SEIZURES OR EPILEPSY – Causes and Risk Factors, Classification, Clinical Manifestations, Medical, Surgical and Nursing Management

Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Inn epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness.

 

CAUSES AND RISK FACTORS

Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings and actions. Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures.

Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity – from illness to brain damage to abnormal brain development – can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors. Having seizures does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy.

Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity – from illness to brain damage to abnormal brain development – can lead to seizures. Common causes of epilepsy include:

  • Genetic influence
  • Stroke or transient ischemic attack (TIA)
  • Dementia, such as Alzheimer’s disease
  • Traumatic brain injury
  • Infections, including brain abscess, meningitis, encephalitis and AIDS
  • Brain problems that is present at birth (congenital brain defect)
  • Brain tumor
  • Abnormal blood vessels in the brain
  • Other illness that damage or destroy brain tissue
  • Brain injury that occurs during or near birth
  • Metabolism disorders that a child may be born with (such as phenylketonuria)
  • Developmental disorders, such as autism and Down syndrome
  • Exposure to lead, carbon monoxide, and many other poisons
  • Exposure to street drugs and from overdoses of antidepressants and other medications


 

CLASSIFICATION

Seizure types are organized according to whether the source of the seizures within the brain is localized (partial or focal onset seizures) or distributed (generalized seizures)

1. Focal Seizures

          When seizures appear to result from abnormal activity in just one part of the brain, they are called focal or partial seizures. These seizures fall into two categories.

a. Simple Focal Seizures: These seizures don’t result in loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. The person may experience sudden and unexplainable feelings of joy, anger, sadness, or nausea. They may also result in involuntary jerking of part of the body, such as an arm or leg, and spontaneous sensory symptoms such as tingling, vertigo and flashing lights. He or she also may hear, smell, taste, see, or feel things that are not real.


b. Complex Focal Seizures: In a complex focal seizure, the person has a change in or loss of consciousness for a period of time. His or her consciousness may be altered, producing a dreamlike experience. Complex focal seizures often result in staring and non purposeful movements – such as hand rubbing, chewing, swallowing or walking in circles.

People having complex focal seizures may display strange, repetitious behaviors such as blinks, twitches, mouth movements, or even walking in a circle. These repetitious movements are called automatisms. More complicated actions, which may seem purposeful, can also occur involuntarily.  Patients may also continue activities they started before the seizure began, such as washing dishes in a repetitive, unproductive fashion. These seizures usually last just a few seconds.

 

 2. Generalized Seizures

Generalized seizures are a result of abnormal neuronal activity on both sides of the brain. These seizures may cause loss of consciousness, falls, or massive muscle spasms. Seizures that seem to involve all of the brain are called generalized seizures. Six types of generalized seizures exist.

  1. Absence seizures: In absence seizures, the person may appear to be staring into space and/or have jerking or twitching muscles and can cause a brief loss of awareness. These seizures are sometimes referred to as petit mal seizures, which is an older term.
  2. Tonic seizures: Tonic seizures cause stiffening of the muscles, generally those in back, arms and legs and may cause you to fall to the ground.
  3. Clonic seizures: These types of seizures are associated with rhythmic, jerking muscle contractions, usually affecting the arms, neck and face.
  4. Myoclonic seizures: These seizures usually appear as sudden brief jerks or twitches of the upper body, arms, or legs.
  5. Atonic seizures: Also known as drop attacks. Atonic seizures cause a loss of normal muscle tone. The affected person will fall down or may drop his or her head involuntarily.
  6. Tonic – clonic seizures: The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking and sometimes loss of bladder control or biting your tongue. Tonic-clonic seizures are sometimes referred to by an older term: grand mal seizures.​


CLINICAL MANIFESTATIONS

Because epilepsy is caused by abnormal activity in brain cells, seizures can affect any process brain coordinates. Symptoms vary from person to person. Some people may have simple staring spells, while others have violet shaking and loss of alertness. The type of seizure depends on the part of the brain affected and cause of epilepsy.

A seizure can produce:

  • Temporary confusion
  • A staring spell
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness or awareness
  • Involuntary changes in body movement or function, sensation, awareness, or behavior
  • A fleeting numbness of a part of the body
  • Brief or long term loss of memory, visual changes
  • Dizziness, lightheadedness, tightening of the chest


 

DIAGNOSTIC EVALUATIONS


  • Neurological and behavioral exam
  • Blood tests
  • Lumbar puncture (spinal tap)
  • Electroencephalogram (EEG)
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Single-photon emission computerized tomography (SPECT)
  • Neuropsychological tests


 

MEDICAL MANAGEMENT

Doctors generally start by treating epilepsy with medication. If that doesn’t work, they may propose surgery or another type of treatment. The choice of which drug to prescribe, and at what dosage, depends on many different factors, including the type of seizures a person has, the person’s lifestyle and age, how frequently the seizures occur, and for a woman, the likelihood that she will become pregnant.

Numerous anticonvulsant medications are available, each with specific actions, therapeutic ranges, and potential side effects. If seizures are not controlled on a single drug, another medication is added. Most anticonvulsants require periodic blood tests to monitor serum levels and kidney and liver function.

  1. Carbamazepine: Carbamaxepine is used for partial and generalized seizures. It decreases synaptic transmission in CNS; may be used for some types of neuralgias. Administer PO up to 1600 mg/day in divided doses.
  2. Phenytoin: Phenytoin is used for partial and generalized seizures. It limits seizure propagation; may be used for some cardiac dysrhythmias and some types of nerve pain. Administer IV 900 mg – 1.5 gm run at 50 mg/min; PO 300 mg/kg in divided doses.
  3. Clonazepam: Clonazepam is used for generalized seizures such as absence, atonic and myoclonic. It is a CNS sedative; may also be used for neuralgia or restless leg syndrome. Administer PO up to 20 mg/day.
  4. Valproic Acid: Valproic acid is used for partial and generalized seizures. It increases GABA, an inhibitory neurotransmitter in CNS. Administer PO initially 15 mg/kg/day.
  5. Ethosuxamide: For generalized seizure such as absence seizures, ethosuximide is often the primary treatment. Administer initially 1000 mg/day in divided doses.


Other Commonly prescribed drugs include lamotrigine, oxcarbazepine, Phenobarbital and primidone. Some relatively new epilepsy drugs include tiagabine, gabapentin, topiramate, levetiracetam, and felbamate. Other drugs are used in combination with one of the standard drugs or for intractable seizures that do not respond to other medications.

Surgical Management

        Surgery is most commonly done when tests show that seizures originate in a small well-defined area of brain that doesn’t interfere with vital functions like speech, language or hearing. In these types of surgeries, doctor removes the area of the brain that’s causing the seizures.

        Surgery is indicated for patients whose epilepsy is results from intracranial tumors, abscess, cysts or vascular abnormalities. Respective and palliative operations such as temporal lobectomy, extratemporal resection, corpus callosotomy and hemispherectomy are performed.

        Surgery to place a vagus nerve stimulator (VNS) may be recommended. It can help reduce the number of seizures. This therapy involves a device called a vagus nerve stimulator that’s implanted underneath the skin of chest like a heart pacemaker. Wires from the stimulator are wrapped around the vagus nerve in neck. The battery- powered device delivers short bursts of electrical energy to the brain through the vagus nerve.

Nursing Management

        The prime objective in caring for a patient experiencing a seizure is to prevent injury. In some cases, seizures may also involve isolated abnormal movements of a limb, periods of staring or abnormal stiffening without rhythmic jerking.

Take the following actions if someone is having a seizure:


  1. Move harmful objects out of the way; cushion the head and protect the person form falling.
  2. Side rails should be padded to prevent injury if the patient strikes his or her extremities against them.
  3. Loosen ties, scarves or other neckware.
  4. Do not put anything in the person’s mouth.
  5. The individual should not be restrained, because this may increase the risk of injury.
  6. A small pillow should be placed under the patient’s head to prevent striking it on the floor, taking care that the airway does not become occluded.
  7. After the convulsion ceases or if the person is vomiting, roll the person onto his or her left side to protect the airway and to help drain away any mouth secretions.
  8. An oral airway and suction should be readily available. Do not force an airway in once the seizure has begun.
  9. Make sure the airway is clear and the person is breathing. If not, start rescue breathing and seek immediate medical attention.
  10. Observe the length of the seizure, the movements involved, direction of head and eye movements and the time it takes to return to full consciousness and alertness, so you can report this information to a medical professional.


 

 

SEIZURES OR EPILEPSY – Causes and Risk Factors, Classification, Clinical Manifestations, Medical, Surgical and Nursing Management 

SEIZURES OR EPILEPSY – Causes and Risk Factors, Classification, Clinical Manifestations, Medical, Surgical and Nursing Management
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