Epilepsy a.k.a. seizure disorder is a common condition featuring abnormal recurring excessive self-terminating electrical discharge from neurons. This abnormal neuronal activity that may involve all or part of the brain, disturbs skeletal motor function, sensation, autonomic function of the viscera, behaviour and consciousness.
Epilepsy Incidence and Prevalence
- Epilepsy is considered to be the 4th most common neurological disorder
- Epilepsy affects up to 50 million people worldwide
- Technological advances in obstetric and paediatric care are allowing high-risk neonates to survive; other technological advances are improving survival following traumatic brain injury; Additionally we have an ever increasing ageing population. All of these are contributing towards an increase in the incidence of epilepsy
- Idiopathic epilepsy (epilepsy with no identifiable cause) with multiple episodes is diagnosed as a seizure disorder
- Secondary epilepsy results from conditions affecting the brain or other organs, such as following birth injury and PIH (pregnancy-induced hypertension), drug and alcohol overdose and withdrawal; systemic metabolic conditions eg. hypoglycaemia, hypoxia, uraemia, and electrolyte imbalance; brain pathologies eg. meningitis, cerebral bleeding, cerebral oedema, infection, vascular abnormalities, trauma or tumors
Epilepsy Classification
Focal/Partial Seizures are typically the result of an affected portion of the motor cortex, leading to recurrent muscle contractions. Activity may be confined in a particular area, or spread to adjacent areas.
Focal/Partial Seizures can be subdivided into 3:
- Simple partial seizure without impaired consciousness
- Complex partial seizure with impaired consciousness – commonly originate in the temporal lobe, usually preceded by an aura, an unusual smell, metallic taste etc.; patient may engage in repetitive involuntary activity a.k.a. automatisms, such as lip smacking, aimless walking or picking on clothes
- Partial evolving into secondary generalised seizures
Generalised Seizures
Seizures affecting both hemispheres of the brain as well as deeper brain structures are referred to as generalised seizures. In generalised seizures, consciousness is always impaired…
Generalised Tonic-Clonic Seizures
Tonic Seizures
Tonic seizures are characterised by a sudden onset of stiffing of the muscles resulting in increased muscle tone, usually leading to a fall…
Clonic Seizures
Clonic seizures are characterised by rapidly alternating contraction and relaxation of a muscle of the arms and legs…
Myoclonic Seizures
Myoclonic seizures are characterised by brief arrhythmic jerking motor movements lasting less than a second, usually happening in clusters…
Atonic Seizures
Atonic seizures are characterised by a brief loss of postural tone, commonly resulting in falls and injuries…
Absence Seizures
Absence seizures are characterised by sudden brief cessation of all motor activity accompanied by a blank stare and unresponsiveness, usually lasting about 5-10 seconds (repeated involuntary movements such as lip smacking may occur)…
Status Epilepticus
In Status Epilepticus, seizures become continuous, with barely any time for recovery in between. In this case, the patient becomes prone to developing hypoxia, acidosis, hypoglycaemia, hypothermia and exhaustion. Status Epilepticus is life-threatening that requires immediate treatment and care with the aim of halting the seizures.
Non-Epileptic Seizures
Non-Epileptic Seizures a.k.a. Non-Epileptic Attack Disorder NEAD can be either Psychogenic – episodes of altered movement, sensation or experience caused by psychological process with no association to abnormal electrical discharges in the brain, or Physiological – caused by psychological dysfunction eg. cardiac arrhythmias, hypotensive episodes, or cerebrovascular disease.
Epilepsy Diagnosis
- History (ideally information should be provided by both the person experiencing the seizure and an eye-witness, for accurate diagnosis)
- CT Scan
- MRI
- X-ray of the skull
- EEG
- Lumbar Puncture
Note: An adult experiencing an acute epileptic fit for the first time should be checked for the presence of a brain tumor.
Epilepsy Medication & Possible Side Effects
Epilepsy Nursing Management
ASSESS:
- Obtain complete seizure history
- Did the person experience an aura before the seizure?
- Assess the person’s neurologic condition during and after seizure (person may die from cardiac involvement or respiratory depression)
- Assess effects of epilepsy on the person’s lifestyle
DIAGNOSIS:
- Assess risk of injury in relation to seizure activity
- Assess fear in relation to future seizures
- Assess for ineffective coping in relation to the stress imposed by epilepsy
- Assess for lack of knowledge on epilepsy and controlling factors
POSSIBLE COMPLICATIONS:
- Status epilepticus
- Medicinal toxicity
PLANNING:
- Injury prevention
- Seizure control
- Aim for satisfactory psychosocial adjustment
- Educate about the condition
- Aim to reduce possibility of complications
INJURY PREVENTION:
- Ease the person onto the floor to prevent unnecessary injuries
- Provide privacy in case of presence of onlookers
- Protect the person’s head with a cushion or pad
- Loosen up clothing if restrictive
- Clear the surrounding area from furniture that may cause further injuries to the person
- If the person is in bed, remove pillows and raise bed sides
- Turn the person to the side with the head flexed forward to promote pharyngeal secretion draining
- Ensure availability of suction equipment to clear out secretions
- DO NOT attempt to open a clenched jaw
- DO NOT attempt to insert anything in the person’s mouth
- DO NOT attempt to restrain the person undergoing a seizure
REDUCING FEARS ASSOCIATED WITH SEIURES:
- Emphasise importance of compliance to treatment
- Help in determining factors leading to seizures so the person can aim to avoid them eg. emotional distress, environmental stressors, onset of menstruation, fever…
- Encourage routine lifestyle, diet, exercise and rest
- Encourage avoidance of photic stimulation eg. bright flickering lights. If unavoidable, covering one eye or wearing dark glasses can help in lessening the effect
- Encourage stress management classes
COPING MECHANISMS:
- Provide counseling to help understand epilepsy and its associated limitations
- Encourage participation in social and recreational activities
- Educate the person + family about epilepsy symptoms and management
CARE:
- Prevent and control gingival hyperplasia (gum overgrowth), which is a side effect of Dilantin, by educating about oral hygiene and gum massage, and encouraging regular dental care
- Encourage contact with GP if any changes with medication are required
- Educate the person about side effects and toxicity of prescribed medication
- Provide safety guidelines in the case of medicinal overdose
- Encourage the person to keep a drug and seizure chart
- Educate on the importance of taking showers rather than baths to avoid drowning; similarly, instruct to never swim alone
- Wear an identification bracelet and carry an emergency medical identification card
- If desired, encourage to seek genetic counseling
FINANCIAL CONSIDERATIONS:
- Encourage the person to seek Schedule 5 and POYC for epilepsy medication
EXPECTED PATIENT OUTCOME:
- Person is knowledgeable about epilepsy
- No sustained injuries during seizure activity
- Decreasing fear in relation to epilepsy
- Displaying effective coping mechanisms
- Experiences no complications related to injury or complications of status epilepticus
Did you find the above nursing information useful? Follow us on Facebook and fill in your email address below to receive new blogposts in your inbox as soon as they’re published 🙂
Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
- The NUPO Diet Review: trying NUPO before going under the knife - 19/12/2023
- Antimicrobial Resistance Symposium - 11/11/2023
- Examination of the Abdomen for Nursing Students - 01/07/2023
