The Acute Management of an
Individual with Epilepsy
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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
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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??
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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
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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
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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