Epilepsy

OM VERMA
ASSISTANT PROFESSOR
MEDICAL - SURGICAL NURSING
GRACIOUS COLLEGE OF NURSING ABHANPUR

1. RELIANCE INSTITUTE OF NURSING OOOOOOO OM VERMA LECTURER IN MEDICAL SURGICAL NURSING

2. INTRODUCTION SOMETIMES CALLED CONVULSION ARE PAROXYSMAL MOTOR SENSORY OR COGNITIVE MANIFESTATIONS OF SPONTANEOUS ABNORMALLY DISCHARGES OF COLLECTIONS OF NEURONS IN THE CEREBRAL CORTEX. IN MOST PERSONS THE FIRST SEIZURE EPISODE OCCURS BEFORE 20 YEARS OF AGE

3. DEFINITION Epilepsy is a chronic disorder of abnormal recurring , excessive & self terminating electrical discharge from neurons . Epilepsy is characterized by recurring seizure accompanied by some type of change in behavior { LEMANE, BRURKE} Epilepsy is a paraoximal uncontrolled electrical discharge of neurons in the brain that interupts normal function . { B.T.BASANTHAPPA}

4. Con………………………………. A GROUP OF SYNDROMES CHARACTERIZED BY PAROXYSMAL TRANSIENT DISTURBANCES OF BRAIN FUNCTION. BRUNNER & SUDDARTH RECURRENT PAROXYSMAL ELECTRICAL DYSFUNCTION OF BRAIN CHARACTERISED BY ALTERED CONSCIOUSNESS & MOTOR/ SENSORY PHENOMENA. JAYPEES NURSES DICTIONARYS

5. INCIDENCE Epilepsy affecting up to 25million people in united states People of any age may be affected Prevalence & incidence of epilepsy increase in older adults

6. ANATOMY & PHYSIOLOGY

7. ETIOLOGY First 6 month of life Birth injury Congenital defects involving the CNS Infection Trauma Genetic factors 2-20 years of age Birth injury Infection Trauma Genetic factors

8. cont…….. 20-30 years of age Structural lesion such as truma,brain tumors ,vascular disease, After 50 years Cerebrovascular lesions Metastatic brain tumors

9. RISK FACTORS Anoxia Perinatal problem Congenital CNS defects Mental retardation Febrile condition Family history of Epilepsy Head trauma CNS infection CNS tumors Alcohol or drug abuse Exposure to toxins

10. PATHOPHYSIOLOGY

11. PATHOPHYSIOLOGY Due to etiological factor ↓ A group of abnormal neurons firing ↓ This firing spread by physiological pathological pathways to involve distance area of brain ↓ This acting is spread to involve the whole brain ↓ A generalized seizure (epilepsy) occurs.

12. TYPES GENERALIZED SEIZURES TONIC –CLONIC SEIZURE ABSENCE SEIZURES MYOCLONIC SEIZURES TONIC SEIZURES ATONIC SEIZURES CLONIC SEIZURES PARTIAL SEIZURESS SIMPLE PARTIAL SEIZURES COMPLEX PARTIAL SEIZURES

13. PARTIAL SEIZURES Partial seizure involves the activation of only a restricted part of cerebral hemisphere Two types of partial seizure Simple partial seizure Complex partial seizure

14. Simple partial seizure A partial seizure accompanied by no alteration in cosciousness is called simple partial seizure . Clinical manifestation Abnormal sensation Hallusination Tachycardia Flushing hypotension & hypertension Psychic manifesation such as sense of de ‘ ja’va Inappropriate fear & anger

15. Complex partial seizure partial seizure in which coscioueness is impaired Clinical manifestation Non puposeful activity such as lip smacking,aimless waking or picking of clothing these behavor iscalled automatism

16. Generalized seizure Generalised seizure involve both hemisphere of brain as well as deeper brain structures such as thalamus ,basal ganglia, upper brain stem . Consiousness is always impaired Types are Absense seizure Tonic clonic seizure

17. Tonic – clonic seizure A generalized tonic- clonic seizure is a seizure involving the entire body. It is also called a grand mal seizure. Such seizures usually involve muscle rigidity , violent muscle contractions , and loss of consciousness .

18. Symptoms Tonic – clonic seizure Many patients have an aura (a sensory warning sign) before the seizure. This can include vision, taste, smell, or sensory changes, hallucinations, or dizziness . The seizure itself involves: Loss of consciousness or fainting , usually lasting between 30 seconds and 5 minutes General muscle contraction and rigidity (tonic posture), usually lasting 15 - 20 seconds Violent rhythmic muscle contraction and relaxation ( clonic movement), usually lasting for 1 -2 minutes Biting the cheek or tongue, clenched teeth or jaw Incontinence (loss of urine or stool control)

19. Stopped breathing or difficulty breathing during seizure Blue skin color Almost all people lose consciousness, and most people have both tonic and clonic muscle activity. After the seizure, the person usually has: Normal breathing Sleepiness that lasts for 1 hour or longer Loss of memory (amnesia) regarding events surrounding the seizure episode Headache Drowsiness Confusion , temporary and mild Weakness for up to 24 - 48 hours following seizure (This is called Todd's paralysis.)

20. A bsence seizure Absence seizure — also known as petit mal seizure — involves a brief, sudden lapse of conscious activity. Occurring most often in children, an absence seizure may look like the person is merely staring into space for a few seconds

21. Symptoms Absence seizure Signs of absence seizures include: Staring, without unusual movement Lip smacking Fluttering eyelids Chewing Hand movements Small movements of both arms Absence seizures last only a few seconds. Full recovery is almost instantaneous. Afterward, there is no confusion, but also no memory of the incident. Some people experience hundreds of these episodes each day, which interferes with their performance at school or work

22. TONIC CLONIC SEIZURES LOSS OF CONSCIOUSNESS FALLING TO THE GROUND CYANOSIS EXCESSIVE SALIVATION TONGUE OR CHEEK BITING MYOCLONIC SEIZURES SUDDEN EXCESSIVE JERK OF THE BODY OR EXTREMITIES

23. ATONIC SEIZURES LOSS OF MUSCLE TONE FALLING TO GROUND CLONIC SEIZURES LOSS OF CONSCIOUSNESS SUDDEN LOSS OF MUSCLETONE LIMB JERKING COMPLEX PARTIAL SEIZURES DISTORTIONS OF VISUAL OR AUDITORY SENSATIONS VERTIGO

24. DIAGNOSTIC STUDIES Diagnostic history & physical examination Birth & development history Significant illnes & injury Family history Seizure history Presipitating factor Seizure describtion Diagnostic studies CBC Urine analysis Fasting blood glucose Lumber puncture for CSF analysis

25. Cont. CT scan MRI EEG Cerebral angiography Single photo emmission computed tomography

26. Medical management Hydatonis phenotoin Barbiturate Phenobarbital Succinamide Ethosuximied Other drugs Carbamazepine Valproic acid

27. Surgical management Different surgical procedures are available to treat epilepsy. The type of surgery used depends on the type of seizures and the area of the brain where the seizures start. The surgical options include:

28. Lobe resection: The largest part of the brain, the cerebrum, is divided into four paired sections, called lobes -- the frontal, parietal, occipital and temporal lobes. Temporal lobe epilepsy, in which the seizure focus is located within the temporal lobe, is the most common type of epilepsy in teens and adults. In a temporal lobe resection , brain tissue in the temporal lobe is resected, or cut away, to remove the seizure focus. The anterior (front) and mesial (deep middle) portions of the temporal lobe are the areas most often involved. Extra temporal resection involves removing brain tissue from areas outside of the temporal lobe.

29. Cont.. Lesionectomy: This is surgery to remove isolated brain lesions -- areas of injury or defect such as a tumor or malformed blood vessel -- that are responsible for seizure activity. Seizures usually stop once the lesion is removed. Corpus callosotomy: The corpus callosum is a band of nerve fibers connecting the two halves (hemispheres) of the brain. A corpus callosotomy is an operation in which all or part of this structure is cut, disabling communication between the hemispheres and preventing the spread of seizures from one side of the brain to the other. This procedure, sometimes called split-brain surgery, is for patients with extreme forms of uncontrollable epilepsy who have intense seizures that can lead to violent falls and potentially serious injury.

30. Cont…. Functional hemispherectomy: This is a variation of a hemispherectomy, a radical procedure in which one entire hemisphere, or one half of the brain, is removed. With a functional hemispherectomy, one hemisphere is disconnected from the rest of the brain, but only a limited area of brain tissue is removed. This surgery generally is limited to children younger than 13 years old who have one hemisphere that is not functioning normally. Multiple subpial transection (MST): This procedure is used to help control seizures that begin in areas of the brain that cannot be safely removed. The surgeon makes a series of shallow cuts (transections) in the brain tissue. These cuts interrupt the movement of seizure impulses but do not disturb normal brain activity, leaving the person's abilities intact.

31. Vagual nerve stimulation therapy

32. Introduction Vagus nerve stimulation therapy is another form of treatment that may be tried when medications fail to stop seizures. It is currently approved for use in adults and children over the age of 12 who have partial seizures that resist control by other methods. The therapy is designed to prevent seizures by sending regular small pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck.

33. The energy is delivered by a flat, round battery, about the size of a silver dollar, which is surgically implanted in the chest wall. Thin wires (electrodes) are threaded under the skin and wound around the vagus nerve in the neck. The battery is programmed by the health team to send a few seconds of electrical energy to the vagus nerve every few minutes. If the person with the system feels a seizure coming on, he or she can activate the discharge by passing a small magnet over the battery. In some people, this has the effect of stopping the seizure. It is also possible to turn the device off by holding the magnet over it.

34. Side effects Side effects of VNS therapy are mostly hoarseness and, sometimes, discomfort in the throat. There may be a change in voice quality during the actual stimulation. Although complete seizure control is seldom achieved, the majority of people who use VNS therapy experience fewer seizures. In some its effectiveness increases with time, and patients report an improved quality of life. As with surgery and the ketogenic diet, it will almost always be necessary to continue anti-epileptic medication although the patient should be able to take less medication than in the past.

35. NURSING MANAGEMENT NURSING DIAGNOSIS Ineffective breathing pattern relaed to neuro muscular impairement secondary to prolonged to tonic phase of seizure as during postictal period as evidence as abnormal respiratory rate rhythm & depth INTER VENTION Airway management monitor respiratory & oxygenation status Position patient to maximise ventilation potential Facilitate intubation as necessary Perform endotrachial or nasotrachial suctioning

36. NURSING DIAGNOSIS Risk of injury related to seizure activity & subcequent impaired physical mobility secondary to postictul weakness. INTERVENTION Seizure management Lossen the clothing to prevent restricted breathing Apply oxygen as appropriate NURSING DIAGNOSIS Ineffective cooping related to persived loss of control & denial of diagnosis evidenced by verbalization about not having epilepsy, lack of truth telling regarding seizure frequency , non- complain behaviour INTERVENTION Coping enhancement Appraise patient to change body image Provide factual information concerning diagnosis, treatment & prognosis

37. COMPLICATION Tonic clonic seizure is the most dangerous it causes Ventilator insufficiency Hypoxemia Cardiac dysarryhtmia Hyperthermia Sistemic acidosis Another complication Severe injury Death

38. Health education Drug must be taken as prescribed Use relaxation therapy,Bio -feedback training Avoilance of excessive alchol intake,Fatigue , Loss of sleep