• Sudden withdrawal from AEDs
• Infections
• Acute alcohol withdrawal
• Head trauma
• Cerebral Edema
• Metabolic disturbances
• It is a Neurologic Emergency.
42. Diagnostic tests
Along with history taking and physical examination
Blood tests: CBC, electrolytes, glucose, Calcium,
Magnesium, phosphate, hepatic and renal function
Lumbar puncture only if meningitis or encephalitis
suspected and potential for brain herniation is ruled out
Blood or urine screen for drugs
• EEG
• CT Scan
• MRI
• PET
• Laboratory studies to determine metabolic or genetic
disorders.
45. Pharmacotherapy
• Major component of management.
• Introduces one drug at a time to achieve
seizure control.
• Dosage of medications are adjusted to achieve
therapeutic blood levels without causing
major side effects.
46.
47.
48. Surgical management
• Resective Surgery: In this the focal area of the
seizures activity is excised.
• Callosotomy: Include the separation of the
connection between the two hemispheres of the
brain and is used in some generalized seizures.
• Vagus nerve stimulation and deep brain
stimulation:- It uses an implantable device that
reduces seizure in individuals who have not had
effective control with drug therapy.
53. NURSING MANAGEMENT
Aims:
• To control seizures
• Protecting the person from injury
• To determine and to treat the
underlying cause.
• To prevent and to treat medial
complications
• To provide accurate data based on
observation of the patient
54. • To rehabilitate and to teach the patient and his
family.
Immediate care:
• The patient experiencing a seizure demands
immediate attention.
• Airway management and safety are the top two
priorities.
55. Before and during a seizure:
If the patient is seated when a major seizure
occurs, ease him or her to the floor if
possible.
If the patient experiences an aura, have him
to lie down to prevent injury.
Move person away from danger e.g. Fire,
water, furniture , machinery etc.
56. Provide privacy by pulling the bed curtains,
screen or closing the door.
Remove patient’s eyeglasses
Loosen any constricting clothing
Do not try to force anything into the mouth
Remove objects that may obstruct breathing
or cause injury to patient.
57. Avoid tongue biting by inserting spoon or a
piece of wood wrapped with cloth
Use a naso pharyngeal airway if needed.
Forcing a tongue blade or airway into the
mouth may break teeth or hamper breathing
efforts
Never insert your fingers into patients’ mouth
during a seizure. Turn patient on his side to
provide for drainage of oral secretions
58. Don’t forcibly restrain patient during
seizures
Protect patient head from injury by putting
a pillow or folded blanket under the
patients head.
Guide the movements to prevent injuries
Inform the doctor and carry out the orders
Stay with the patient throughout the
seizure to ensure safety
59. Essential steps to ensure safety:
Keep bed flat and patient turned on his side.
The side rails of the bed should be up and
padded.
Suction and airway should be made
available.
Room lighting should be dim and noise to be
kept to a minimum
60. check vital signs immediately.
check lips, tongue and inside of
mouth for injuries.
if patient is incontinent, change
clothing and bedding.
check the seizure prone patients
temperature with a rectal
thermometer.
61. After a seizure:
• Position the patient on the side.
• Provide adequate ventilation.
• Suctioning may be necessary.
• Allow the patient to sleep after the seizure.
• On awakening, orient the patient
62. Nursing assessment and documentation
Collecting data
Observations
Verbal reinforcement
63. CONTROLLING SEIZURES
Patients should be put on anti-convulsant
drugs.
Assess the effectiveness of the drug.
Observe for any signs of toxicity to the drug.
Attend to the oral hygiene.
64. DRUG NURSING INTERVENTIONS
Divalproex (Depakote)
Valproic Acid
(Depakene)
Monitor for hairloss, tremor, increased liver enzymes,
bruising and N/V.
Monitor CBC, PT, PTT and AST
Gabapentin (Neurontin) Watch for increased appetite and weight gain.
Monitor for ataxia, irritability, dizziness and fatigue.
Phenobarbital Note that this is less desirable than other AEDs
because of sedation.
Overdose can be fatal.
Monitor for drowsiness, sleep disturbances, cognitive
impairment and depression.
Phenytoin Monitor for gastric distress, gingival hyperplasia,
anemia, ataxia, and nystagmus.
Check CBC and Calcium levels.
For IV, Flush catheter with saline before and after
administration.
66. Make regular follow-up.
Visit the doctor as suggested .
No food restriction.
Continue all routine work.
Make use of proper support and give
encouragement to client.
67. Do’s:
• Take prescribed medicines regularly
• Eat regularly – patient should not fast
• Rest regularly as lack of sleep or tiredness can
precipitate an attack.
• Take tablets regularly for 3-5 years
68. Do’s:
• They can go to school
• They can play
• They can work like others except near the machines
or electrical installations.
• They can marry but there must be at least a year fit
free period before marrying.
70. References
• Joyce M Black, M.S.N.R.N. Nursing specialist, “Medical –Surgical
Nursing”, fifth edition, W.B. Saunders company, pages-834-835.
• Hickey Joanne, “the clinical practice of neurological, neurosurgical
nursing”, fifth edition, published in London-2003, pages-612-618.
• Luckmann and sovensons, “Medical and surgical nursing”, fourth
edition, printed in London, W.B.S Saunders company-1996, pages-
106-108.
• T.P.Prema, K.F.Graicy, “essentials of neurological and neurosurgical
nursing”, Jaypee brothers, pages-155-157.
www.google.com
Hinweis der Redaktion
American Epilepsy Society
In the majority of cases of epilepsy, 65%to 70%, the cause of epilepsy is unknown. causes. Other major causes are a result of vascular disease, congenital anomalies, trauma, brain tumors, neurodegenerative diseases, or infections of the central nervous system.
Causes of epilepsy in infants and children are birth injuries, inborn errors of metabolism and congenital malformations. In childhood and adolescence, most epilepsy is idiopathic, genetic, or a result of an infection to the central nervous system such as encephalitis or meningitis.
Idiopathic or cryptogenic epilepsy refers to epilepsy arising spontaneously or from an obscure or unknown cause. Some of these are presumed or found to have a genetic basis
Many older adolescent and young adults acquire epilepsy as a result of head trauma due to accidents. Many have acute seizures as a result of drug intoxication or drug withdrawal. In older adults the number one cause of epilepsy is stroke, followed by brain tumors, trauma, and degenerative disorders. Acute seizures can occur in the setting of acute metabolic disturbances.
Many cases of epilepsy develop as post traumatic epilepsy and can be a result of a subtle or severe head injury. The extent and location of the injury may impact the likelihood of developing seizures. Seizures can develop in the acute setting following the injury or may develop later as a result of the injury. Early treatment with AEDS may not affect the probability of developing seizures later on in life.
Epilepsy 101: Getting Started
American Epilepsy Society
American Epilepsy Society
American Epilepsy Society
SUDEP, or sudden unexplained death is epilepsy, is an area of major interest. The term applies to any sudden death in someone known to have epilepsy, when there is no obvious cause for the death found. The numbers of people experiencing SUDEP is unclear as there have not been any population-based studies done. Frequency has been found to vary from 1 in 10,000 people from a sample of people with newly diagnosed epilepsy, and 9 out of 1,000 people from samples of people being evaluated for epilepsy surgery. This latter group would be considered to have intractable epilepsy.
