Epilepsy / Seizures

Dr. Ayaanl Ahmed

Borama somaliland
 Welcome to new semester
• Course outline
• 1) epilepsy
• 2) atypical antipsychotic
• 3) suicide
• 4) mood disorders
• 5) personality disorders
• 6) pschopharcotherapy
Epilepsy / Seizures
Epilepsy / Seizures
Epilepsy is a chronic condition, characterized by
recurrent unprovoked seizures.
It has several causes; it may be genetic or may
occur in people who have a past history of birth
trauma, brain infections or head injury.
.
Epilepsy / Seizures
In some cases, no specific cause can be
identified.
Seizures are caused by abnormal discharges in
the brain and can be of different forms; people
with epilepsy can have more than one type of
seizure
Cont..
The two major forms of seizures are convulsive
and non-convulsive.
Non-convulsive epilepsy has features such as
change in awareness, behaviour, emotions or
senses (such as taste, smell, vision or hearing)
similar to mental health conditions, so may be
confused with them
Cont..
Convulsive epilepsy has features such as sudden
muscle contraction, causing the person to fall
and lie rigidly, followed by the muscles
alternating between relaxation and rigidity, with
or without loss of bowel or bladder control.
This type is associated with greater stigma and
higher morbidity and mortality.
Epilepsy
Epilepsy is derived from the Greek word ‘epilepsia’
which means to take hold of or to seize.
It is paroxysmal neurological disorder causing
recurrent episodes of:
1. Loss of consciousness
2. Convulsive movements or motor activity
3. Sensory phenomena or
4. Behavioral abnormalities
Cont..
The following are important characteristics of
epilepsy:
Seizure A paroxysmal, uncontrolled, abnormal
discharge of electrical activity in the gray matter
with in the brain causes events that interfere
with normal function, a symptom rather than a
disease.
Cont..
Prodromal phase:
This Phase precedes some seizures and may last
minutes or hours: a vague change occurs in
emotional reactivity or affective responses (e.g.
depression or anxiety)
Cont..
Aura: A brief sensory experience occurs e.g. a
feeling of weakness, dizziness strange sensations
in an arm or leg numbness, an odor that occurs
at the onset of some seizures
Epileptic cry: A cry, occurring in some seizures,
caused by a thoracic and abdominal spasm
which expels air through the narrowed spastic
glottis.
Cont..
Ictus, post ictal: Ictus is synonymous with
seizures, post ictal refers to the time
immediately after a seizure during which the
client usually experiences some change in
consciousness, behavior, or activity.
Etiology
The etiology of seizures varies remarkably in
adults and includes:
 - Brain tumor is the most common cause for
organic seizure (intracranial mass)
 - Head injury
Clinical manifestations
There are various types and classifications of
seizures. They can be classified into two major
groups:
1. Generalized seizures:
 Tonic clonic seizures (grand mal)
 Absence (petit mall)
 Minor motor seizures (akinetic, myoclonic,
atonic)
Clinical manifestations
2. Partial seizures (focal epilepsy)
 Partial seizures with motor components
 Partial seizures with sensory components
 Partial seizures with complex symptoms
 Partial seizures that secondarily generalize
Diagnostic assessment
Assessment of a client experiencing seizures
involves:
History including, prenatal, birth, and
developmental history, family history, age of
seizure onset, trauma, illness and complete
description of seizure including precipitating
factors:
Diagnostic assessment
Psychosocial assessment, including mental
status examination
 Complete physical examination, including a
detailed neurological examination
 Skull radiographs
 EEG
 CT scan to detect tumor
Medical management
Medical management includes:
 Eliminating factors that may cause or
precipitate seizures.
 Improving the client’s physical and mental
health
 Specific medical treatment
 Possible surgical treatment.
Drug treatment

Drug treatment include:

1. Phenobarbital 30 - 100 mg po/daily (for grand
mal epilepsy)
2. Phenytoin (dilantin) 100 mg po/day
3. Carbamazepine (tegretol)
Cont..
Side effects of anti epileptic drugs include
mental dullness, ataxia, diplopia, hypertrophy of
gums, emotional and mental changes including
depression, irritability, impotence, withdrawal
seizures, if drug is not discontinued slowly.
Nursing management
Nurses have a role in supporting and educating
clients and their significant others with epilepsy
to provide information about the following
important points.
1. How anticonvulsants prevent seizures
2. The importance of taking prescribed
medication regularly
3. Care during seizure
Cont..
Nursing care help the client identify factors that
precipitate seizures and ways of avoiding these
factors. Such factors include:
 Increased stress
 Lack of sleep
 Emotional upset and
 Alcohol use
Cont..
Certain dangerous activities should be avoided or
performed with special safeguards including:
 Swimming
 Horse back riding
 Tree climbing
 Activity involving fire hazards
 Driving motor vehicles
Nurses should advise adequate diet, fluid intake, sleep
,and moderate recreation and exercise.
Emotional effects of epilepsy
Clients with epilepsy often have a poor self-
image. They may experience:
 Feelings of inferiority
 Self-consciousness
 Guilt
 Anger
 Depression and
 Other emotional problems
Observation (assessment during the seizure
attacks)
Nurses should make the following observations during
seizures:
 Duration of the seizure (tonic clonic 30 - 60 seconds)
 Were the seizure begun?
 Did eyes deviate?
 Were the respiration’s labored or frothy?
 Was client incontinent?
 Status epilepticus (persistent and uncontrollable
seizure).
Family education
The client's family needs to know what to do for the client in
the event of a seizure. Nurses can advise the family about:
 Protecting the patient from self injury
 Loosening their clothing
 Protecting the patients head from impact and sharp
objects
 Not to restrain the patient forcibly during seizure.
 Not to insert hard object or finger in the mouth
 Position the patient to their side when the seizure is over.
questions ?