SEIZURE DISORDERS AND EPILEPSY

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					SEIZURE DISORDER AND EPILEPSY Seizure- sudden abnormal electrical discharge from the brain that results changes in sensation, behaviour, movement, perception or consciousness Epilepsy – chronic disorder characterized by recurrent unprovoked seizure activity and maybe inherited Convulsion- tonic- clonic movement associated with some seizures Epilepsy - Also known as the sacred disease Classification: 1. Primary epilepsy – is not associated with any identifiable brain lesion 2. Secondary epilepsy - caused by tumor and trauma (most common) Causes: 1. Metabolic disorder 2. Acute alcohol withdrawal 3. Electrolyte imbalance (hyperkalemia, water intoxication, and hyperglycemia) 4. Heart disease 5. Increase physical activity, emotional, stress, excessive fatigue, and alcohol or caffeine consumption 6. Any condition that changes neuronal environment 7. Congenital malformation 8. Genetic defect: epilepsy 9. Perinatal injury forcep delivery 10. Infection Effects: 1. increase O2 consumption: 250% increase in CBF 60 % O2 consumption 2. Increase in glucose depletion 3. Lactate accumulation in brain * if continous leads to brain death Manifestation: 1. Aura – peculiar sensation preceding the onset of seizure 2. prodromal – early clinical manifestation occurring few days before onset Eg: malaise, headache and depression 3. Tonic 4. Clonic 5. Post-ictal – time periods following immediate cessation of seizure Classification: 1. Status epilepticus: (medical emergency) - Prolonged partial/generalized seizures with recovery between attacks - regains consciousness after the preceding seizures - Cause: abrupt discontinuation of meds - Result: aspiration Mental retardation Dementia Brain damage Death 2. Generalize Seizure - Bilateral involvement - No local onset - Originate sub cortical and brain impairment - impairment of consciousness SUBTYPES: A. Grandmal (tonic-clonic) - Tonic phase (<1 min over 15 sec.) - clonic phase (2-5 mins)

- Unresponsiveness (5 mins)  If awake: headache : disorientation : stimulation loss : muscle fatigue

B. Absent (Petit mal) - Abrupt cessation of activity with monetary arrest of the consciousness (5-10 secs.) - Eyes: vacant and may roll, stares straight ahead, lip twitching, (+) drooling and unresponsive C. Myoclonic - Minor major seizure - jerking of 1 or more extremity or entire body - may occur in clusters D. Atonic (drop attacks, akinetic) - Sudden loss of all muscular contraction/ postural muscle tone (collapse) 3. Partial - Unilateral neuron involvement - Specific brain parts are affected SUBTYPES: a. Simple seizures – no impairment of consciousness - Focal motor seizures can be clonic in nature b. Complex partial (with impairment of consciousness) - temporal lobe seizures - psychomotor seizures *Hallmark: (+) automatism, smacking and chewing, swallowing movement, patting , rubbing self or cloth Last for 1-4 mins. Medical Management: First Aid: convulsion 1. Loosen tight clothing 2. Cushion the person’s head 3. Lay person on the ground Drug therapy 1. Carbamazepin (tegretol) Indication: Partial generalized tonic Clonic seizures Nursing Implication: o Given with meals o Monitor headache, dizziness, diplopia or blurred vision, N/V and leukopenia o Do not crush or chew sustained release capsule 2. Diazepam Indication: status epilepticus Nursing Implication: o Monitor respiratory distress if given through IV o Monitor vital signs carefully 3. Depakene (valproic acid) Indication: absence (petit mal) All types of seizures Nursing Implication: o Monitor for hair loss, tremor, increase liver enzymes, bruising and N/V o Monitor CBG, PT, PTT and AST

4. Gabapentine (Neurontin) Indication: partial seizures Nursing management: o Watch for increase appetite and weight gain o Monitor for ataxia, irritability, dizziness and fatigue 5. Phenobarbital (Lumina) Indication: generalized tonic-clonic seizures Partial seizures Nursing implication: o Overdose can be fatal o Monitor for drowsiness, sleep disturbances, cognitive impairment and depression 6. Phenytoin (Dilantin) Indication: all types except myoclonic and atonic seizures Nursing implication: o Monitor for gastric distress o Monitor for anemia o Check CBC Surgical Management: Corpus callostomy Temporal lobectomy Hemispherectomy Nursing management: 1. During a seizure - Protect from injury - Raise siderails - Pad hard surfaces - Loosen restrictive clothing - Side lying, head forward 2. After: - Vital signs - side – risk for aspiration - Oxygen - Rest - Reorient 3. Document: - Aura - Start - Type of movement - Inability to speak after - Automatism - Duration DEMENTIA I. Alzheimers’s Disease - one form of dementia, is a progressive degenerative brain disease, memory, thinking and behaviour TYPES: 1. Senile onset - occurs after age 65 years old 2. Pre-senile onset - occurs before age 65 years old *Hallmark: accumulation of CHON fragments called amyloid plaques

*Normally these CHON fragment would be broken down and eliminated * In AD brain, the fragments accumulate to form hard insoluble fragments *Neurofibrillary tangle – consist of insoluble twisted fibers that are found inside of the brain cells *Primary consist of molecules and CHON called TAU 5 A’s Anomia – inability to remember names or things Amnesia – memory loss Apraxia – misuse of objects because of failure to identify things Agnosia – inability to recognize familiar objects, tastes, sounds and other sensations Aphasia – inability to express oneself through speech Clinical Manifestation: Early stage: Forgetfulness Recent memory loss Poor control Late stage: Severe memory loss and forgetfulness Inability to hold a conversation Poor hygiene and grooming: inappropriate dressing Inability to perform instrumental ADL Can no longer survive without assistance Behavioral Changes: Depression Anxiety Wandering Impulse behaviour Diagnostic Findings:  After death microscopic examination of brain  CT scan and MRI reveal atrophy  U/A, CBC, ESR, BUN, creatinine and liver function test Management:  There is no cure  Goals: o Slow the progression o Manage behavioural problems, confusion and agitation o Modify home environment o Support family member Drug Therapy: Nivastigmine (Exelon), Cognex (tacrine), Aricept (donepezil), galantimine (razadyne)  Affects the level of acetylcholine in the brain to improve persons mental capabilities Supplements: 1. Folate (Vit. B9) – works with B12 and Vit. C to help body digest and utilize CHON - Responsible for clearing homocysteine 2. Ginko Biloba and Vit. E - improves blood flow in the brain and contains flavonoids that acts as an antioxidant - Readily enters the brain and may slow down cell damage

STOP: Antihistamine Cimetidine Sleeping pills Pain killer CNS depressant

= WORSEN CONFUSION

Management:  Structured environment  Provide consistency  Prepare patient in change in environment  Assist with facial recognition o Encourage presence family pictures and reminiscing  Promote bladder and bowel continence o Take the client to the CR frequently  Promote independence in ADL II. Multi – infarct dementia o Blood clots blocks small blood vessels in the brain and destroy brain tissues o Progressive decline in cognition is evident III. Pick’s disease o Marked by “Pick bodies” rounded, microscopic structures found within affected cells o Pick’s disease is usually sharply confined to the front parts of the brain IV. Creudzfeldt-Jakob disease (virion, prion and slow virus) o Is a rare fatal brain disease that produces progressive dementia, myoclonus and progressive changes on the EEG o Can be cause by genetics and infections o Also known as “mad cow disease”, incubation period ranges from 4-21 years Clinical Manifestation: Personality changes Early stage: progressive memory loss Visual impairment Dysphagia Progressive dementia VI. Huntington’s disease o Hereditary condition o Child has 50% risk if a parent is affected o Caused by abnormal gene in Chromosomes 4 o Progressive degeneration of basal ganglia and cerebral cortex o Starts at 38 years old o Bizarre involuntary movements (chorea) dance Manifestations: Early sign Restlessness Cleanliness Forgetfulness Balance and coordination Altered handwriting Involuntary hyperkinetic movement: torso, face, resp. Muscles and oropharynx Final stage: Anarthria Aspiration Immobility Death Management: Drug therapy: Behavior: Librium Haldol Thorazine Co-enzyme Q10 – may minimally decrease progression of disease Nursing Intervention: 1. Promote proper nutrition

2. Promote proper communication 3. Prevent injury 4. Pads on wheelchair and beds ALTERATION IN VISION A. Glaucoma - inability of aqueous humor to leave the eye through the trabecular meshwork and canal schlemm - the build up of pressure to the optic nerve and eventually loss of vision Risk Factor: Glaucoma- Blindness is a danger Risk for developing primary glaucoma: family history of glaucoma : increasing age : diabetes Secondary Glaucoma is a result of an outside conditions such ads injury to the eyes, tumors, inflammation, cataracts and certain meds. *Once the loss of vision occurs it is permanent and cannot be corrected *Regualr tonometry is required (N=10-21 ocular pressure) TYPES: Chronic Open Angle Glaucoma: Cause/effect: gradual blockage of drainage channel, ocular pressure builds slowly Symptoms: gradual loss of side vision Affects peripheral vision This type of glaucoma progresses very slowly and is a lifelong condition Acute Closed Angle Glaucoma Total blockage of drainage channels sudden increase in OP Nausea, blurred vision and severe pain and halos around lights This condition constitute a medical emergency *No mydriatrics to patients with glaucoma Management: Chronic Open angle glaucoma  Miotic eyedrops (pilocarpine) to increase outflow of aqueous humor  Epinephrine eyedrops to decrease aqueous humor production  Acetazolamide o Diamox: carbonic anhydrase inhibitor to decrease aqueous humor production  Timolol maleate: decrease IOP  Trabeculectomy – to create artificial opening for the outflow of aqueous humor  Laser Trabeculoplasty – use of a laser with similar results as trabeculectomy Acute Close Angle Glaucoma  Drug therapy before surgery  Miotic eyedrops o Pilocarpine to cause pupil to contract and draw iris away from the cornea  Osmotic agents (glycerine oral, IV mannitol) to decrease IOP  Narcotic analgesic for pain  Surgery: peripheral iridectomy


				
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