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The Acute Management of an Individual with Epilepsy

The Acute Management of an Individual with Epilepsy. Classification & Different types of Seizure The Facts Diagnosis Nursing/Medical Management Status Epilepticus Psycho-social implications: more next term. Epilepsy : The Facts.

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The Acute Management of an Individual with Epilepsy

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  1. The Acute Management of an Individual with Epilepsy • Classification & Different types of Seizure • The Facts • Diagnosis • Nursing/Medical Management • Status Epilepticus • Psycho-social implications: more next term

  2. Epilepsy : The Facts • Epilepsy is the 2nd most common neurological disorder what is first? • The incidence is 1 in 200 a prevalence that is very close to Diabetes • Approx 70% of people with epilepsy are controlled on drugs • Epilepsy still carries huge stigma • Prejudice in job market: others anxieites

  3. More FACTS • 2/3rds of people at time of their marriage had not informed their partners of their epilepsy • Only 28% of those in full time jobs informed employers • 33% of those who disclosed to partner experienced broken realtionship • Scrambler & Hopkins (1997)

  4. Definition of Epilepsy • A seizure is the synchronous & excessive discharge of a group of neurones • Epilepsy is the repetitive occurance of these discharges • Seizures are a symptom, not a cause or syndrome

  5. Classification of Seizures • Partial seizures: Simple Partial & Complex Partial • General seizures

  6. Partial Seizures • Simple Partial: consciousness is not impaired & manifestations depend on which group of neurones is involved i.e. seizures with focal motor signs • Autonomic symptoms, pallor, flushing • Somatosensory symptoms, flashing lights, unpleasant odours, taste • Psychic symptoms, dejavu, fear

  7. Complex Partial • Consciousness is impaired • they may evolve from simple partial seizures or occur with impairment of awareness at onset • Automatisms may be involved e.g. chewing, swallowing, fumbling, smaking of lips

  8. Generalised Seizures • Absence seizures: brief blank episodes for few seconds ‘petit mal’ • Myoclonic seizures: sudden muscle jerks • Clonic seizures: without the stiffness • Tonic seizures: sudden increase in muscle tone- person may fall like a board

  9. Tonic-Clonic Seizures • Grand Mal • Tonic phase may start with an expulsion of air resulting in a high pitched cry. Falls, legs extended, arms flexed may be cyanosed • Clonic phase: rhythmic movements of arms & legs, tongue biting

  10. Atonic seizures • Sudden often brief loss of body tone which may result in a fall • Also known as ‘drop attacks’

  11. Diagnosis • History: witness account very useful, type aura, how long, post-seizure period • EEG: Electroencephalography not always useful particularly if N.A.D. between seizures • Videotelmetry: EEG & Video • MRI scan to exclude structural cause

  12. Common AED’s • Phenytoin • Tegretol (Carbamazepine) • Gabapentin • Lamotrigine • Epilim (Sodium Valporate) • Phenobarbitone • Aim for Monotherapy

  13. Goals of Treatment • Seizure freedom: Overall prognosis is good. 20 years after onset 70-80% in remission for 5 years, 50% in remission for at least 5 years and no longer take AED’s • To decrease seizure severity. More likely with partial seizures, reduce to simple partial

  14. Intractable Seizures • Trick is to try to achieve some sort of balance between side effects of AED’s & seizure control: part of Epilepsy Nurses role

  15. Status Epilepticus • Any type of seizure which occurs so frequently that the patient is unable to recover to a normal level of functioning between seizures • Most common form is Tonic/Clonic • Mortality rate is 3-27% • Classed as a medical emergency

  16. Safety Issues • Tonic/Clonic seizures classed as medical emergency ?ITU/HDU • Aim to stop seizures, IV access, Oxygen Sats • Diazepam rectally, IV Lorazepam, IV Phenytoin • Airway: Tongue biting, hypoxia, ventilation

  17. Other safety issues • Location on ward/unit, near nurses, oxygen & suction • Use of cotsides, pillows, safe positioning on side • Location of seizure: bathing, hard floor, call bell • Oedema, resp arrest, ventilation & ITU

  18. What do I need to know about someones epilepsy?? • What types of seizure? • Do they have an aura? • How long do they last & how frequent? • How long does it take to recover? • Do they need to sleep after? Are they confused before, during or after? • Is there a history of status?

  19. Self Management • Keep a diary • Managing drug therapy - non-compliance • Identifying triggers I.e. stress, alcohol • Safety at home, work, medic alert bracelet • Voluntary organisations • Emphasis on what they can do

  20. Causes of Status • AED non-compliance • Head injury/surgery • Raised ICP • Stress • Metabolic imbalance i.e. Diabetes, low Sod. • Drug/alcohol toxicity • Pyrexia

  21. Carol Forde-Johnston • Lecturer Practitioner in Neurosciences • The Radcliffe Infirmary, Oxford

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