OM VERMA ASSISTANT PROFESSOR MEDICAL - SURGICAL NURSING GRACIOUS COLLEGE OF NURSING ABHANPUR

3. INTRODUCTION
• SOMETIMES CALLED CONVULSION ARE
PAROXYSMAL MOTOR SENSORY OR
COGNITIVE MANIFESTATIONS OF
SPONTANEOUS ABNORMALLY DISCHARGES OF
COLLECTIONS OF NEURONS IN THE CEREBRAL
CORTEX. IN MOST PERSONS THE FIRST
SEIZURE EPISODE OCCURS BEFORE 20 YEARS
OF AGE

4. DEFINITION
• Epilepsy is a chronic disorder of abnormal recurring
, excessive & self terminating electrical discharge
from neurons .
• Epilepsy is characterized by recurring seizure
accompanied by some type of change in behavior
{LEMANE, BRURKE}
• Epilepsy is a paraoximal uncontrolled electrical
discharge of neurons in the brain that interupts
normal function.
{B.T.BASANTHAPPA}

5. Con……………………………….
BRUNNER & SUDDARTH
JAYPEES NURSES DICTIONARYS

6. INCIDENCE
• Epilepsy affecting up to 25million people in united
states
• People of any age may be affected
• Prevalence & incidence of epilepsy increase in older
adults

7. ANATOMY & PHYSIOLOGY

9. ETIOLOGY
• First 6 month of life
• Birth injury
• Congenital defects involving the CNS
• Infection
• Trauma
• Genetic factors
• 2-20 years of age
• Birth injury
• Infection
• Trauma
• Genetic factors

10. cont……..
• 20-30 years of age
• Structural lesion such as truma,brain tumors
,vascular disease,
• After 50 years
• Cerebrovascular lesions
• Metastatic brain tumors

11. RISK FACTORS
• Anoxia
• Perinatal problem
• Congenital CNS defects
• Mental retardation
• Febrile condition
• Family history of Epilepsy
• Head trauma
• CNS infection
• CNS tumors
• Alcohol or drug abuse
• Exposure to toxins

12. PATHOPHYSIOLOGY

13. PATHOPHYSIOLOGY
• Due to etiological factor
↓
• A group of abnormal neurons firing
↓
• This firing spread by physiological pathological
pathways to involve distance area of brain
↓
• This acting is spread to involve the whole brain
↓
• A generalized seizure (epilepsy) occurs.

14. TYPES
 GENERALIZED SEIZURES
1. TONIC –CLONIC SEIZURE
2. ABSENCE SEIZURES
3. MYOCLONIC SEIZURES
4. TONIC SEIZURES
5. ATONIC SEIZURES
6. CLONIC SEIZURES
 PARTIAL SEIZURESS
1. SIMPLE PARTIAL SEIZURES
2. COMPLEX PARTIAL SEIZURES

15. PARTIAL SEIZURES
• Partial seizure involves the activation of only a
restricted part of cerebral hemisphere
• Two types of partial seizure
• Simple partial seizure
• Complex partial seizure

16. Simple partial seizure
• A partial seizure accompanied by no alteration in
cosciousness is called simple partial seizure .
• Clinical manifestation
• Abnormal sensation
• Hallusination
• Tachycardia
• Flushing hypotension & hypertension
• Psychic manifesation such as sense of de ‘ja’va
• Inappropriate fear & anger

17. Complex partial seizure
• partial seizure in which coscioueness is
impaired
• Clinical manifestation
• Non puposeful activity such as lip
smacking,aimless waking or picking of clothing
these behavor iscalled automatism

18. Generalized seizure
• Generalised seizure involve both hemisphere
of brain as well as deeper brain structures
such as thalamus ,basal ganglia, upper brain
stem .
• Consiousness is always impaired
• Types are
• Absense seizure
• Tonic clonic seizure

19. Tonic –clonic seizure
• A generalized tonic-clonic seizure is a seizure
involving the entire body. It is also called a grand
mal seizure. Such seizures usually involve muscle
rigidity, violent muscle contractions, and loss of
consciousness.

20. Symptoms Tonic –clonic seizure
• Many patients have an aura (a sensory warning sign) before
the seizure. This can include vision, taste, smell, or sensory
changes, hallucinations, or dizziness.
• The seizure itself involves:
• Loss of consciousness or fainting, usually lasting between
30 seconds and 5 minutes
• General muscle contraction and rigidity (tonic posture),
usually lasting 15 - 20 seconds
• Violent rhythmic muscle contraction and relaxation (clonic
movement), usually lasting for 1 -2 minutes
• Biting the cheek or tongue, clenched teeth or jaw
• Incontinence (loss of urine or stool control)

21. • Stopped breathing or difficulty breathing during seizure Blue skin
color
• Almost all people lose consciousness, and most people have both
tonic and clonic muscle activity.
• After the seizure, the person usually has:
• Normal breathing
• Sleepiness that lasts for 1 hour or longer
• Loss of memory (amnesia) regarding events surrounding the seizure
episode
• Headache
• Drowsiness
• Confusion, temporary and mild
• Weakness for up to 24 - 48 hours following seizure (This is called
Todd's paralysis.)

22. Absence seizure
• Absence seizure — also known as petit mal
seizure — involves a brief, sudden lapse of
conscious activity. Occurring most often in
children, an absence seizure may look like the
person is merely staring into space for a few
seconds

23. Symptoms Absence seizure
• Signs of absence seizures include:
• Staring, without unusual movement
• Lip smacking
• Fluttering eyelids
• Chewing
• Hand movements
• Small movements of both arms
• Absence seizures last only a few seconds. Full recovery
is almost instantaneous. Afterward, there is no
confusion, but also no memory of the incident. Some
people experience hundreds of these episodes each
day, which interferes with their performance at school
or work

24. • TONIC CLONIC SEIZURES
 MYOCLONIC SEIZURES

25. • ATONIC SEIZURES
CLONIC SEIZURES
COMPLEX PARTIAL SEIZURES

26. DIAGNOSTIC STUDIES
• Diagnostic history & physical examination
• Birth & development history
• Significant illnes & injury
• Family history
• Seizure history
• Presipitating factor
• Seizure describtion
• Diagnostic studies
• CBC
• Urine analysis
• Fasting blood glucose
• Lumber puncture for CSF analysis

27. Cont.
• CT scan
• MRI
• EEG
• Cerebral angiography
• Single photo emmission computed
tomography

28. Medical management
• Hydatonis
phenotoin
• Barbiturate
• Phenobarbital
• Succinamide
• Ethosuximied
• Other drugs
• Carbamazepine
• Valproic acid

29. Surgical management
Different surgical procedures are available to treat
epilepsy. The type of surgery used depends on the
type of seizures and the area of the brain where the
seizures start. The surgical options include:

30. Lobe resection: The largest part of the brain, the
cerebrum, is divided into four paired sections, called
lobes -- the frontal, parietal, occipital and temporal
lobes. Temporal lobe epilepsy, in which the seizure
focus is located within the temporal lobe, is the most
common type of epilepsy in teens and adults. In a
temporal lobe resection, brain tissue in the temporal
lobe is resected, or cut away, to remove the seizure
focus. The anterior (front) and mesial (deep middle)
portions of the temporal lobe are the areas most
often involved. Extra temporal resection involves
removing brain tissue from areas outside of the
temporal lobe.

31. Cont..
• Lesionectomy: This is surgery to remove isolated brain lesions -
areas of injury or defect such as a tumor or malformed blood
vessel -- that are responsible for seizure activity. Seizures usuall
stop once the lesion is removed.
• Corpus callosotomy: The corpus callosum is a band of nerve
fibers connecting the two halves (hemispheres) of the brain. A
corpus callosotomy is an operation in which all or part of this
structure is cut, disabling communication between the
hemispheres and preventing the spread of seizures from one si
of the brain to the other. This procedure, sometimes called split
brain surgery, is for patients with extreme forms of
uncontrollable epilepsy who have intense seizures that can lead
to violent falls and potentially serious injury.

32. Cont….
• Functional hemispherectomy: This is a variation of a
hemispherectomy, a radical procedure in which one
entire hemisphere, or one half of the brain, is removed.
With a functional hemispherectomy, one hemisphere is
disconnected from the rest of the brain, but only a
limited area of brain tissue is removed. This surgery
generally is limited to children younger than 13 years old
who have one hemisphere that is not functioning
normally.
• Multiple subpial transection (MST): This procedure is
used to help control seizures that begin in areas of the
brain that cannot be safely removed. The surgeon makes
a series of shallow cuts (transections) in the brain tissue.
These cuts interrupt the movement of seizure impulses
but do not disturb normal brain activity, leaving the
person's abilities intact.

33. Vagual nerve stimulation therapy

35. Introduction
• Vagus nerve stimulation therapy is another form of
treatment that may be tried when medications fail
to stop seizures. It is currently approved for use in
adults and children over the age of 12 who have
partial seizures that resist control by other
methods. The therapy is designed to prevent
seizures by sending regular small pulses of electrical
energy to the brain via the vagus nerve, a large
nerve in the neck.

36. • The energy is delivered by a flat, round battery,
about the size of a silver dollar, which is surgically
implanted in the chest wall. Thin wires (electrodes)
are threaded under the skin and wound around the
vagus nerve in the neck. The battery is programmed
by the health team to send a few seconds of
electrical energy to the vagus nerve every few
minutes. If the person with the system feels a
seizure coming on, he or she can activate the
discharge by passing a small magnet over the
battery. In some people, this has the effect of
stopping the seizure. It is also possible to turn the
device off by holding the magnet over it.

37. Side effects
• Side effects of VNS therapy are mostly hoarseness
and, sometimes, discomfort in the throat. There may
be a change in voice quality during the actual
stimulation. Although complete seizure control is
seldom achieved, the majority of people who use
VNS therapy experience fewer seizures. In some its
effectiveness increases with time, and patients
report an improved quality of life. As with surgery
and the ketogenic diet, it will almost always be
necessary to continue anti-epileptic medication
although the patient should be able to take less
medication than in the past.

38. NURSING MANAGEMENT
• NURSING DIAGNOSIS
• Ineffective breathing pattern relaed to neuro muscular
impairement secondary to prolonged to tonic phase of
seizure as during postictal period as evidence as
abnormal respiratory rate rhythm & depth
• INTER VENTION
• Airway management monitor respiratory &
oxygenation status
• Position patient to maximise ventilation potential
• Facilitate intubation as necessary
• Perform endotrachial or nasotrachial suctioning

40. • NURSING DIAGNOSIS
• Risk of injury related to seizure activity & subcequent
impaired physical mobility secondary to postictul weakness.
• INTERVENTION
• Seizure management
• Lossen the clothing to prevent restricted breathing
• Apply oxygen as appropriate
• NURSING DIAGNOSIS
• Ineffective cooping related to persived loss of control &
denial of diagnosis evidenced by verbalization about not
having epilepsy, lack of truth telling regarding seizure
frequency , non- complain behaviour
• INTERVENTION
• Coping enhancement
• Appraise patient to change body image
• Provide factual information concerning diagnosis, treatment
& prognosis

41. COMPLICATION
• Tonic clonic seizure is the most dangerous it causes
• Ventilator insufficiency
• Hypoxemia
• Cardiac dysarryhtmia
• Hyperthermia
• Sistemic acidosis
• Another complication
• Severe injury
• Death

42. Health education
• Drug must be taken as prescribed
• Use relaxation therapy,Bio-feedback training
• Avoilance of excessive alchol intake,Fatigue,
Loss of sleep