EPILEPSY- Epilepsy is a brain disorder in which a person has repeated seizures (convulsions ) over time.

 

EPILEPSY

 Epilepsy  is a brain disorder in which a person  has repeated   seizures (convulsions ) over  time.  Epilepsy is a brain disorder in which clusters of nerve cells, or neurons , in the brain  something signal  abnormally . in epilepsy, the normal  pattern of neuronal activity becomes   disturbed, causing strange  sensations, emotions , and  behavior or sometimes convulsions,  muscle spasms, and loss of consciousness.

Causes and risk factors

Neurons normally generate electro chemical impulses that act on other neurons, glands,  and muscles to produce human thoughts , feeling , and action . epilepsy occur when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals . this results in repeated , unpredictable seizures.

Epilepsy is a  disorder with many possible causes.  Anything that disturbs the normal pattern of  neuron activity –form illness to brain damage  to abnormal  brain development – can lead to seizures. Epilepsy may develop because  of an abnormality in  brain wiring , an imbalance of  nerve signaling chemicals called  neurotransmitters,  or some combination of these factors . having a seizure does not necessarily  mean that a person has epilepsy . only when a person has had two or more  seizures is he or she considered to have epilepsy .

Epilepsy is a disorder with may possible cases .  anything  that disturbs the normal pattern of neuron    activity – from illness to brain damage to abnormal brain development    -can  lead to seizures.

 Common causes of epilepsy include: 

·         Genetic influence

·         Stroke or transient ischemic attack (TIA)

·         Dementia ,such as Alzheimer’s  disease

·         Traumatic brain injury

·         Infections , including brain abscess , meningitis, encephalitis , and AIDS

·         Brain problems that is present at birth (congenital brain defect)

·         Brain  tumor

·         Abnormal blood vessels in the brain

·         Other illness that damage or destroy brain tissue

·         Brain injury that occurs during or near birth

·         Metabolism disorders that a child may be born with (such as phenylketonuria )

·         developmental  disorders, such as autism and down syndrome exposure to lead, carbon monoxide, and many other   poisons

·         exposure to street drugs and from overdoses of antidepressants and other medications.

 

 

Classification

 

Seizure types are organized according to whether the source of the seizure within the brain is localized (partial or focal onset seizures) or distributed (generalized seizures),

1.      Focal Seizures

 

        When seizures appear to result from abnormal activity in just one part of the brain, they're called focal or partial seizures. These seizures fall into two categories.

        A. Simple Focal Seizures: These seizures don't result in loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. The person may experience sudden and explainable feelings of joy, anger, sadness, or nausea. They may also result in involuntary jerking of part of the body, such as an arm or leg, and spontaneous sensory symptoms such as tingling, vertigo and flashing lights. He or she also may hear, smell, taste, see, or feel things that are not real.

       B. Complex Focal Seizures: In a complex focal seizure, the person has a change in or loss

of consciousness for a period of time. His or her consciousness may be altered, producing a

dreamlike experience. Complex focal seizures often result in staring and non purposeful

movements -such as hand rubbing, chewing, swallowing or walking in circles.

           People having a complex focal seizure may display strange, repetitious behaviors such as blinks, twitches, mouth movements, or even walking in a circle. These repetitious movements are called automatism. More complicated actions, which may seem purposeful, can also occur involuntarily. Patients may also continue activities they started before the seizure began, such as washing dishes in a repetitive, unproductive fashion. These seizures usually last just a few seconds.

 

2.      Generalized Seizures

     Generalized seizures are a result of abnormal neuronal activity on both sides of the brain. These seizures may cause loss of consciousness, falls, or massive muscle spasms. Seizures that seem to involve all of the brain are called generalized seizures. Six types of generalized seizures exist.

 

        A. Absence seizures: In absence seizures, the person may appear to be staring into space

and/or have jerking or twitching muscles and can cause a brief loss of awareness. These seizures are sometimes referred to as petit mal seizures, which is an older term.

       B.  Tonic seizures: Tonic seizures cause stiffening of the muscles, generally those in back, arms and legs and may cause you to fall to the ground.

       C. Clonic seizures: These types of seizures are associated with rhythmic, jerking muscle contractions, usually affecting the arms, neck and face.

       D. Myoclonic seizures: These seizures usually appear as sudden brief jerks or twitches of the upper body, arms, or legs.

       E.  Atonic  seizures: also known as drop attacks. Atonic seizures cause a loss of normal muscle tone . the affected person will fall down or may drop his or her head involuntarily.

       F .  Tonic- clonic seizures: the most intense of all types of seizures, these are characterized by a loss of consciousness  body stiffening  and  shaking , and sometimes loss of bladder control or biting your tongue. Tonic-clonic seizures are sometime referred to by an older term: grand mal seizures .

Clinical manifestations

Because  epilepsy is caused by  abnormal activity in brain cells, seizures can affect any  process brain coordinates . symptoms vary from person to person. Some people may have simple staring  spells, while others have violent shaking and loss of alertness. The type of seizure depends on the part  of the brain affected and   cause of epilepsy.

A seizure  can produce:

Temporary confusion

·         A staring spell

·         Uncontrollable jerking movements of the arms and legs

·         Loss of consciousness or awareness

·         Involuntary  changes in body movement or function , sensation, awareness , or behavior

·         A fleeting numbness of a  part  of the body

·         Brief or long term loss of memory, visual changes

·         Dizziness , light hotheadedness , tightening  the chest

Diagnostic evaluations

·         Neurological  and behavioral  exam

·         Blood tests

·         Lumbar puncture (spinal tap)

·         Electroencephalogram (EEG)

·         Computerized  tomography(CT)

·         Magnetic resonance   imaging(MRI)

·         Positron emission tomography (PET)

·         Single –photon emission computerized tomography (SPECT)

·         Neuropsychological  tests

Medical management

Doctors generally start by treating epilepsy with medication . if that doesn’t work ,they may propose surgery or another type of treatment . the choice of which drug to prescribe , and at what dosage ,depends on many different factors, including the type of seizures a person has the person ‘s lifestyle and age , how frequently the  seizures occur , and , for a woman , the  likelihood that she will become pregnant.

 Numerous anticonvulsant medications are available , each with specific actions, therapeutic ranges,  and potential side effects . if seizures are  not controlled on  a single drug , another  medication is added . most anticonvulsants  require periodic blood tests to monitor serum levels and kidney and liver function.

1.      Carbamazepine    : carbamazepine is used for partial and generalized seizures . it decreases synaptic transmission in CNS; may be used for some types of neuralgia. Administer PO up to 1600mg /day in divided doses .

2.      Phenytoin  :  phenytoin is used  for partial and generalized seizures.

3.      Clonazepam  : clonazepam is used for generalized seizures such as absence, atonic and myoclonic . it is a CNS  sedative : may also be used for neuralgia or restless leg syndrome. administer PO  up to  20 mg / day.

4.      Valproic acid: valproic acid is used for  partial and generalized seizures. It increases GABA, an inhibitory neurotransmitter in CNS.  Administer PO initially 15 mg /kg /day.

5.      Ethosuxamide: for generalized seizure such as absence seizures, ethosuxamide is often the primary treatment . administer  initially 1000 mg/day in  divided doses.

    Other commonly prescribed drugs include lamotrigine, oxcarbazepine, Phenobarbital   , and pyrimidine. Some relatively new epilepsy drugs include  tiagabine, gabapentin,  topiranate, levetiracetam , and felbamate . other drugs  are used in combination with  one of the standard  drugs or for intractable seizures that do not respond to other medications.   

 

Surgical management                     

 Surgery  is most commonly done when tests show that seizures originate in a small, well    defined area   of brain that doesn’t interfere with vital functions like speech , languages or hearing in these types of surgeries , doctor removes  the area of the brain that’s   causing the seizures.

      Surgery is indicated  for patients whose epilepsy is results from intracranial tumors, abscess, cysts or vascular abnormalities . respective and palliative operations such as temporal lobectomy, extra temporal resection , corpus callosotomy and hemispherectomy are performed .

Surgery to place    a  vagus nerve stimulator (VNS)   may be recommended . it can help reduce the number of seizures. This therapy    involves a device called a vagus nerve stimulator that’s implanted underneath  the  skin of chest like a heart pacemaker . wires from the stimuli tor are wrapped  around the vagus nerve in neck . the battery- powered device delivers short bursts of electrical energy to the brain through the vagus nerve .

Nursing  management  

 The   prime objective in caring for a patient experiencing a seizure is to prevent injury . in  some  cases , seizures may also involve isolated abnormal movements of a limb , periods of staring  or abnormal stiffening  without rhythmic jerking.

Take  the following action if someone is having a seizure:

1        move harmful objects out of the way ; cushion the head and protect the person  from falling.

2        Side  rails should be padded to  prevent injury if the patient strikes his her extremities against them.

3        Loosen ties , scarves or other neck ware.

4        Do not put anything in the person ‘s  mouth.

5        The individual should not be restrained , because this may increase the risk of injury.

6        A small pillow  should be placed under the patient ‘s   head to  prevent striking it on  the floor, taking care that the airway does not become occluded.

7        After the convulsion ceases or if the person is vomiting ,roll the person onto  his or her left side to protect  the airway.