Epilepsy: Causes, Classification, Management

Epilepsy:

 

Epilepsy is a tendency to have recurrent seizures, which results from disturbances in the normal electrical activity of the brain.

 

The human brain is a unique computer, which works for all 24 hours. It is built up of billions of nerve cells called neuron. The neuron has electrical activity and this is transmitted through the axons and dendrites. These electrical impulses are transmitted from one neuron to another through the chemical messengers neurotransmitters, which are present in the synapse. If a group of nerve cells start sending these impulses excessively, it results into epileptic attacks.

 

Causes:

 

Epilepsy is a symptom of many diseases. Just as headache, it is a symptom, which has a number of causes. Epilepsy can be caused by a number of illness in the brain.

1        Idiopathic  :        No demonstrable cause

2        Symptomatic       :        Prenatal injuries

                   :  Low sugar, sodium or calcium

                   :  Developmental defect of the brain

                   :  Cerebral  infections  like  meningitis,

                             encephalitis

                   :        Cerebral injuries

                   :        Cerebral tumors

                   :        Cerebro vascular attack

                   :        Cysticercus and tuberculomas

                   :        Others

Classification of seizures:

 

1.     Partial seizures:

 

a.     Simple partial seizures

 

b.     Complex partial seizures

 

2.     Generalised seizures:

 

a.     Grandmal seizures

 

b.     Petitmal seizures

 

Partial Seizures:

 

In partial seizures the abnormal electrical discharges occur in a localised area in the brain. Hence the symptoms depend upon the area of brain involved, motor or sensory.

These simple partial seizures, when associated with impairment in the consciousness they become complex partial seizures.

 

Generalised seizures:

 

In generalised seizures the abnormal electrical discharges originate from the entire cortex of the brain. This leads to loss of consciousness. In tonic clonic seizures, a common type of generalised seizures, patient falls to the ground without warning. Limbs become stiff. This is called tonic phase. This is followed by jerking movements, which is called clonic phase.

 

Most patients sink into a deep sleep after a seizure for half an hour to two hours. During fits patients may have pooling of saliva at mouth, bite his or her tongue, pass urine or motion.

 

When the patient wakes up he or she is totally unaware of what had happened. He or she may have headache or body aches due to muscular exertion. The duration of seizures can vary and usually it may last for one or two minutes.

 

Management of seizures disorder:

 

The general principles in the management of seizures are

 

1.     Regular food and sleep habits

 

2.     Avoid triggers

 

3.     Regular visits to doctors.

 

Medical Management:

 

Antiepileptic drugs should always be taken under medical supervision. Following are the commonly used drugs:

 

Phenobarbitone (gardinal) Phenytoin sodium (eptoin) carbamazepine ( tegretal)

 

Sodium valporate (valparin) clonozepam.

 

Psychological supports from parents, siblings, teachers colleagues and friends are needed. One' s own positive will and others support substantiate the efforts.

 

Nursing management:

 

Knowledge of the disease by the nurse is very essential in the effective management of the patient.

First aid for major seizure:

 

Do' s

 

1.     Keep calm, help the patient lie down, remove glasses, lose the tight clothing.

 

2.     Clear the area of hard, sharp or hot objects, which could hurt him or her. Keep rolled up towel or pillow under his or her head.

 

3.     Turn him or her to the side to drain the saliva from tightly held teeth.

 

4.     After the attack, if patient is sleeping permit him or her to sleep.

 

Don' ts

 

1.     Do not allow people to gather around him

 

2.     Allow free air circulation.

 

3.     Do not restrain the convulsive movements.

 

4.     Do not force anything between his or her tightly held teeth.

 

5.     Do not offer any thing to eat or drink till he or she is fully conscious.

 

Call for doctor only if

 

1.     Patient is injured

 

2.     Has repeated seizures.

 

3.     Patient is unconscious for a long period.

 

4.     Has difficulty in breathing

 

5.     If it is the first seizure.

 

Epilepsy and mental retardation:

 

Epilepsy affects approximately 1 % of general population, whereas the prevalence of epilepsy in people with mental retardation is much higher. About 20 to 30 % of people with mental retardation are affected by epilepsy.

 

Note:

 

Repeated fits can damage the brain and can lead on to further deterioration.

1.     When a child with mental retardation is learning a task, occurrences of fit can lead to difficulty in learning.

 

2.     Explain to the family members regarding the nature and probable cause of epilepsy, the importance of the usage of recommended drug, in optimal dose, for required duration, the side effects of medications, the importance of monitoring the drug levels in blood periodically and the importance of limitations of investigation ( EEG, CT scan or MRI) the risk of recurrence and relapse and the prognosis of the condition. The importance of rehabilitating the person with mental retardation and epilepsy is essential. Due care should be taken to restore the socio occupational and psychological status of the person.