week 3 Flashcards
Prevalence: Approximately ___ of Canadians have epilepsy
0.6%
What is a seizure?
An abnormal, sudden excessive, uncontrolled electrical discharge of neurons within the brain, which may lead to a sudden, uncontrolled alteration in consciousness, motor or sensory ability, and/or behaviour.
It may be paroxysmal and episodic, as in epilepsy, or transient and acute, as after a head concussion.
Epilepsy
is a symptom of a neurological disorder that is characterized by recurrent seizure activity.
Epilepsy is not a disease, it is a symptom of a neurological disorder - a physical condition - that from time to time produces brief disturbances in the normal electrical functions of the brain. Epilepsy is characterized by sudden, brief seizures whose nature and intensity vary from person to person.
Paroxysmal:
short, sudden and frequent occurrence
Etiology of Epilepsy
Primary (idiopathic):
Abnormality in neuronal activity
Imbalance of neurotransmitters especially GABA
Combination of above
Secondary :
Other underlying problems that result in seizures
Common Causes of Seizures
In 50 - 60% of cases, the cause of epilepsy is unknown.
The following causes are most common:
brain tumour and stroke
head trauma of any type. The more severe the injury, the greater the chance of developing epilepsy
injury, infection, or systemic illness of the mother during pregnancy
brain injury to the infant during delivery may lead to epilepsy
aftermath of infection (meningitis, viral encephalitis)
poisoning, from substance abuse of alcoholism
www.epilepsy.ca
PARTIAL SEIZURES
Partial seizures begin in one place in the brain, called the seizure focus, and affect only part of the brain.
GENERALIZED SEIZURES
In generalized seizures, abnormal excessive electricity occurs throughout the whole brain at once, with no apparent focal point of onset or warning beforehand.
Types of Partial Seizures:
type 1
These seizures are characterized by:
strange or unusual sensations, for example odours or visual abnormalities.
Other characteristics of SPS include sudden or restless movement, hearing distortion, stomach discomfort, and a sudden sense of fear. Alteration of consciousness or memory is generally not associated with simple partial seizures.
As mentioned before, partial seizures are localised to one region of the brain. Each region of the brain is responsible for certain body functions, sensations, and movements. By observing the motor manifestations and sensory responses during SPS, the neurologist may be able to determine the brain region affected. This may help determining which drugs are best for the treatment of each individual’s epilepsy.
The ICES has categorised simple partial seizures into 4 main categories: motor, sensory, psychic, and autonomic. Each category has several types of SPS.
types of partial seizures 1/2
Complex partial seizures (CPS - formerly psychomotor or temporal lobe seizures)
:Complex partial seizures are often preceded by an “aura.” They are often identified by the manifestation of complicated motor and sensory action. The person can appear dazed and confused – random walking, mumbling, head turning, or pulling at clothing may be observed. These repeated idiosyncratic motions are often called automatisms and are usually not recalled by the person. There may be some change in consciousness or memory.
In children, this seizure should not be confused withabsence seizures. CPS often originate in the temporal or frontal lobes of the brain.
Generalized absence seizures (formerly petit mal):
Characterized by a complete loss of awareness. The person may stare into space and appear to be daydreaming orin a daze. Absence seizures are not preceded by a warning (aura) and are followed by normal activity by the individual. There is very minimal movement during the actual seizure so many times it may go unnoticed by others.
These seizures often occur in children. They may, however, develop into other types of seizures, such as complex-partial or tonic-clonic. (Absence seizures may be difficult to distinguish from Complex-partial seizures. Absence seizures are usually more quick in duration and have less recovery time than CPS.)
Absence seizures usually diminish into adulthood (opposite of tonic-clonic/grand mal seizures.)
There are two types of absence seizures: Typical Absence Seizures: They are non-convulsive and muscle tone is usually preserved. The seizure event usually lasts for less than 10 seconds in duration.
Atypical Absence Seizures: They are longer in duration than typical absence seizures. There may or may not be a loss in muscle tone and often tonic/clonic-like movements are observed.
Tonic-clonic seizures (formerly grand mal):
A generalized convulsion occurring in two phases. In the tonic phase, there is stiffening of the muscles, the person loses consciousness and falls, as the body grows rigid. In the clonic phase, body extremities jerk and twitch. The seizure event may often be ended by another tonic phase. After the seizure, consciousness returns slowly. When the person wakes up, they are often confused or disoriented.
This seizure, while perhaps the type of epilepsy most visible in the public mind, is not the most common. Approximately two-thirds of people with epilepsy have complex partial seizures.
A secondary generalized tonic-clonic seizure begins locally (with partial seizure) and it may be preceded by an aura.
Myoclonic Seizure:
There is no loss of consciousness during this type of seizure. It is often associated with single or repetitive jerking motions of the muscles (myoclonus). Myoclonic seizures are primarily observed in young children and infants. They arerarer in adults.
Atonic/akinetic –
loss of muscle tone
Aura
Sensation or warning before a seizure
Sometimes gives person time to lie down and prevent falling injury
Varies person to person
May be:
Change of body temperature, feeling of tension or anxiety
Musical sound, strange taste or striking odour
Description helps to identify focal point of seizure
May not be followed by a full-scale seizure
Aura is actually a simple partial seizure
Postictal Phase
First few minutes after the seizure may be limp and nonresponsive
Pupils begin to react to light and return to their normal size
After about 5 min, may be sleepy, semiconscious, confused, unable to speak clearly, and uncoordinated; have a headache; complain of muscle aches; and have no recollection of the seizure event. This phase usually lasts less than 15 min.
Temporary weakness, dysphasia, or hemianopia lasting up to 24 hr after the seizure may be experienced.
Get help if confusion lasts more than one hour following seizure
Once fully conscious and stable, person may be very tired and sleep for several hours
Treatment
Secondary Seizures - remove/treat underlying cause
Primary Epilepsy Drug therapy: Antiepileptic medications – the major component of therapy Surgery Vagal nerve stimulation (VNS) Remove seizure foci from brain
Antiepileptic Drugs (AEDs)
Most people with epilepsy can be successfully treated with medicines known as anti-epileptic drugs (AEDs). AEDs do not cure epilepsy, but they can prevent seizures from occurring.
There are many different AEDs.Generally, theywork by changing the levels of the chemicals in your brain that conduct electrical impulses. This reduces the chance of a seizure.
The drugs used to treat epilepsy are often referred to as first-line and second-line drugs. This does not mean that one type of drug is better than the other, but it refers to when the drugs were first introduced. First-line drugs are older and have treated epilepsy for decades. Second-line drugs are much newer.
Nursing Diagnosis
Deficient knowledge related to unfamiliarity with purpose, precautions, and side effects of AEDs
Desired Outcome: Before hospital discharge, patient verbalizes accurate knowledge about the prescribed AED.
General Points - AED
Brand vs. generic - generic medicine usually works well, but it may not generate the same blood levels as brand name
Starting schedule - started slowly to minimize side effects
Blood levels: Target blood levels are broad guides to clinical use.
desirable level depends upon the type and number of seizures, side effects, taking one vs. multiple drugs and other clinical factors.
side effects of AED
Side effects: brief compilation of the most common and most worrisome, not a full list:
fatigue, dizziness, unsteadiness, blurry vision, stomach upset, headaches, and reduced resistance to colds, memory and thinking problems.
Weight gain or Weight loss (depending on drug)
Suicide warning: suicide warning on all AEDs, but the actual risk for suicide due to AEDs is quite low.
