EPILEPSY

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WELCOME

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PRESENTED BY: KIRAN RANDHAWA EPILEPSY

INTRODUCTION : 

INTRODUCTION Epilepsy is a chronic neurological disorder characterised by recurrent seizure activity Epilepsy is derived from greek epilepsia , meaning “seizure” Epilepsy is a chronic disorder of recurrent seizures. An isolated seizure does not constitute epilepsy

CONTD…. : 

CONTD…. Historically seizures were associated with superstitions also It was said that a person who commit sins is given the punishment by god in form of seizures It was also associated with the power gifted by god

DEFINITION : 

DEFINITION EPILEPSY is abnormal , recurrent , sudden electrical discharge from the brain that result in changes in sensation , behavior , movements , perception , or consciousness

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CLASSIFICATION

CLASSIFICATION : 

CLASSIFICATION SEIZURE PARTIAL GENERALIZED SIMPLE TONIC-CLONIC TONIC COMPLEX CLONIC ABSENCE SECONDARY ATONIC GENERALIZED MYOCLONIC

Contd…. : 

Contd…. SIMPLE PARTIAL: With motor symptoms With somatosensory symptoms With autonomic symptoms Compound forms

Contd…. : 

Contd…. COMPLEX PARTIAL SEIZURE: With impairment of consciousness With cognitive symptoms With affective symptoms With psychosensory symptoms Automatisms Compound forms

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ETIOLOGY

ETIOLOGY : 

ETIOLOGY Trauma Tumor Cranial surgery Metabolic disorders Drug toxicity CNS infection

CONTD….. : 

CONTD….. Circulatory disorders Drug withdrawal states Congenital neurodegenerative disorders Nonepileptogenic behaviors

RISK FACTORS : 

RISK FACTORS Increased physical activity Emotional stress Excessive fatigue Alcohol/caffeine consumption Certain foods/chemicals

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PATHOPHYSIOLOGY

PATHOPHYSIOLOGY : 

PATHOPHYSIOLOGY Neurons have certain permeability gradients & voltage gradients Some factors affect the permeability & ion concentration Such as when the integrity of neuronal cell membrane is altered (contd…)

CONTD…. : 

CONTD…. Cell begins firing with increased frequency & amplitude When the intensity of the discharges reach a threshold Neuronal firing spreads to adjacent normal neurons (contd..)

CONTD… : 

CONTD… Produce hyperexcitability & demonstrate hypersynchromy Abnormal discharge in brain stem causes muscle contraction SEIZURE

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CLINICAL MANIFESTATIONS

CLINICAL MANIFESTATIONS : 

CLINICAL MANIFESTATIONS PARTIAL SEIZURE MOTOR MANIFESTATIONS Convulsive movement of extremities & face Change in posture Spoken utterances SOMATOSENSORY MANIFESTATIONS Numbness & tingling Visual changes

CONTD… : 

CONTD… Aphasia Gustatory changes AUTONOMIC MANIFESTATIONS Epigastric sensations Pallor Sweating Flushing Piloerection

CONTD… : 

CONTD… Pupillary dilation Tachycardia Tachypnea PSYCHIC MANIFESTATIONS Aura Visual distortions Deja Vu

CONTD… : 

CONTD… COMPLEX PARTIAL SEIZURE AUTOMATISM: Lip-smacking Chewing Patting a part of body Picking at clothes Inapt. Or antisocial behavior

CONTD… : 

CONTD… GENERALIZED SEIZURES AURA UNCONSCIOUSNESS TONIC SEIZURES Rigid body Sudden fall Interrupted respirations Cyanosis

CONTD… : 

CONTD… Fixed jaws Clenched hands Dilated pupils & fixed CLONIC SEIZURES Rhythmic & jerky contractions of body muscles Incontinence Tongue bite Frothing

CONTD… : 

CONTD… POST-ICTAL STAGE General fatigue Depression Confusion Headache Nausea Amnesia for seizure episode Petechial hemorrhages

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DIAGNOSTIC EVALUATION

ASSESSMENT : 

ASSESSMENT HISTORY PHYSICAL EXAMINATION NEUROLOGICAL EXAMINATION

DIAGNOSTIC EVALUATION : 

DIAGNOSTIC EVALUATION EEG MRI PET MSI SPECT CT-Scan Neurophysiological studies

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MANAGEMENT

GOAL OF MANAGEMENT : 

GOAL OF MANAGEMENT TO PARTIALLY OR COMPLETELY ELIMINATE THE SEIZURES TO PREVENT ANY TYPE OF INJURY TO PATIENT TO PSYCHOLOGICALLY ALLEVIATE THE PATIENT

PHARMACOTHERAPY : 

PHARMACOTHERAPY ANTIEPILEPTIC DRUGS eg. Carbamazepine Phenytoin Clonazepam Diazepam CLIENT EDUCATION : Take prescribed dosage of medications to maintain your blood levels Consult your physician if you are unable to take medication due to illness

CONTD… : 

CONTD… Observe for side effects of anticonvulsant drugs Notify the physician if seizure activity is not being controlled Do not take any over-the-counter medications without consulting your physician Obtain a medical alert identification card

SURGICAL MANAGEMENT : 

SURGICAL MANAGEMENT CORTICAL RESECTION TEMPORAL LOBECTOMY HEMISPHERECTOMY VAGAL NERVE STIMULATOR IMPLANTATION

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NURSING MANAGEMENT

NURSING ASSESSMENT : 

NURSING ASSESSMENT Obtain seizure history Document the following about seizure activity: Circumstances before attack,such as visual,auditory,olfactory,or tactile stimuli Description of movement Position of eyes & head;size of pupils Presence of automatisms

CONTD… : 

CONTD… Incontinence of urine or feces Duration of each phase of the attack Presence of unconsciousness & its duration Behavior after attack Investigate the psychosocial effect of seizure Obtain history of drug or alcohol abuse Assess compliance & medication-taking strategies

NURSING DIAGNOSIS: ALTERED TISSUE PERFUSION r/o seizure activity : 

NURSING DIAGNOSIS: ALTERED TISSUE PERFUSION r/o seizure activity GOAL:Maintaining cerebral tissue perfusion NURSING INTERVENTIONS: Maintain a patent airway Provide O2 during seizure if color changes

CONTD… : 

CONTD… Stress the importance of taking medicine regularly Monitor patient for toxic adverse effects of medications Monitor serum levels for therapeutic range of medications Monitor platelets & liver functions for toxicity due to medications

NURSING DIAGNOSIS:RISK FOR INJURY r/o seizure activity : 

NURSING DIAGNOSIS:RISK FOR INJURY r/o seizure activity GOAL:Preventing injury NURSING INTERVENTIONS: Provide a safe environment by padding side rails & remove clutter Place the bed in a low position Do not restrain the patient during a seizure Do not put anything in the patient’s mouth during a seizure

CONTD… : 

CONTD… Place the patient on side during a seizure to prevent aspiration Protect patient’s head during a seizure Stay with the patient who is ambulating or who is in a confused state during seizure Manage the patient in status epilepticus

NURSING DIAGNOSIS: INEFFECTIVE COPING r/o seizure activity : 

NURSING DIAGNOSIS: INEFFECTIVE COPING r/o seizure activity GOAL:Strengthening coping NURSING INTERVENTIONS: Consult with social worker for community resources for vocational rehabilitation,counselors,support groups Teach stress reduction techniques that will fit into patient’s lifestyle

CONTD… : 

CONTD… Initiate appropriate consultation for management of behaviors related to personality disorders,brain damage secondary to chronic epilepsy Answer questions related to use of computerized video EEG monitoring & surgery for epilepsy management

COMPLICATIONS : 

COMPLICATIONS STATUS EPILEPTICUS

MISCONCEPTIONS : 

MISCONCEPTIONS Epilepsy is a power given by god Epilepsy is a punishment given by god Epilepsy is cured by marriage Epilepsy is treated by smelling shoes Epilepsy occurs by going near fire

CONTD…. : 

CONTD…. Epilepsy is treated by inserting spoon into the mouth of patient Epilepsy occurs at some particular age Epilepsy is treated by pouring water into the mouth Epilepsy is treated by giving keys to the patient

SUMMARIZATION : 

SUMMARIZATION DEFINITION CLASSIFICATION ETIOLOGY CLINICAL MANIFESTATIONS ASSESSMENT DIAGNOSTIC EVALUATION MANAGEMENT COMPLICATIONS

BIBLIOGRAPHY : 

BIBLIOGRAPHY Brunner & Suddharths, “Medical-Surgical Nursing,10th Edn,Lippincott publishers,Pp 1320-1321 Lewis & Dirksen, “Medical-Surgical Nursing”,Mosby Publishers,4th Edn,Pp 978-979 Williams & Wilkins, “Manual of Medical-Surgical Nursing”,Lippincott Publishers,4thEdn, Pp 567-569 Black M., “Medical-Surgical Nursing”,Vol 2,F.A. Davis Publishers,Pp 2478-2480 WWW.efa.org