Epilepsy

A serious neurological problem that commonly affects people is epilepsy. It can strike any
person regardless of age, gender, race or social class. However, it tends to appear more
commonly is children and people over the age of 65 years. There are different types of
epilepsy seizures that can affect different individuals. This article will help explain more
about epilepsy and its prognosis.

What is Epilepsy?
Epilepsy is a word derived from ancient Greek word epilepsia. It is characterized by
seizures occurring within the brain due to an abnormal or excessive neuronal activity.
These are usually unprovoked seizures that briefly affect a persons movements, actions
or level of consciousness. Epilepsy can be controlled with the help of medications.
However, there is no cure for epilepsy.
A person, who suffers from more than one seizure that was not caused by any known
medical conditions or as a symptom of alcohol withdrawal as well as low blood sugar, is
said to be suffering from epileptic seizures. The normal electrical activity within the brain
is disturbed and causes the nerve cells to spark off random signals. This leads to seizures
that last for a few seconds to several minutes.

What Leads to Epilepsy?
There are millions and millions of nerve cells in the brain. They are constantly passing
signals to each other that help us move, think, laugh, walk and even concentrate.
However, any disruption occurring during the passage of these signals leads to seizures.
These seizures are commonly called as fits or attacks. When one suffers from seizures,
all senses, consciousnesses as well as movements are affected. Although, epilepsy is a
neurological condition, it is also partly a physical condition as the body too is affected
during a seizure. The person becomes lost, confused, and suffers from loss of control over
the body movements during an epileptic fit. All because of the short circuit occurring
within the electrical signals of the brain neurons.

What Causes Epilepsy?
Epilepsy is often categorized into two types. This division is based on the causes of
epilepsy. The first type is called as symptomatic epilepsy and the other is called as
idiopathic epilepsy.
Symptomatic epilepsy means there is a known cause for the development of epilepsy in a
particular patient. This includes:
Head injury
Meningitis infection
Underdeveloped brain
Stroke
Tumor or scar tissue in the brain
Tuberous sclerosis, a genetic condition affecting certain people

In children who suffer from symptomatic epilepsy, the causes include:
Hypoxic ischemic encephalopathy
Congenital CNS abnormalities
Trauma before or during birth
Febrile seizures (seizures due to high fever)
Brain tumors
Alcohol withdrawal or illegal drug use in adolescents

In case of idiopathic epilepsy, the condition has no known cause for developing epilepsy.
It can either be termed as a hereditary or genetic condition. Thus, a persons genes were
programmed to be prone to seizures leading to epilepsy.
There is a third type, called as cryptogenic epilepsy where the exact cause symptomatic
or idiopathic is not found after conducting various tests and investigations.

Types of Seizures
There are different types of seizures that are categorized into two groups primary
generalized seizures and partial seizures. These types are divided based on how they
begin in an affected person. Seizures occur in different parts of the brain, that is, lobes.
Primary Generalized Seizures
Generalized seizures are those tend to affect both sides of the brain. The seizure first
begins on one side (hemisphere) of the brain and then spreads to the other hemisphere as
well. This causes the patient to lose consciousness. After a seizure episode the patient
may not remember anything that happened during the attack.
There are different types of generalized seizures that include:
Absence seizures
Atypical absence seizures
Atonic seizures
Myoclonic seizures
Clonic seizures
Tonic seizures
Tonic-clonic seizures

Partial Seizures

Also called as focal seizures, these begin and affect just one part of the brain. This part
is called as the focus. It can either occur in one small region of a lobe or large area in the
hemisphere. These seizures are usually related to a brain injury, infection, tumor or
stroke. In this case, either the patient may partially or fully remember the occurrences
during an episode.
However, many suffer from varied levels of consciousness. Some of the types of partial
seizures are as follows:
Complex partial seizures
Simple partial seizures
Secondarily generalized seizures

How is Epilepsy Diagnosed?
Epilepsy is diagnosed only after a person suffers from more than one seizure. Febrile
seizures are generally not considered as epileptic seizures. There are different tests that
are used to diagnose epilepsy.
These include:
Blood tests that help in determining anemia, diabetes, electrolyte imbalance, etc.
due to seizures
Neurological examination to check motor and behavioral capacity
CT Scan
MRI Scan
Electroencephalogram (EEG)
Positron emission tomography (PET), etc.

How is Epilepsy Treated?
Epilepsy is generally treated using epilepsy drugs and medication. These medications help
people overcome their seizures. The frequency of seizures decreases greatly, thus,
improving their quality of life. However, the doctor may decrease or increase the dose and
strength of the drugs for a while to find the best suitable dose for an individual. But, keep
in mind, these anti-seizure medications are not free from side effects. Thus, make sure
you learn all about the possible side effects from your doctor related to the drug
prescribed.
Surgery is advised only to people who are resistant to drug therapy. In this case, if the
seizure occurs in a part of the brain that is not concerned with one's senses, thinking or
motor ability, surgery will be advised. The affected part will be removed to control the
epileptic seizures. If the seizures occur in an important part of the brain, surgery is
discouraged.
Other than this, alternative methods such as the ketogenic diet, is advised. Vagus nerve
stimulation, deep brain stimulation is opted for where a device is inserted into the body
like a pacemaker to control the seizures.
Seizures can occur at any point in life. Thus, it is very difficult to pinpoint the exact reason
for a seizure. People suffering from epilepsy have always been socially stigmatized due to
the poor awareness regarding the disease in the general public. However, over the years,
people have been accepting the fact that epileptic seizures are not demonic possessions
and they can be controlled with medications. One should seek medical advise related to
seizures and get a control over the seizures as well as their lives.

Dos and do nots in dealing with someone having a seizure
Do
Loosen any tight clothing around the neck
Protect the person from injury (remove sharp or hard objects from the vicinity; or
guide the person away from danger)
Cushion the person's head if they fall down
Help breathing by gently placing the person on his or her side if they have fallen
over. Be quietly reassuring (stay with them until they come round. Go over any
missed events if they have had an absence).
Don't
Try to restrain the person having the seizure
Put anything in the person's mouth or force anything between his/her teeth
Try to move them unless they are in danger
Give anything to drink

Advise from your physician
Seek medical advice if you experience a seizure for the first time.
Also, seek medical help if any of the following occur:
The seizure lasts more than five minutes.
Recovery from your seizure is slow.
A second seizure follows immediately.
You're pregnant or have diabetes.
Your seizures change in frequency and severity.
There's a change in the way you feel during and after the seizures.
Your seizure is preceded by a sudden, severe headache or other symptoms or
signs of stroke including weakness or numbness on one side of your body, vision
loss, confusion, and coordination or speech problems.
Written by: Healthplus24 team
Date last updated: November 27, 2012
http://www.healthplus24.com/diseases/epilepsy.aspx

Description

Also known as convulsions, epileptic seizures, and if recurrent, epilepsy.
It is a sudden alterations in normal brain activity that cause distinct changes in
behavior and body function. They are thought to result from abnormal, recurrent,
uncontrolled electric discharges of neurons in the brain.
Pathophysiology of seizures is poorly understood but seems to be related to
metabolic and electrochemical factors at the cellular level.
Predisposing factors include head or brain trauma, tumors, cranial surgery, metabolic
disorders (hypocalcemia, hypoglycemia or hyperglycemia, hyponatremia, anoxia);
central nervous system infection; circulating disorders; drug toxicity; drug
withdrawal states (alcohol, barbiturates); and congenital neurodegenerative
disorders.
Seizures are classified as partial or generalized by the origin of the seizure activity
and associated clinical manifestations.
o Simple partial seizures manifest motor, somatosensory, and
psychomotor symptoms without impairment of consciousness.
o Complex partial seizures manifest impairment of consciousness with or
without simple partial symptoms.
o Generalized seizures manifest a loss of consciousness with convulsive or
nonconvulsive behaviors and include tonic-clonic, myoclonic, atonic, and
absence seizures.
Simple partial seizures can progress to complex partial seizures, and complex partial
seizures can secondarily become generalized.
Seizures affect all ages. Most cases of epilepsy are identified in childhood, and
several seizure types are particular to children.

Causes/ Risk Factors

The origin of 50-70% of all cases of epilepsy is unknown. Epilepsy sometimes is the result of
trauma at birth. Such causes include insufficient oxygen to the brain; head injury; heavy
bleeding or incompatibility between a woman's blood and the blood of her newborn baby;
and infection immediately before, after, or at the time of birth.

Modifiable:

head trauma resulting from a car accident, gunshot wound, or other injury.
alcoholism
brain abscess or inflammation of membranes covering the brain or spinal cord
phenylketonuria (PKU, a disease that is present at birth, often is characterized by
seizures, and can result in mental retardation) and other inherited disorders
infectious diseases like measles, mumps, and diphtheria
degenerative disease
lead poisoning, mercury poisoning, carbon monoxide poisoning, or ingestion of some
other poisonous substance
suddenly discontinuing anti-seizure medication
hypoxic or metabolic encephalopathy (brain disease resulting from lack of oxygen or
malfunctioning of other physical or chemical processes)
acute head injury
blood infection caused by inflammation of the brain or the membranes that cover it
Non-Modifiable:

Genetic factors

Assessment

1. Generalized tonic-clonic (grand mal) seizure
o May be preceded by an aura such as a peculiar sensation or dizziness; then
sudden onset of seizure with loss of consciousness.
o Rigid muscle contraction in tonic phase which clenched jaw and hands; eyes
open with pupils dilated; lasts 30 to 60 seconds.
o Rhythmic, jerky contraction and relaxation of all muscles in clonic phase with
incontinence and frothing at the lips; may bite tongue or cheek, lasts several
minutes.
o Sleeping or dazed postictal state for up to several hours.
2. Absence ( petit mal) seizure
o Loss of contact with environment for 5 to 30 seconds.
o Appears to be day dreaming or may roll eyes, nod head, move hands, or
smack lips.
o Resumes activity and is not aware of seizure.
3. Myoclonic seizure (infantile spasm)
o Seen in children or infants, caused by cerebral pathology, often with mental
retardation.
o Infantile spasms usually disappear by age 4, but child may develop other
types of seizures.
o Brief, sudden, forceful contractions of the muscles of the trunk, neck, and
extremities.
o Extensor type infant extends head, spreads arms out, bend body backward
in spread eagle position.
o Mixed flexor and extensor types may occur in clusters or alternate.
o May cause children to drop or throw something.
o Infant may cry out, grunt, grimace, laugh, or appear fearful during an attack.
4. Partial (focal) motor seizure
o Rhythmic twitching of muscle group, usually hand or face.
o May spread to involve entire limb, other extremities and face on that side,
known as jacksonian seizure.
5. Partial (focal) somatosensory seizure
o Numbness and tingling in a part of the body.
o May also be visual, taste, auditory, or olfactory sensation.
6. Partial psychomotor (temporal lobe) seizure
o May be aura of abdominal discomfort or bad odor or taste.
o Auditory or visual hallucinations, dj vu feeling, or sense of fear or anxiety.
o Repetitive purposeless movements (automatisms) may occur, such as picking
at clothes, smacking lips, chewing, and grimacing.
o Lasts seconds to minutes.
7. Complex partial seizures begin as partial seizures and progress to impairment of
consciousness or impaired consciousness at onset.
8. Febrile seizure
o Generalized tonic-clonic seizure with fever over 101.8 degrees Fahrenheit.
o Occurs in children younger than age 5.
o Treatment is to decrease temperature, treat source of fever, and control
seizure.
o Long-term treatment to prevent recurrent seizures with fever is controversial.

Diagnostic Evaluation

EEG, with or without video monitoring, locates epileptic focus, spread, intensity, and
duration, helps classify seizure type.
CT scanning or MRI identifies lesion that may cause of seizure.
Single photon emission CT scanning (SPECT) or positron emission tomography (PET)
identifies seizure foci.
Neuropsychological studies evaluate for behavioral disturbances.
Serum electrolytes, glucose, and toxicity screen determine the cause of first seizure.
Lumbar puncture and blood cultures may be necessary if fever is present.

Primary Nursing Diagnosis

Risk for Trauma/Suffocation

Therapeutic Intervention

When a seizure occurs, the main goal is to protect the person from injury. Try to
prevent a fall. Lay the person on the ground in a safe area. Clear the area of
furniture or other sharp objects.
Cushion the person's head.
Loosen tight clothing, especially around the person's neck.
Turn the person on his or her side. If vomiting occurs, this helps make sure that the
vomit is not inhaled into the lungs.
Look for a medical I.D. bracelet with seizure instructions.
Stay with the person until he or she recovers, or until you have professional medical
help. Meanwhile, monitor the person's vital signs (pulse, rate of breathing).

Pharmacologic Interventions

Antiepileptic drugs (AEDs) may be used singly or in combination to increase
effectiveness, treat mixed seizure types, and reduce adverse effects.
A wide variety of adverse reactions may occur, including hepatic and renal
dysfunction, vision disturbances, drowsiness, ataxia, anemia, leukopenia,
thrombocytopenia, psychotic symptoms, skin rash, stomach upset, and idiosyncratic
reactions.
Surgical Interventions:

Surgical treatment of brain tumor or hematoma may relieve seizures caused by
these.
Temporal lobectomy, extratemporal resection, corpus callosotomy, or
hemispherectomy may be necessary in medically intractable seizure disorders.

Nursing Interventions

Monitor the entire seizure event, including prodromal signs, seizure behavior, and
postictal state.
Monitor complete blood count, urinalysis, and liver function studies for toxicity
caused by medications.
Provide safe environment by padding side rails and removing clutter.
Place the bed in low position.
Do not restrain the patient during seizure.
Do not put anything in the patients mouth during seizure.
Maintain a patent airway until the patient is fully awake after a seizure.
Provide oxygen during the seizure if the patient become cyanotic.
Place the patient on side during a seizure to prevent aspiration.
Protect the patients head during the seizure.
Teach stress reduction techniques that will fit into the patients lifestyle.
Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and
adds to sedation.
Encourage the patient to determine existence of triggering factors for seizures, such
as skipped meals, lack of sleep, and emotional stress.
Remind the family the importance of following medication regimen and maintaining
regular laboratory testing, medical check ups, and visual examinations.
Encourage patient to follow a moderate lifestyle routine, including exercise, mental
activity, and nutritious diet.

Discharge and Home Healthcare Guidelines

Provide client teaching and discharge concerning:
Care during a seizure
Need to continue drug therapy
Safety precautions/activity limitations
Need to wear Medic-Alert identification card
Potential behavioral changes and school problems
Availability of support groups/community agencies
How to assist the child in explaining disorder to peers
http://www.rnpedia.com/home/notes/medical-surgical-nursing-notes/seizure-disorder
Sources:
http://www.nlm.nih.gov
Nursingcrib.com
http://www.Thefreedictionary.com
http://www.themerc.com
NSNA NCLEX-RN Review, 2000 ed.