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Lesson 43. Epilepsy

2-43. EPILEPSY

a. Definition. Epilepsy is an abnormal electrical disturbance in one or more areas of the brain. An estimated 2 to 4 million persons in the United States are afflicted with epilepsy and more that half of those are under 20 years of age.

(1) The basic problem is thought to be an electrical disturbance in the nerve cells in one section of the brain, causing them to give off abnormal, recurrent, uncontrolled electrical discharges that produce a seizure or convulsion.
(2) The underlying disorder may be structural, chemical, physiological, or a combination of all three.
(3) Factors that may predispose a patient to epilepsy/seizures.
(a) Trauma to the head/brain.
(b) Brain tumor.
(c) Circulatory disorder, stroke.
(d) Metabolic disorder (such as hypoglycemia, hypocalcemia, or cerebral anoxia).
(e) Drug/alcohol toxicity.
(f) Infection (meningitis/brain abscess).

b. Grand Mal Seizure. (Characterized by three phases.)

(1) Preictal phase.

(a) Consists of vague emotional changes (depression, anxiety, nervousness).
(b) Lasts for minutes to hours. Followed by an "aura."
(c) Aura is usually a sensory "cue" (odor or sound) or sensation "cue" (weakness, numbness). It is related to the anatomical origin of the seizure, and warns the patient that a seizure is imminent.
(d) Preictal phase may or may not be present in all patients.

(2) Tonic-clonic phase.

(a) Loss of consciousness.
(b) Skin may become cyanotic, breathing is spasmodic, jaws are tightly clenched, and tongue and inner teeth may be bitten.
(c) Urinary and fecal incontinence usually occur.
(d) Phase may last one or more minutes.
(e) Tonic activity is characterized by rigid contraction of the muscles.
(f)   Clonic activity is characterized by alternate contraction and relaxation of muscles, causing jerking movements of the arms and legs.

(3) Postictal phase.

(a) Phase will vary in symptoms.
(b) Many patients fall into a deep sleep which may last for several hours.
(c) Patient may experience headache, fatigue, confusion, and nausea.

c.  Petit Mal Seizure.

(1) Characterized by brief loss of consciousness, or "blank spells."
(2) Individual stares blankly, eyelids may flutter, and there is slight movement of head and extremities.
(3) More common in children.
(4) May occur dozens of times per day.

d. Psychomotor Seizure.

(1) Different forms of seizure activity often appearing as irrational or odd behavior, such as removing one's clothing or purposeless behaviors such as smacking one's lips.
(2) Last only a few moments and individual has no recall of behavior.
(3) Auditory, visual, or olfactory hallucinations may also occur.

e. Jacksonian Seizure. (Also called focal or marching seizures.)

(1) Seizures may start in one part of the body and move to another. Consciousness may not be lost.
(2) May be followed by a grand mal seizure.

f. Status Epilipticus.

(1) Series of grand mal seizures experienced by the patient without regaining consciousness.
(2) Extreme neurological emergency.
(3) May occur spontaneously or if anticonvulsant medications are suddenly stopped.

g.     Medical and Nursing Management.

(1) Objectives of care:

(a) Determine and treat underlying cause of seizures if possible.
(b) Prevent recurrence of seizures and therefore allow patient to live a normal life.

(2) Institute and reinforce the importance of anticonvulsant drug therapy:

(a) Drug therapy is a means of controlling the condition; it is not a cure.
(b) Initially, dosage will have to be monitored and altered to provide maximum control with minimum side effects.
(3) Instruct patient to keep record of events surrounding his/her seizures (number, duration, time, sleep/eating patterns).
(4) Use of multidisciplinary approach to cope with social, emotional, and vocational pressures of the person with epilepsy.
(5) Place a padded tongue blade and oral airway at the patient's bedside. Tape them to the headboard or wall above the bed. This provides easy emergency access.
(6) Take the seizure prone patient's temperature with a rectal thermometer; prevents possibility of patient biting an oral thermometer if a seizure should occur.
(7) Set up suction equipment at the patient's bedside.
(a) Check the equipment daily to be sure it is working properly.
(b) Use during or after a seizure to clear the patient's airway.

(8) Essential steps necessary to protect the patient during a seizure.

(a) Turn patient on his side to provide for drainage of oral secretions.
(b) Do not forcibly restrain patient during seizure.
(c) Remove objects that may obstruct breathing or cause injury to patient.
(d) Protect patient's head from injury with pillow, blanket, etc.

(9) Essential steps necessary to ensure safety of the patient following a seizure.

(a) Keep bed flat and patient turned on his side until he is alert.
(b) Room lighting should be dim and noise kept to a minimum.
(c) Loosen restrictive clothing (if not done during seizure).
(d) Check vital signs immediately following seizure and every 30 minutes (or as ordered) until patient is alert.
(e) Check lips, tongue, and inside of mouth for injuries.
(f)   If patient is incontinent, change clothing and bedding with as little disturbance as possible.

h. Documentation.

(1) Document all precautions taken.
(2) Document all activity observed during a seizure, to include the time, location, circumstances, length of seizure activity, and vital signs.
(3) Document any injury sustained during a seizure.

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