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Epilepsy (seizure disorder)
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4. EPILEPSY (SEIZURE DISORDER)EPILEPSY (SEIZURE DISORDER)
•Epilepsy is a disorder of brain in which
a fit occurs because of abnormal
electrical discharge between certain
brain cells.
•a sudden loss of consciousness which is
often accompanied by repeated jerky
movements called convulsions.
•These attacks are sometimes called
fits or seizures.
•Epilepsy is due to disturbance in the
electrical activity of the brain.
5. Contd….Contd….
Is caused by a transient, excessive
and abnormal discharge of nerve
cells.
The abnormal discharge may involve
a small part of brain only ( partial or
focal seizure) or much more
extensive area in both hemispheres
(generalized seizures).
It can start at any age.
In majority of the cases, it starts in
childhood and adolescence.
11. DIFFERENT CAUSES OF EPILEPSY ARE
COMMON IN CERTAIN AGE GROUPS:
NEONATAL PERIOD AND EARLY INFACY:
HYPOXIC ISCHEMIC ENCEPHALOPATHY,
CNS INFECTIONS, TRAUMA, CONGENITAL
CNS ABNORMALITIES, METABOLIC
DISORDES.
LATE INFANCY AND EARLY
CHILDHOOD: CNS INFECTIONS AND
TRAUMA
CHILDHOOD: WELL DEFINED EPILEPSY
SYNDROME.
12. • ADOLESCENCE AND ADULTHOOD:
SECONDARY TO ANY CNS LESIONS,
IDIOPATHIC EPILEPSY, STRESS,
TRAUMA, CNS, INFECTIONS, BRAIN
TUMORS, ILLICITS DRUGS.
•OLDER ADULT:
CEREBROVASCULAR DISEASES,
TUMORS, HEAD TRAUMAS, OTHER
DEGENERATIVE DISEASES SUCH AS
DEMENTA.
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15. EPILEPSY ARE CLASSIFIED IN FIVE
WAYS:
BY THEIR FIRST CAUSE
BY THE OBSERVABLE
MANIFESTITIONS OF SEIZURES,
KNOWN AS SEMIOLOGY.
BY THE LOCATION IN THE BRAIN
WHERE SEIZURES ORIGINATES.
16. • AS A PART OF DISCRETE,
INIDENTIFIABLE MEDICAL
SYNDROME.
•BY THE EVENT THAT TRIGGERS
THE SEIZURES, SUCH AS
READING OR MUSIC.
17. ANOTHER CLASSIFICATIONSANOTHER CLASSIFICATIONS
1. Generalized seizures
Major epilepsy( Grand mal
seizure/epilepsy)
Minor epilepsy(Petit mal,
absence seizure)
Myoclonic seizures
2. Partial seizures ( Focal/
Jacksonian seizure)
3. Status epilepticus
18. GENERALIZED SEIZUREGENERALIZED SEIZURE
Involves the entire brain
Consciousness is lost and the
seizure may last from several
seconds to several minutes
Types include;
1.Major epilepsy
2.Minor epilepsy
3.Myoclonic epilepsy
19. Major (Grand mal) EpilepsyMajor (Grand mal) Epilepsy
The attack or fit occurs suddenly
at any place or time.
The patient falls down and loses
awareness of his surroundings
Convulsion proceeds as follows:
Aura :
Is a warning signal prior to onset
of seizures e.g sensation of
peculiar test or smell, spots
before eyes, dizziness and feeling
of weakness.
20. contd….contd….
Epileptic cry:
Patient loses consciousness with an
epileptic cry, it is caused by spasm of
thoracic and abdominal muscles
expelling air through the glottis.
Tonic stage:
Patient falls to the ground with all his
muscle in an increased tone with
rigidity.
The skin become pale and cyanotic,
the respiration ceases.
Pupil dilated and fixed. It lasts for
10-30 sec.
21. Contd…Contd…
Clonic stage:
Is characterized by rhythmic,
jerking movements that follow the
tonic stage.
Usually start at one place and
become generalized, including the
muscle of the face.
There is frothing at the mouth and
incontinence of urine and faeces.
Duration is approximately 1-5 min.
22. Contd…Contd…
Post ictal stage:
It refers to the recovery period
after a seizure
The patient may sleep deeply for
30 min to several hours.
Following this deep stage, client
may complain of headache,
confusion, fatigue.
Client may realize that they had a
seizure but not remember the
event itself.
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25. b. Minor epilepsy (absence seizure)b. Minor epilepsy (absence seizure)
Also referred as petit mal
seizures.
Are more common in children and
usually disappears after puberty
Such patient doesn’t fall
The patient demonstrates a brief
change such as rolling of the eyes,
blinking and slight mouth
movement.
26. Contd…Contd…
They often describe their attack
as “blackouts”
Because of the brief duration and
relative lack of prominent
movement, these seizures often
go unnoticed.
People with absence seizure can
have them many times a day.
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28. Myoclonic seizureMyoclonic seizure
Are characterized by sudden,
excessive jerking of the arms,
legs or entire body.
In some instances, the muscle
activity is so severe that the
client falls to the ground
These seizures are brief.
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30. 2. Partial seizure( Focal/Jacksonian)2. Partial seizure( Focal/Jacksonian)
It begins in a specific area of the
cerebral cortex.
A partial seizure can progress to a
generalized seizure.
It begins as a localized motor
seizure, with convulsions starting
in one part of the body eg. From
the thumb and gradually involving
hand and arms, face and other
parts.
31. Contd…Contd…
Patient may or may not loose
consciousness.
Feeling of nausea, sweating, skin
flushing and dilation of pupil can
also occur.
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35. 3.Status epilepticus3.Status epilepticus
It is characterized by at least
30 min of repetitive seizure
activity with out return to
consciousness.
In other words, it is state in
which a person has continuous
seizures lasting at least 30 min.
This is medical emergency and
requires prompt intervention to
prevent irreversible neurological
39. APPROACH CONSIDERATIONS:
THE GOAL OF TREATMENT IN
PATIENTS WITH EPILEPTIC
SEIZURES IS TO ACHIEVE A
SEIZURES FREE STATUS WITHOUT
ADVERSE EFFECTS. THIS GOAL IS
ACCOMPLISHED BY IN MORE THAN
60% OF PATIENTS WHO REQUIRE
TREATMENT WITH ANTI-
CONVULSANTS.
40. ANTICONVULSANT THERAPY:
THE MAINSTAY OF SEIZURE
TREATMENT IS ANTICONVULSANT
MEDICATION. THE DRUG OF CHOICE
DEPENDS ON AN ACCURATE
DIAGNOSIS OF THE EPILEPTIC
SYNDROME, AS RESPONSE TO
SPECIFIC ANTICONVULSANTS
VARIES AMONG DIFFERENT
SYNDROMES.
41. ANTI CONVULSANTS CAN BE DIVIDED
INTO LARGE GROUP BASED ON THEIR
MECHANISM, AS FOLLOWS:
• BLOKERS OF REPETITIVE ACTIVATION
OF THE SODIUM CHANNEL:
PHENYTOIN, CARBAMAZEPINE.
• ENHANCER OF SLOW INACTIVATION OF
THE SODIUM CHANNEL:
LACOSAMIDE, RUFINAMIDE.
• GABA-A RECEPTOR ENHANCERS:
PHENOBARBITAL.
42. •N AND L- CALCIUM CHANNEL
BLOCKERS: LAMOTRIGINE,
VALPORATE
•H- CURRENT MODULATORS:
GABAPENTIN, LAMOTRIGINE.
•BLOCKERS OF UNIQUE BINDING
SITES: GABAPENTIN
•NEURONAL POTASSIUM CHANNEL
OPENER: EZOGABINE.
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44. THE TWO METHODS ARE:
A KETOGENIC OR MODIFIED
ATKINS DIET( LOW
CARBOHYDATE DIET)
VAGAL NERVE STIMULATION
(VNS)
45. THE KETOGENIC DIET, WHICH RELIES
HEAVILY ON THE USE OF FAT, SUCH AS
HYDROGENATED VEGETABLE OIL
SHORTENING, HAS A ROLE IN THE
TREATMENT OF CHILDREN WUTH
SEVERE EPILEPSY.
ALTHOUGH THIS DIET IS
UNQUESTIONABLY EFFECTIVE IN SOME
REFRECTORY CASES OF SEIZURE, A
KETOGENIC DIET IS DIFFICULT TO
MAINTAIN; LESS THAN 10% OF
PATIENTS CONTINUE THE DIET AFTER
YEAR.
47. VAGAL NERVE STIMULATION:
VNS IS A PALLIATIVE
TECHNIQUE THAT INVOLVES
SURGICAL IMPLANTATION OF A
STIMULATING DEVICE. IT IS
CURRENTLY INDICATED FOR
PATIENT OLDER THAN 12
YEARS WITH MEDICALLY
PARTIAL SEIZURE THAT ARE
NOT TREATED SURGICALLY.
48. • VNS MAY HAVE IMPROVED
EFFICACY OVER TIME.
•CHILDREN SHOULD BE
CAREFULLY MONITORED FOR
THE SITE OF INFECTION AFTER
VNS IMPLANTATION.
52. THE MAJOR PROBLEM FOR
PATIENTS WITH SEIZURES IN
THE UNPREDICTABILITY OF THE
NEXT SEIZURE. CLINICIANS
SHOULD DISCUSS THE
FOLOWING TYPES OF SEIZURES
PRECAUTIONS WITH PATIENTS
WHO HAVW EPILEPTIC
SEIZURES:
56. ASSESSMENT:
• HISTORY, INCLUDING PRENATAL,
BIRTH, AND DEVELOPMENTAL
HISTORY, FAMILY HISTORY, AGE AT
SEIZURE ONSET, HISTORY OF ALL
ILLNESS AND TRAUMAS.
•DETERMINE WHETHER THE
PATIENT HAS AN AURA BEFORE AN
EPILEPTIC SEIZURE, WHICH MAY
INDICATE THE ORIGIN OF SEIZURE.
57. •OBSERVE AND ASSESS
NEUROLOGICAL CONDITION.
•ASSESS VITALS AND
EUROLOGICAL SIGNS
CONTINUOUSLY.
•ASSESS EFFECT OF EPILEPSY ON
LIFESTYLE.
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59. •RISK FOR INJURY RELATED TO
SEIZURE ACTIVITY.
•FEAR RELATED TO POSSIBILITY OF
HAVING SEIZURES.
•INFEECTIVE COPING RELATED TO
STRESS IMPOSED BY EPILEPSY.
•DEFICIT KNOWLEDGE ABOUT
EPILEPSY AND ITS CONTROL.
60. PREVENTION OF INJURY.
CONTROL OF SEIZURES.
ACHIEVEMENT OF
PSYCHOSOCIAL ADJUSTEMENT.
ACQUISITION OF KNOWLEDGE.
ABSENCE OF COMPLICATIONS.
