Epilepsy/Seizure Disorders

Epilepsy/Seizure Disorders

Definition: Seizures (also known as epileptic seizures and, if recurrent, epilepsy) are defined as a sudden alteration in normal brain activity that causes distinct changes in behavior and body function. Seizures are thought to result from disturbances in the cells of the brain that cause cells to give off abnormal, recurrent, uncontrolled electrical discharges.

Classification

The International League Against Epilepsy developed an international classification of epileptic seizures that divides seizures into two major classes: partial- onset seizures and generalized-onset seizures.

1. Simple-partial seizures can have motor, somato sensory, psychic, or autonomic symptoms without impairment of consciousness.

2. Complex-partial seizures have an impairment (but not a loss) of consciousness with simple-partial features, automatisms, or impairment of consciousness only.

3. Generalized seizures have a loss of consciousness with convulsive or non convulsive behaviors.

4. Simple-partial seizures can progress to complex-partial seizures, and complex-partial seizures can secondarily become generalized.

Causes

The etiology may be unknown or due to one of the following:

·              Trauma to head or brain resulting in scar tissue or cerebral atrophy

·              Tumor in the brain

·              Cranial surgery

·              Metabolic disorders (hypocalcemia, hypoglycemia)

·              Drug toxicity, such as theophylline, lidocaine, penicillin

·              CNS infection

·              Circulatory disorders

·              Drug withdrawal states (alcohol, barbiturates)

·              Congenital neuro degenerative disorders.

·               Non epileptogenic behaviors, which can emulate seizures but have a psychogenic, rather than an organic, origin

Signs and Symptoms

Manifestations are related to the area of the brain involved in the seizure activity and may range from single abnormal sensations, aberrant motor activity, altered consciousness or personality to loss of consciousness and convulsive movements.

1.           Impaired consciousness

2.           Disturbed muscle tone or movement

3.           Disturbances of behavior, mood, sensation, or perception

4.           Disturbances of autonomic functions.

Diagnostic Evaluation

·              EEG (Electroencephalography) – locates epileptic focus, spread, intensity, and duration; helps classify seizure type

·              MRI, CT scan–to identify lesion that may be cause of seizure

·               Neuropsychological studies–to evaluate for behavioral disturbances

·               Serum laboratory studies or lumbar puncture–to evaluate for infectious, hormonal, or metabolic etiology.

Management

·              Pharmacotherapy - Anti-Epileptic Drugs selected according to seizure type.

·              Surgery–operations (temporal lobectomy,

·               extratemporal resection, corpus callosotomy, hemispherectomy)

·              Vagal nerve stimulation anterior thalamic stimulation

·              A ketogenic diet

Nursing Management

·              Establish airway

·              Maintain blood pressure (BP).

·              Monitor vital and neurologic signs on a continuous basis.

·              Administer oxygen–there is some respiratory depression associated with each seizure,

·              Establish I.V. lines, and keep open for blood sampling, drug administration, and infusion of fluids.

·              Administer I.V. anticonvulsant slowly to ensure effective brain tissue and serum concentrations.

·              Monitor the patient continuously; depression of respiration and BP induced by drug therapy .

·              Determine (from family member) if there is a history of epilepsy, alcohol/drug use, trauma, recent infection.

·              Counsel patients with uncontrolled seizures about driving or operating dangerous equipment.

·               Assess home environment for safety hazards in case the patient falls, such as crowded furniture arrangement, sharp edges on tables, glass. Soft flooring and furniture and padded surfaces may be necessary.

·               Support patient in discussion about seizures with employer, school, and so forth.

Complications

·              Difficulty learning.

·              Aspiration pneumonia

·              Injuries from falls, bumps, and self-inflicted bites.

Self-care at home for epilepsy

·              Loosen any tight neckwear.

·              Turn the person on his or her side.

·              Do not hold the person down or restrain the person.

·              Do not place anything in the mouth or try to pry the teeth apart. The person is not in danger of swallowing his or her tongue.

·               Observe seizure characteristics – length, type of movements, and direction of head or eye turning. These characteristics may help the doctor diagnose the type of seizure.