Epilepsy seizure

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1. SEIZURE DISORDER OR EPILEPSY:

2. SEIZURE DISORDER OR EPILEPSY: DEFINITION: Convulsions are a series of forceful involuntary contraction and relaxation of voluntary muscles due to disturbance of brain function. Convulsions are abnormal, involuntary, paroxysmal, motor, sensory, autonomic or sensorial changes resulting from abnormal electrical discharges from the brain.

3. INCIDENCE AND ETIOLOGY: Epileptic seizures usually begin between age 5- 20 years, but can happen at any age. Cause of convulsion according to age are: Early neonatal period Birth asphyxia Intraventricular hemorrhage Pyridoxine dependency Inborn error of metabolism Late neonatal period Hypocalcemia Kernicterus Meningitis

4. Intrauterine infections Tetanus neonatrum Inborn error of metabolism From one month to three year Infection of central nervous system Post vaccination encephalopathy Metabolic causes Brain lesion Drugs or poisons Heat stroke

5. PATHOPHYSIOLOGY: Genetic Na+, K+, Ca2+ transport across neurons Neuronal depolarization Excitatory neurotransmitter Inhibitory Neurotransmitters Hypoglycemia, hypoxia, hypercapnia Toxins, endogenous ammonia, PKU, BACTERIAL TOXINS Environment

6. CLASSIFICATION OF SEIZURE: Seizure Generalized Partial Seizure Tonic- Clonic Seizure Absence Seizure Complex partial Simple Partial

7. PARTIAL SEIZURES: Partial seizures begin focally and result from abnormal electrical discharges from a circumscribed small portion of brain. Partial seizure are of two types: Simple partial seizures: It do not affect awareness or memory. It often begin with thumb/ mouth. Jacksonian seizures also called M arch seizures. Complex partial seizures: Complex partial seizures affect awareness or memory of events before, during and immediately after seizures.

8. The symptoms include: Abnormal muscle contraction Muscle contraction/ relaxation One side of the body is affected Abnormal head movement Automatism Repetitive purposeless movements Starring spells Lip smacking Abnormal sensation Numbness, tingling, crawling sensation on the skin May occur with or without motor symptoms

9. GENERALIZED SEIZURE: It involve abnormal electrical discharges from both cerebral hemisphere, consciousness is always impaired. Generalized seizure are of two type: Absence or Petit- mal Seizures: It is a brief (usually less than 15 seconds) disturbances of brain function, it is commonly occur under 20 years of age. Generalized Tonic- clonic Seizure ( Grandmal Seizures): They can occur at any age and onset is usually abrupt. Child loses consciousness suddenly and falls on the ground, convulsion consist of orderly sequence of steady muscle contraction (tonic phase) followed by repeated coarse muscle jerks ( clonic phase).

10. Initial phase consist of intense muscle contraction, jaw clenches, abdomen and chest become rigid, pallor and cyanosis occur, neck and leg extended, arms are flexed or contracted Next phase is clonic phase in which jerking movements are produced. It last for 30 seconds to 30 minutes.

11. 3. OTHER TYPES OF SEIZURES ARE: Myoclonic seizures: It is sudden repeated contractures of the muscles of head, extremities or torso. It is occur when the child is drowsy and just falling asleep or just waking up. There is no loss of consciousness. Akinetic seizures (Drop attacks) These seizure occur between age 2 and 5 years and are manifested by sudden loss of muscle tone with head dropping forward for few seconds and child losses consciousness.

12. DIAGNOSTIC EVALUATION: History EEG Other neurodiagnostic tests include: Roentgenogram Computed axial tomography Positron emission tomography Magnetic resonance imaging Miscellaneous tests include: Blood chemistry Complete blood count Kidney and liver function test Lumbar puncture

13. MANAGEMENT: Medical management: TYPE OF SEIZURE NAME OF DRUG 1. SIMPLE OR COMPLEX PARTIAL SEIZURE CARBAMAZEPINE, PHENOBARBITONE, PHENYTOIN AND PRIMIDONE 2. GENERALIZED TONIC- CLONIC SEIZURE SODIUM VALPROATE, CARABAMAZEPINE, PHENOBARBITONE 3. GENERALIZED ABSENCE SEIZURE ETHOSUXIMIDE AND VALPROIC ACID 4. MYOCLONIC SEIZURE CLONAZEPAM OR VALPROIC ACID 5. AKINETIC SEIZURE VALPROIC ACID

14. 2. Surgical management: Corpus callostomy is done. 3. Nursing management: Emergency care during seizures: Assist the child to lying position Take off eye glasses, loosen tight clothes Maintain patent airway Administer prescribed medication on time Side rails of bed should be padded Do not force anything into the child mouth during seizures.

15. Care of the child after seizure: Child should be provided complete bed rest Change the clothes and bed sheet, if soiled Suction the airway Turn the face of the child to one side, to avoid aspiration of secretion

16. Thank You…!