epilepsy medical surgical nursing disorder

1. EPILEPSY
BY
MRS VIJAYALAXMI. DASHRATH.
PROFESSOR
ALKAREEM COLLEGE OF
NURSING
KALABURGI

2. INTRODUCTION
 Epilepsy has been prevalent since time
immemorial. In those days, epilepsy was
attributed to evil spirits. Hence, the
treatment went along such lines like
worshiping the Gods, using charms and
amulets etc. Even today, in many parts of
India these practices holds way and the
price the patients have to pay is
enormous.

3.  At the global levels nearly 40million people are
estimated to be suffering from epilepsy. India
contributes for nearly one third of global epilepsy
problem (8-10 million). In our country. We have
the Indian Epilepsy Association (IEA), which is
committed to increase the awareness about
epilepsy and also fight for the right of the
epileptics. In many places, other voluntary
agencies also contributes their mite to tackle the
problem. Every year November 17 is celebrated
as National Epilepsy Day.

4. MEANING
 The word ‘epilepsy’ and ‘epileptic’ are of
Greek origin, have the same meaning-to
‘seize’ or to ‘attack’. Epilepsy acquired its
name because it attacked or seized both
the senses and level of conscious/
orientation to self and environment.

5. DEFINITION
 Epilepsy is the consequence of a
paroxysmal uncontrolled discharge of
electrical impulses/neurons within the
central nervous systems.
 konduru Reddemma in 2006

6.  Epilepsy as ‘occasional, sudden,
excessive, rapid and local discharges of
grey mater’.
 Hughlings Jackson in 1873.

7.  Epilepsy is a disturbance of the normal rhythms
of the brain.
Lennox in 1960.
Epilepsy as a group of disorders in which there
are recurrent episodes of altered cerebral
function associated with paroxysmal excessive
and hyper synchronous discharge of cerebral
neurons.
Cull in 1992

8.  Epilepsy (from the Ancient Greek
ἐπιληψία epilēpsía) is a common chronic
neurological disorder characterized by
recurrent unprovoked seizures.
 These seizures are transient signs and/or
symptoms of abnormal, excessive or
synchronous neuronal activity in the brain.
Wikipedia and Encyclopedia 2009.

9.  Epilepsy is a disorder of the brain. People
with epilepsy have brain cells that create
abnormal electricity, causing seizures. In
some cases, a seizure may cause jerking,
uncontrolled movements and loss of
consciousness. In other cases, seizures
cause only a period of confusion, a staring
spell or muscle spasms.
Medline 2009.

10. Etiology
 The etiology is unknown in 70% cases.
 Family history of epilepsy.
 History of perinatal complications.
 Asphyxia neonatorum
 Prematurity
 Trauma during birth
 Intra cranial infection
 Post traumatic epilepsy.
 Intracranial space occupying lesion.
 Vascular malformation, subarachnoid hemorrhage, stroke and
vasospasm.
Atherosclerosis
 Biochemical disorders- Alcoholism, drug overdose, diabetes.

11. PRECIPITATING FACTORS
 Physical illness-febrile fits
 Nutritional deficiency, hypoglycemia.
 Endocrine disorders
 Unexpected loud noise, music, reading.
 While watching TV.
 Exposure to cold weather/rain.
 Hot water bath.
 Angry/Fearful situation.
 Sleep deprivation
 Looking down from a height.

12. CLASSIFICATION
International classification of Epilepsy and
Epileptic syndrome (commission, 1989)
is used most frequently to classify
epilepsy.
1. A. Localized (partial, focal)
2. B. Generalized form
3. A. Multiple seizure types- include partial
seizures with or without becoming
secondarily generalized.

13.  B. Generalized seizures with tonic, clonic,
phases.
 C. Myoclonic seizures.
 D. Atonic seizures (drop attacks)
 E. Atypical absence seizures.

14. 1. A. Localized (partial, focal):
seizure types is between partial (focal)
seizures in which paroxysmal neuronal
activity is limited to one part of the
cerebrum. So it is localized seizure.

15. B. Generalized form
 Generalized seizures where the electro
physiological abnormality involves large
areas of both hemispheres simultaneously
and synchronously.

16. 2. A. Idiopathic (unknown cause)
Idiopathic seizures may occur without any
identifiable cause. The basis of idiopathic
seizure disorders may be a biochemical
imbalance.
B. Symptomatic with a demonstrable brain
lesions (Brain abscess, tumors, hematomas),
infections (encephalitis), vascular lesions
embolus), hemorrhages).

17. Multiple seizure types
 If partial seizures remain localized, the
symtomatology is elementary and
depends on the cortical area affected;
awareness is preserved, and the attack is
termed ‘simple’.

18.  Generalized seizures with tonic, clonic,
phases:
 A tonic-clonic seizure is the typical
grandmal seizure of older classification.
The seizure may have several phases.

19. Signs and symptomts
 Aura, Tonus, Clonus
 Convulsion/seizure/shaking limbs
 A loud cry
 Unconsciousness for few seconds
 Behavioral disturbances/ alteration in
appearance
 Features of epileptic attack
 Skin colour changes in to blue

20.  Passes urine/ motion during fit.
 May sustain injury due to fall at the time of
fits
 May bring out froth in the mouth
 May get confused soon after fit.

21. Diagnosing epilepsy
 Take a detailed history from the patient
 Interview an eye-witness who has
observed the attacks
 Explore the underlying cause
 Structured history- Frequency, duration,
timing, triggering factors and clinical
manifestation of the attack.
 Physical and Neurological examination.

22. Investigation in Epilepsy
 Full blood count, ESR
 Blood urea, electrolytes, calcium, glucose
 Liver function tests
 Serological tests for syphilis
 HIV serology in high risk groups
 Chest and skull radiographs
 Electrocardiogram (ECG)
 Electro encephalography
 Computed tomography (CT)
 Magnetic resonance imaging (MRI)

23. Management
 1. Immediate care of seizures:
 Move person away from danger (fire,
water, machinery)
 After convulsions cease, turn patient into
semi-prone position, ensure their airway is
patent.
 If convulsions continue for more than 5
minutes or begin again, sum one medical
help.

24.  To try to prevent tongue biting a padded
gag or tightly rolled hand kerchief may be
inserted between the teeth.
 Metallic or plastic objects and helper’s
fingers should not be used. It is often not
possible to prevent tongue biting once a
seizure has started.
 To offset cerebral hypoxia, give oxygen at
high concentration, if available.

25. Medical Management
 Barbiturates- Phenobarbital 60-200mg
 Hydantoins- dilantin 300-400mg
 Carbamazepine – Tegretal 600 (200-
1200)mg
 Valporic acid-Depekene 800-200mg
 Diazepam-valium 5-10mg IV
 Steroids to control cerebral edema.

26. SEIZURE INHIBITING DRUGS
seizures can arise from removal of gaba
induced inhibition when gaba levels drop
vitamin b6 (pyridoxal phosphate) is important
for gaba synthesis
most gaba is eventually converted to
succinate by gaba aminotransferase
a gaba aminotransferase inhibitor, sodium
dipropylacetate, is widely used as an
anticonvulsant

27. most gaba is eventually converted to
succinate by gaba aminotransferase
a gaba aminotransferase inhibitor,
sodium dipropylacetate, is widely used
as an anticonvulsant
gaba is most commonly found in local-
circuit interneurons
drugs that act as agonists or
modulators for postsynaptic gaba
receptors, such as barbiturates, are also
used to treat epilepsy

28. Surgical Management
 Only when no response to drugs
 Has unilateral focus
 Has a significant alteration in the quality of
life.
 Locate and excise as much of the
epileptogenic areas possible.
 Removal of the causative factor like a
brain tumor, blood clot, pus collection in
the brain etc.

29. Surgical removal of epileptogenic region
Cutting corpus callosum to prevent
spread of seizures between
hemispheres