Epilepsy Epilepsy

Epilepsy
Epilepsy
 A group of seizures characterized by unprovoked, recurring seizures (AANN, 2007)
 A disease diagnosed primarily from a history of seizure episodes because of increased
basal level of excitability of the CNS
 Epilepsy is a central nervous system (neurological) disorder in which brain activity
becomes abnormal, causing seizures or periods of unusual behavior, sensations, and
sometimes loss of awareness.
Epileptic Syndromes are classified by specific patterns of clinical features, including:
 Age at onset
 Family history
 Seizure type
Classification
GRAND MAL
 Abrupt onset produced by an aura (any peculiar feeling, sight, sound, taste, smell, or
twitching and spasm of small muscle groups).
 Child falls to the ground, becomes pale, and pupils dilate with upward rolling of the
eyeballs. Head is thrown backward or to one side; chest and abdominal muscles are rigid;
limbs are rigid and contracted (tonic phase)
 As air is forced out of a closed glottis by sudden contraction of the diaphragm, the child
lets out a short, starting cry; the tongue may be bitten
 Involuntary urination and defecation will follow
 The 20 to 40 second tonic phase is followed by clonic activity involving spams of the
entire body.
 The child sleeps after the episode. Upon awakening, he or she appears drowsy and
stuporous, and accomplishes routine task in an automatic fashion.
 When seizures are so frequent that they appear to be constant, the condition is called
STATUS EPILEPTICUS, a medical emergency which may result in brain damage
because of decreased oxygen supply to the cerebrum.
PETIT MAL
 Transient losses of consciousness
 Eye-rolling; drooping or fluttering of eyelids; drooping of the head; quivering of limb or
trunk muscles
 After the seizure, the child immediately resumes activity without knowledge of what
happened.
 It can be precipitated by hyperventilation or induced by a blinking light.
JACKSONIAN
 Convulsion starts with a muscle or group of muscles and then spreads to other parts of the
body.
FOCAL SEIZURES
FOCAL SEIZURES WITHOUT LOSS OF CONSCIOUSNESS
 Simple partial seizures, don't cause a loss of consciousness
 They may alter emotions or change the way things look, smell, feel, taste or sound.
 They may also result in involuntary jerking of a body part, such as an arm or leg, and
spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
FOCAL SEIZURES WITH IMPAIRED AWARENESS
 Complex partial seizures, these seizures involve a change or loss of consciousness or
awareness.
 During a complex partial seizure, you may stare into space and not respond normally to
your environment or perform repetitive movements, such as hand rubbing, chewing,
swallowing or walking in circles.
GENERALIZED SEIZURES
ABSENCE SEIZURES
 Previously known as petit mal seizures, often occur in children and are characterized
by staring into space or subtle body movements such as eye blinking or lip smacking.
 These seizures may occur in clusters and cause a brief loss of awareness.
TONIC SEIZURES
 Cause stiffening of your muscles
 These seizures usually affect muscles in your back, arms and legs and may cause you
to fall to the ground.
ATONIC SEIZURES
 Also known as drop seizures, cause a loss of muscle control, which may cause you to
suddenly collapse or fall down.
CLONIC SEIZURES
 Are associated with repeated or rhythmic, jerking muscle movements.
 These seizures usually affect the neck, face and arms.
MYOCLONIC SEIZURES
 Usually appear as sudden brief jerks or twitches of your arms and legs.
TONIC-CLONIC SEIZURES
 previously known as grand mal seizures, are the most dramatic type of epileptic
seizure and can cause an abrupt loss of consciousness, body stiffening and shaking,
and sometimes loss of bladder control or biting your tongue.
SYMPTOMS
 Temporary confusion
 A staring spell
 Uncontrollable jerking movements of the arms and legs
 Loss of consciousness or awareness
 Psychic symptoms such as fear, anxiety or déjà vu
*Symptoms vary depending on the type of seizure.
CAUSES
 Genetic influence
 Head trauma
 Brain conditions
 Infectious diseases
 Prenatal injury
 Developmental disorders
RISK FACTORS
 Age
 Family history
 Head injuries
 Stroke and other vascular diseases
 Dementia
 Brain infections
 Seizures in childhood
COMPLICATIONS
 Falling
 Drowning
 Car accidents
 Pregnancy complications
 Emotional health issues
LIFE-THREATENING COMPLICATIONS
STATUS EPILEPTICUS
 Occurs if you're in a state of continuous seizure activity lasting more than five minutes or
if you have frequent recurrent seizures without regaining full consciousness in between
them. People with status epilepticus have an increased risk of permanent brain damage
and death.
SUDDEN UNEXPECTED DEATH IN EPILEPSY (SUDEP)
 People with epilepsy also have a small risk of sudden unexpected death. The cause is
unknown, but some research shows it may occur due to heart or respiratory conditions.
People with frequent tonic-clonic seizures or people whose seizures aren't controlled by
medications may be at higher risk of SUDEP. Overall, about 1 percent of people with
epilepsy die of SUDEP.
DIAGNOSIS
 ELECTROENCEPHALOGRAM (EEG). This is the most common test used to
diagnose epilepsy. In this test, electrodes are attached to your scalp with a paste-like
substance or cap. The electrodes record the electrical activity of your brain.
 HIGH-DENSITY EEG. In a variation of an EEG test, doctor may recommend high-

density EEG, which spaces electrodes more closely than conventional EEG — about a
half a centimeter apart.
 COMPUTERIZED TOMOGRAPHY (CT) SCAN. A CT scan uses X-rays to obtain

cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that
might be causing your seizures, such as tumors, bleeding and cysts.
 MAGNETIC RESONANCE IMAGING (MRI). An MRI uses powerful magnets and

radio waves to create a detailed view of your brain. Your doctor may be able to detect
lesions or abnormalities in your brain that could be causing your seizures.
 FUNCTIONAL MRI (FMRI). A functional MRI measures the changes in blood flow

that occur when specific parts of your brain are working. Doctors may use
an fMRI before surgery to identify the exact locations of critical functions, such as
speech and movement, so that surgeons can avoid injuring those places while operating.
 Positron emission tomography (PET). PET scans use a small amount of low-dose

radioactive material that's injected into a vein to help visualize active areas of the brain
and detect abnormalities.
 Single-photon emission computerized tomography (SPECT). This type of test is used

primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain
where the seizures are originating. A SPECT test uses a small amount of low-dose
radioactive material that's injected into a vein to create a detailed, 3-D map of the blood
flow activity in your brain during seizures.
 Neuropsychological tests. In these tests, doctors assess your thinking, memory and
speech skills. The test results help doctors determine which areas of your brain are
affected.
Along with your test results, your doctor may use a combination of analysis techniques to help
pinpoint where in the brain seizures start:
 Statistical parametric mapping (SPM). SPM is a method of comparing areas of the
brain that have increased metabolism during seizures to normal brains, which can give
doctors an idea of where seizures begin.
 Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto

an MRI of the brain to show doctors where seizures are occurring.
 Magnetoencephalography (MEG). MEG measures the magnetic fields produced by

brain activity to identify potential areas of seizure onset.
MANAGEMENT
 During seizures in grand mal, ease child to the floor and loose clothes around the neck
and the abdomen. Remove all chairs, tables, and on other objects that can harm the child.
Keep the head on the side or lay the child on his or her abdomen with the head on one
side to prevent the tongue from falling back or obstructing the airway.
 May participate actively in sports, but not in hazardous activities unless accompanied by
a responsible adult.
 Ketogenic (high-fat) diet is believed to decrease the incidence of seizures.
 Mainstays of treatment – anticonvulsant drug
Important information
 Purpose: To allow the child to function as normally as possible.
 Choice of drugs depends on the type of seizure and the severity of the symptoms.
 Alterations of drugs are done infrequently since the medicine takes 1 to 2 weeks
before they exert their maximal effects
 When patient has been seizure-free, medications must still be continued on a
regular basis for at least 4 to 5 years after the last seizure.
 Drug should not be discontinued suddenly (just like steroids), especially during
puberty when incidence of seizures is again expected to rise.
 Dosage and drugs are re-evaluated during early adolescence to identify if dosage
has to be changed or drugs must be replaced.
For Grand Mal:
 Phenobarbital – initial drug of choice: safe to use
 Dilantin – causes stomatitis and hypertrophy of the gums (implication: meticulous
oral hygiene is a must). Folic acid and Vitamin B 12 are given to prevent
megaloblastic anemia.
For Petit Mal:
 Zarontin: Blood dyscrasias are less common
 Trimethadione (Tridione) – decreases the excitability of the motor area of the
cerebral cortex; less hypnotic effect than Zarontin but has a toxic effects: blood
dyscrasias, insomnia, fatigue, photophobia, and skin rashes.
MEDICATIONS
Medication Dose-Related Side Effects Toxic Effects

Carbamazepine Dizziness, drowsiness, unsteadiness, Severe skin rash, blood
(Tegretol) nausea and vomiting, dyscrasias, hepatitis
diplopia, mild leukopenia
Clonazepam (Klonopin) Drowsiness, behavior changes, Hepatotoxicity,
headache, hirsutism, alopecia, thrombocytopenia,
palpitations bone marrow failure, ataxia
Ethosuximide (Zarontin) Nausea and vomiting, headache, Skin rash, blood dyscrasias,
gastric distress hepatitis, systemic lupus
erythematosus
Felbamate (Felbatol) Cognitive impairments, insomnia, Aplastic anemia,
nausea, headache, fatigue hepatotoxicity
Gabapentin (Neurotonin) Dizziness, drowsiness, somnolence, Leukopenia, hepatotoxicity
fatigue, ataxia, weight gain, nausea
Lamotrigine (Lamictal) Drowsiness, tremor, nausea, ataxia, Severe rash (Stevens-
dizziness, headache, weight gain Johnson
syndrome)
Levetiracetam (Keppra) Somnolence, dizziness, fatigue Unknown
Oxacarbazepine Dizziness, somnolence, double vision, Hepatotoxicity
(Trileptal) fatigue, nausea, vomiting, loss of
coordination, abnormal vision,
abdominal pain, tremor, abnormal gait
Phenobarbital (Luminal) Sedation, irritability, diplopia, ataxia Skin rash, anemia
Phenytoin (Dilantin) Visual problems, hirsutism, gingival Severe skin reaction,
hyperplasia, dysrhythmias, dysarthria, peripheral neuropathy,
nystagmus ataxia, drowsiness, blood
dyscrasias
Primidone (Mysoline) Lethargy, irritability, diplopia, ataxia, Skin rash
impotence
Tiagabine (Gabitril) Dizziness, fatigue, nervousness, Unknown
tremor, difficulty concentrating,
dysarthria, weak or buckling knees,
abdominal pain
Topiramate (Topamax) Fatigue, somnolence, confusion, Nephrolithiasis
ataxia, anorexia, depression, weight
loss
Valproate (Depakote, Nausea and vomiting, weight gain, Hepatotoxicity, skin rash,
Depakene) hair loss, tremor, menstrual blood dyscrasias, nephritis
irregularities
Zonisamide (Zonegran, Somnolence, dizziness, anorexia, Leukopenia, hepatotoxicity
Excegran) headache, nausea, agitation, rash
FIRST AID IN SEIZURE
 First aid for seizure aimed at keeping the person safe until the seizure stops on its own.
References
Epilepsy – Symptoms and Causes, Mayo Clinic, retrieved on 21 March 2020 from
https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-
20350093
First Aid for Seizure Procedure, Epilepsy Foundation, retrieved on 21 March 2020 from
https://www.epilepsy.com/learn/seizure-first-aid-and-safety/first-aid-seizures-stay-safe-
side
Layug, E., (2009). Neurologic Disorders, Pages 580-582, Comprehensive Reviewer for the
Nurse Licensure Exam (NLE), 839 EDSA, South Triangle, Quezon City, C & E
Publishing, Inc.
Secure First Aid: Signs, What Can Be done, MedicineNet retrieved on 21 March 2020 from
https://www.medicinenet.com/first_aid_for_seizures/article.htm#what_first_aid_should_
be_done_for_an_epileptic_seizure
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, H. (2008). Brunner & Suddarth’s Textbook of
Medical-Surgical Nursing, Twelfth Edition, 530 Walnut Street, Philadelphia, PA 19106,
Lippincott Williams & Wilkins

Epilepsy Epilepsy

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Epilepsy

 HIGH-DENSITY EEG. In a variation of an EEG test, doctor may recommend high-

 COMPUTERIZED TOMOGRAPHY (CT) SCAN. A CT scan uses X-rays to obtain

 MAGNETIC RESONANCE IMAGING (MRI). An MRI uses powerful magnets and

 FUNCTIONAL MRI (FMRI). A functional MRI measures the changes in blood flow

 Positron emission tomography (PET). PET scans use a small amount of low-dose

 Single-photon emission computerized tomography (SPECT). This type of test is used

 Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto

 Magnetoencephalography (MEG). MEG measures the magnetic fields produced by

Medication Dose-Related Side Effects Toxic Effects

Medical-Surgical Nursing, Twelfth Edition, 530 Walnut Street, Philadelphia, PA 19106,

Lippincott Williams & Wilkins

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