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.
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.
1. PRIMARY( IDIOPATHIC) EPILEPSY:
Unknown genetic or biochemical
predisposition
2. Secondary epilepsy:
a. Intracranial
Tumor
Cerebro -vascular disease
Arteriovenous malformation
Trauma ( birth injury, depressed
fracture, penetrating wound)
Infection ( meningitis,
encephalitis)
Congenital and hereditary disease (tuberous
sclerosis)
b. Extra cranial
Metabolic
Electrolyte
Biochemical
Inborn errors of metabolism
anoxia
HYPOGLYCEMIA
DRUGS
Drug withdrawal
Alcohol withdrawal
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.
•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.
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.
❑ AS A PART OF DISCRETE,
INIDENTIFIABLE MEDICAL
SYNDROME.
❑ BY THE EVENT THAT TRIGGERS THE
SEIZURES, SUCH AS READING OR
MUSIC.
ANOTHER 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
GENERALIZED 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
MAJOR (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.
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.
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.
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.
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.
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.
MYOCLONIC 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.
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.
CONTD
…
Patient may or may not loose
consciousness.
Feeling of nausea, sweating, skin
flushing and dilation of pupil can
also occur.
3.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
Abrupt cessation of anticonvulsant
therapy is the usual cause of
status epilepticus.
MANAGEMENT OF EPILEPSY
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.
ANTICONVULSANT THERAPY:
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.
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.
•N AND L- CALCIUM CHANNEL
BLOCKERS: LAMOTRIGINE,
VALPORATE
•H- CURRENT MODULATORS:
GABAPENTIN, LAMOTRIGINE.
•BLOCKERS OF UNIQUE BINDING
SITES: GABAPENTIN
•NEURONAL POTASSIUM CHANNEL
OPENER: EZOGABINE.
THE TWO METHODS ARE:
A KETOGENIC OR MODIFIED
ATKINS DIET( LOW
CARBOHYDATE DIET)
VAGAL NERVE STIMULATION
(VNS)
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.
FURTHERMORE, ANY SMALL
CARBOHYDRATES IN TAKE
RESETS KETONE METABOLISM
FOR 2 WEEKS, THEREBY
ELIMINATING ANTISEIZURE
EFFICACY.
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.
VAGAL NERVE STIMULATION:
•VNS MAY HAVE IMPROVED
EFFICACY OVER TIME.
•CHILDREN SHOULD BE
CAREFULLY MONITORED FOR
THE SITE OF INFECTION AFTER
VNS IMPLANTATION.
LOBECTOMY
LESIONECTOMY
A lobectomy is a surgical procedure where
an entire lobe of your lung is removed for a
variety of reasons that may include a lung
cancer diagnosis, infection, COPD or benign
tumors. There are three lobes of your right
lung and two lobes of your left lung.
A lesionectomy is an operation to remove a
lesion -- a damaged or abnormally
functioning area -- in the brain. Brain
lesions include tumors, scars from a head
injury or infection, abnormal blood vessels,
and hematomas (a swollen area filled with
blood).
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:
• DRIVING
•ASCENDING HEIGHTS
•WORKING WITH FIRE OR COOKING
•USING POWER TOOLS OR
•DANGEROUS ITEMS
•TAKING UNSUPERVISED BATHS
•SWIMMING
THESE LIFESTYLES
PRECAUTIONS ARE CLEARLY
MORE APPLICABLE TO SOME
PATIENTS THAN TO OTHERS.
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.
•OBSERVE AND ASSESS
NEUROLOGICAL CONDITION.
•ASSESS VITALS AND
EUROLOGICAL SIGNS
CONTINUOUSLY.
•ASSESS EFFECT OF EPILEPSY ON
LIFESTYLE.
•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.
PREVENTION OF INJURY.
CONTROL OF SEIZURES.
ACHIEVEMENT OF PSYCHOSOCIAL
ADJUSTEMENT.
ACQUISITION OF KNOWLEDGE.
