Transcript 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 • 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 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) 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 Classification of Seizures • Partial seizures: Simple Partial & Complex Partial • General seizures 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 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 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 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 Atonic seizures • Sudden often brief loss of body tone which may result in a fall • Also known as ‘drop attacks’ 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 Common AED’s • • • • • • • Phenytoin Tegretol (Carbamazepine) Gabapentin Lamotrigine Epilim (Sodium Valporate) Phenobarbitone Aim for Monotherapy 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 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 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 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 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 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? 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 Causes of Status • • • • • • • AED non-compliance Head injury/surgery Raised ICP Stress Metabolic imbalance i.e. Diabetes, low Sod. Drug/alcohol toxicity Pyrexia Carol Forde-Johnston • Lecturer Practitioner in Neurosciences • The Radcliffe Infirmary, Oxford