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Epilepsy

Group members: Hung Ka Ying (13504160A)


Chan Ka Kam (13505410A)
Chan Kwan Long (13512553A)
Chu Wai Ting (13510258A)
Hung Wai Yan (13508969A)

Scenario
Profile

Name : Jem
Job: Airport bus driver
Age: 25 years old
Health condition

Good

Accident experience before

A minor head injury after a traffic


accident

n
o
i
s
s
i
m
Before ad
Experience during onset
outbreak

a sudden loss of consciousness


twitching limbs
clenched teeth
drooling

Symptoms

Scenario
After Admiss
i
o
n
Wet pant

Told to have

Seizure

Investigation

-Blood glucose
-Renal and liver function
-Computered tomography(CT)
-Scan of his brain
Normal
EEG
abnormal electrical activity

Waiting result of
investigation

Seizure for 2 minutes

EPILEPSY

Flow
Epilepsy
Pathophysiolo
gy
Diagnosis
Medication
Chan Ka Kam (13505410A)

Management

Epilepsy
A symptom of abnormal brain function
Involve with recurrent of seizures ( 2 times)
Various in classification
Most widely accepted classification :
International League Against Epilepsy (ILAE)

(Shorvon, Perucca & Jr, 2009

Classification of Epilepsy
1. Major division (Seizure type)
a. Localized
b. Generalized

2. Minor division (Etiology)


a. Idiopathic
b. Symptomatic
c. Cryptogenic
(Shorvon, 2011)

Classification of Epilepsy
Epileps
y

Seizure
type

Generalize
d

Localized

Idiopathic

Symptoma
tic

Cryptogeni
c

Idiopathic

Symptoma
tic

Cryptogeni
c

Seizure
usually happens where there is a scar in the brain as a c
onsequence of the injury
a group of nerve cells in the cerebral cortex (gray matter)
to become activated simultaneously, emitting sudden an
d excessive bursts of electrical energy
usually last a few seconds or minutes
Many seizures do not fit well into any of the categories
Divided into partial (=localized), generalized and unclassi
fied

(Shorvon, 200
(Shorvon, Perucca & Jr, 200

Seizure
1. Partial (=localized) Seizures:
Arise in specific, often small, loci of cortex in one hemisphere
Associated with consciousness
Subdivided into 3 categories
A. Partial seizures
1. Simple partial seizures (with unimpaired consciousness)
With
With
With
With

motor signs
somatosensory or special sensory symptoms
autonomic symptoms or signs
psychic symptoms

2. Complex partial seizures (with impaired consciousness)


3. Partial seizures evolving to secondarily generalized seizures
(Shorvon, 2005)

Seizure
2. Generalized Seizures:
Arise from large areas of cortex in both hemispheres
In areas which consciousness is always lost
Subdivided into 7 categories
B. Generalized seizures
1. Absence seizures (lost consciousness)
Absence seizures
Atypical absence seizures
2. Myoclonic seizures
3. Clonic seizures
4. Tonic seizures
5. Tonic-clonic seizures
6. Atonic seizures

(Shorvon, 2005)

Classification of Epilepsy
Epilepsy

Generalize
d

Localized

Etiolo
gy Idiopathic

Symptoma
tic

Cryptogeni
c

Idiopathic

Symptoma
tic

Cryptogeni
c

Etiology of Epilepsy
1. Idiopathic Epilepsy

predominately genetic or presumed genetic origin


no serious neuroanatomic or neuropathologic abn
ormality
Subcategory:
1. Pure epilepsies due to single gene disorders
2. Pure epilepsies with complex inheritance
(Shorvon, 2011)

Classification of Epilepsy by Etiology


2. Symptomatic Epilepsy

acquired or genetic origin


associated with
gross anatomic or pathologic abnormalities/clinical featu
res
cerebral pathologic changes(genetic/acquired) in origin
single gene and other genetic disorders
acute brain injury
(Shorvon, 2011)

Classification of Epilepsy by Etiology


2. Symptomatic Epilepsy
Subcategory:

B . Predominately acquired causation


Hippocampal sclerosis
Childhood epilepsy syndromes
Perinatal and infantile causes
Progressive myoclonic epilepsies
Cerebral trauma
Neurocutaneous syndromes
Cerebral tumor
Other neurologic single gene disorder Cerebral infection
s
Cerebrovascular disorders
Disorders of chromosome function
Cerebral immunologic disorders
Developmental anomalies of cerebral Degenerative and other neurologic co
nditions
structure
A . Predominately genetic or developmental ca
usation

(Shorvon, 2011)

Classification of Epilepsy by Etiology


3.

Cryptogenic Epilepsy

presumed symptomatic nature in which the c


ause has not been identified

(Shorvon, 2011)

Classification of Epilepsy
Epilepsy

Seizure
type
Etiolo
gy
Idiopathic

Generalize
d

Localized

Symptoma
tic

Cryptogeni
c

Idiopathic

Symptoma
tic

Post-traumatic

Cryptogeni
c

(Shorvon, Perucca & Jr, 200

Post-traumatic Epilepsy (PTE)


Type of symptomatic epilepsy
Related to the presence of recurrent two or more Post-tra
umatic Seizures (PTS) due to Traumatic Brain Injury (TBI)
A higher risk of early and late seizures in relation to the se
verity of the Traumatic Brain Injury (TBI)
The characteristics of the trauma and the presence of asso
ciated lesions represent risk factors for a successive devel
opment of Post-traumatic Seizures (PTS)
(Chen, 2012)
(University of Ferrara, 2013)

Post-traumatic Epilepsy (PTE)


Subcategory:
Open head injuries (Dura is breached)
Closed head injuries (No dural breach)

Post-traumatic
Epilepsy (PTE)

(Chen, 2012)
(Shorvon, Perucca & Jr, 2009)
(University of Ferrara, 2013)

Open head
injuries
(Dura is
breached)

Closed head
injuries
(No dural
breach)

Post-traumatic Seizures (PTS)


Level of Post-traumatic
Seizures after Traumat
ic Brain Injury
Subcategory:
Immediate ( 24 hou
rs)
Early ( 1 week)
Late ( 1 week)

Highest -> 1st week

(Chen, 2012
(Shorvon, Perucca & Jr, 2009

Post-traumatic Seizures (PTS)


Posttraumatic
Seizures
(PTS)
Immediate
( 24
hours)

Early
( 1 week)

Late
( 1 week)

Signs and Symptoms

Body stiffening or shaking or jerking


Unresponsiveness and staring
Loss of consciousness
twitching limbs
Clenched teeth
Drooling
Incontinence
Lip smacking
Sudden tiredness or dizziness
Unable to speak

(South Western Sydney Local Health District, n.d.)

Risk factors
1. Patient Characteristics
. Genetic factors
More common in: 1. Generalized seizure > Partial seizure
2. family history > no genetic tendency
Those who develop epilepsy may be more likely to have a history of sei
zures in their family and the risk is higher than usual
Situation:
1. Father has epilepsy: slightly higher
2. Mother has epilepsy: < 5 in 100
3. Both parents have epilepsy: a bit higher

(Epilepsy Foundation, 2013)

Risk factors
1. Patient Characteristics
. Gender
Males > Females

. Age
Highest risk: < age 2 & > age 65
Most common types of seizure in childhood:
generalized seizures: < age 10
partial seizures: age 10-18

. Alcohol with drug use


Side effect & risk of seizures

(Epilepsy Foundation, 2
(Evidence-Based Review of Moderate to Severe Acquired Brain Injury, 2

Risk factors
2. Injury Characteristics
. Head Trauma
Based on the severity of brain injury
The more serious the head injuries are, the higher the risk is
Examples:

Bone/metal fragments
Depressed skull fracture
Focal contusions/injury
Penetrating head injury
Intracranial hemorrhage/ haematoma
Prolonged duration of coma and post traumatic amnesia

(Epilepsy Foundation, 2013)


(Evidence-Based Review of Moderate to Severe Acquired Brain Injury, 2013)
(South Western Sydney Local Health District)

Flow
Epilepsy
Pathophysio
logy
Diagnosis
Medication
Hung Wai Yan (13508969A)

Management

Normal function
Stimu
li

Electrical Signal

Neuron
Action Potential
Neurotransmitters

Communication &

Transmitted information
(Fisher, 2014)

Normal function
During nerve signals transmission
Action potential: Depolarization
Net positive inward ion flux
Release neurotransmitters

Potassium ion

Sodium ion

(Mandal, 2013)

Normal function

o
t
I
n
h
a
i
b
t
i
i
to
c
x
E
Neurotransmitters
r
y
ry
Excitatory: Glutamate - Ionotropic & Metabotropic
Calcium & Sodium channels
Synaptic transmission
Inhibitory: Gamma amino butyric acid (GABA)
Chloride & Potassium channels
Prevent hyper-excitability
Modulate excitatory neurotransmission
(Fischer, 1998)
Limit the spread of abnormal electrical signals
(Mandal, 2013)

Abnormal function in brain after car accident


Brain tissue damage
Neurons in Jems brain are damaged
Traumatic brain injury (TBI)
Interneurons (GABA producer) die
Neurological causes: Unknown

(Tufts University, 2014

Abnormal function in brain after car accident


Suboptimal regulations in brain

Environmental: Abnormalities in the membrane properties of ne

urons
Neurotransmitters: Damage of interneurons
Inhibitory neurotransmission of GABA
Cannot prevents hyper-excitability properly
Enhances the excitatory neurotransmission of
glutamate
Concentrations of ion: Alteration in the voltage-gated ionic chan
nels
Inhibits K+ channels
(Mandal, A., 2013)

(White, J., 2012)

Abnormal function in brain after car accident


Neuronal excitation
Environmental
Neurotransmitters
Concentrations of ion

EXCITATORY
ACTIVITY
Overstimulate brain activity
INHIBITORY
ACTIVITY

<

Increase the potential for abnormal flow of electr


icity
(White, J., 2012)

Abnormal function in brain after car accident


Abnormal & excessive electrical discharge of a group
of neurons

Abnormally discharging epileptic neurons

Recruit adjacent neurons


Large number of cells Abnormally linked
Surges of electrical activity in the brain
Produce seizures

(Fischer, J., 1998


(White, J., 2012)

Understanding Epilepsy (0:27/0:38/0:54


~1:20)

(Fisher, R. S., 2014

Flow

Chan Kwan Long (13512553A)

Diagnosis
A. Medical History
B. Electroencephalogram (EEG)
C. Neuroimaging (MRI, CT scan)
D. Positron emission tomography (PET)
E. Lumbar Puncture

Diagnosis
A. Medical History
B. Electroencephalogram (EEG)
C. Neuroimaging (MRI, CT scan)
D. Positron emission tomography (PET)
E. Lumbar Puncture

A. Medical History
In Jems Case

1. Symptoms
Loss of consciousness
Twitching limbs
Clenched teeth
Drooling
Wet pants
2. Duration of seizures
2 times of seizure, one lasts for 2 minutes

(National Institute of Neurological Disorders and Stroke, 20

3. About the seizures


2 unprovoked seizures
Can be defined as epilepsy

4. Questions about past illness


Minor head injury after a traffic acciden
t
5. Ask for caregivers / surrounding people
Ask his colleagues who had lunch with h
im about the more details when Jem wa
s having seizure.

(National Institute of Neurological Disorders and Stroke, 20


(Fischer, 19

Diagnosis
A. Medical History
B. Electroencephalogram (EEG)
C. Neuroimaging (MRI, CT scan)
D. Positron emission tomography (PET)
E. Lumbar Puncture

B. Electroencephalogram (EEG)
1.
2.
3.

4.
5.

Procedure
Sit / Lie down
Electrodes attach to head with
gel
Breath deeply and Look at the
flashing light
Brains electrical activity will be
altered by these activities
Result helps doctor to make
diagnosis

(Epilepsy Action, 2014

EEG Normal Brain Waves


Types

Occur in

Frequency

Alpha wave

relaxed with eyes


closed

8 - 13 waves per
second

Beta wave

Attention with eyes


open/closed

>13 waves per


second

Theta wave

Between waking and


sleeping

4 7 waves per
second

Delta wave

under 1 year children,


and parts of sleeping

up to 4 waves per
second

intelligent people or
intensive learning

26 100 waves per


second

Gamma wave

(Epilepsy Society, 2007

EEG - Abnormal Brain Waves


Jems abnormal EEG may shows

Interictal epileptiform discharge(IED)

(record of human

suffering from epilepsy)

Types

Spikes
Sharp waves

Characteristics
Short and distinguishable,
duration of 20 to <70 milliseconds
(ms)
Longer duration of 70-200 ms

Spike-and-wave

Spikes are followed by a slow wave


which is higher amplitude than spike

Polyspike-wave

Same as spike-and-wave but 2 more


spikes with 1 or more slow waves

(David, 2014)

B. Electroencephalogram (EEG)
Measuring brain waves (Electrical activity) for brain function
Relationship between EEG patterns and epilepsy varies,
ONLY IED are associated to seizure disorder at a high rate
(but still around 10% of epilepsy patients never show IED)
Can confirm a suspicion of epilepsy but further tests are needed for m
ore information such as causes
Help distinguishing the type of epilepsy
(e.g. Idiopathic generalized epilepsy Spike/ Polyspike)

(Smith, 2005)
(Simon, 2013)

Diagnosis
A. Medical History
B. Electroencephalogram (EEG)
C. Neuroimaging (MRI, CT scan)
D. Positron emission tomography (PET)
E. Lumbar Puncture

C. Neuroimaging
1. Computed Tomography
(CT)
2. Magnetic Resonance
Imaging
(MRI)

1. Computed Tomography (CT)


Procedure
1. Lie on a narrow table
2. Slide into the CT scanner
3. X-ray beam rotates around the client and
thus create a 3-Dimensional images of the
body area (brain)
4. Stay still during CT scanning as the
movement blur the image
(e.g. hold breath for short period of time)
.Duration of CT scan takes few minutes

(Adam & Dixon, 2008

2. Magnetic resonance imaging (MRI)


Procedure
Similar to CT scanning
Processing a magnetic field through
wire coils which are placed around
the clients for sending and receivin
g radio waves

Duration of MRI for brain takes 2045 minutes

(Adam & Dixon, 2008

C. Neuroimaging
Computed tomography (CT)

Magnetic resonance imaging


(MRI)

Lower resolution than MRI

More accurate picture of brain

Faster and cheaper

Slower and more expensive

For most adult at first time seizure

For children at first time seizure

X-Ray

Strong magnetic field and pulses of


radio waves

Shows Abnormalities: atrophy, scar


tissue, bony structure, tumors,
abnormal blood vessels.

Shows Abnormalities: dysplasia, scar


tissue, small brain tumors, abnormal
blood vessel, and change of brain
white matter.

Shows any abnormalities in brain which might be causing seizures

(Kuzniecky & Sirven, 2013) MRI


(Kuzniecky & Sirven, 2013) Computed tomography (

Diagnosis
A. Medical History
B. Electroencephalogram (EEG)
C. Neuroimaging (MRI, CT scan)
D. Positron emission tomography (PET)
E. Lumbar Puncture

D. Positron emission tomography (PET)


An imaging test that shows activity in th
e brain
Procedure
1. Lie on a table next to the scanner
2. Inject the radioactive tracer through in
travenous injection (usually on elbow)
3. The camera will move in circle around
the client to take picture patterns from
the tracer

(Senelick, 2014)

Bright site represents more metabolic activity


Dark site represents fewer metabolic activity

Decreased glucose metabolism increases duration of epileps


y
PET can help for localizing the site of partial seizure (Bristol University, 2002

Diagnosis
A. Medical History
B. Electroencephalogram (EEG)
C. Neuroimaging (MRI, CT scan)
D. Positron emission tomography (PET)
E. Lumbar Puncture

E. Lumbar Puncture

Withdraw the cerebrospinal fluid (CSF) through the needl


e and examine the result in a laboratory
For testing any infections as the cause of epilepsy
e.g. Meningitis (an infection of meninges), Encephalitis (an infection
of brain)

(Karrien-Norwood, 2013

Procedure
1. In the position as shown
2. Offer local anesthetic
3. Insert a hollow tube wit
hin two vertebrate
4. Collect the fluid
5. Cover with bandage
6. Analyze the CSF
7. Abnormal result: infecti
on

(Karrien-Norwood, 2013

Flow

Hung Ka Ying (13504160A)

Medication
Doctors prescription:
Benzodiazepines
GABA analogues

Other common drug:


Dilantin (Phenytoin)
Tegretol (Carbamazepine)
Depacon (Sodium valproate)

Purpose of the drugs


Control seizure
Benzodiazepines (BZDs)

Other common
drugs

Functions :
Control seizure

Dilantin
(Phenytoin)

Blockage of voltagedependent sodium


channels
Cause efflux of
sodium

A group of drugs
Facilitate the actions of GABA
(regulates neuronal excitability)
Tegretol
(Carbamazepine)
in the brain

GABA analogues
A group of drugs
Depacon
Control partial seizure
(Sodium
Block reuptake or metabolism
valproate)
of GABA

Blockage of voltagedependent sodium


channels
Binds to the neuronal
sodium channel

Increase GABA level


in brain
Inhibition of GABA
(Shorvon, 200
transaminase

(Shorvon, Perucca & Jr, 200

Benzodiazepines(BZDs)

E.g. Diazepam, clonazepam, clobazam


Usual preparation: Tablet, capsule, viral
(Dosage: vary from different drugs
Clobazam:tablets,capsules:10mg
Clonazepam:tablsets:0.5,1,2mg)
Toxicity: Low
Pregnancy category: D
Absorption

Bioavailability: most 80-100% at PO


Time to peak conc.: minutes to hours at PO
Small intestine

Metabolism

By liver

Distribution

Bound to plasma protein


Half-life: 2-30mins

Elimination

By kidneys

Drug interaction

Certain antidepressants, sedative antihistamines,


alcohol
(Shorvon, 2005
addictive sedative effect
(Shorvon, Perucca & Jr, 2009

Benzodiazepines(BZDs)
Anticonvulsant
Stop fits due to epilepsy ,
convulsion

Function
Facilitate actions of
-Aminobutyric acid (GABA)
GABA binds to the receptor
Open the chloride ion gates
Bind to GABA receptor
Allowing more chloride ion
enter the neuron
Produce an inhibitory current

(Nimmo, 2013)

Benzodiazepines(BZDs)
Side effect
Over-sedation
Drowsiness
Confusion

Memory impairment
Amnesia

Dependence
Tolerance
GABA and BZDs receptors less responsive
Inhibitory actions of GABA and BZDs

(Nimmo, 2013)

GABA Analogues

E.g. Gabapentin, Vigabatrin


Usual preparation: Tablet, capsule, powder sachet
(Dosage: vary from different drugs
Gabapentin:capsule:100,300,400mg
Vigabatrin:tablets:500mg;podwer sachet:500mg )
Pregnancy category: C
Absorption

Bioavailability: Vary from different drugs among


the group

Metabolism

None

Distribution

None / protein bound


Vd: vary from different drug among the group

Excretion

Urine

Elimination

Half-life : range from 4-9 hrs

Drug interaction

Vary from different drug


Gabapentin and Vigabatrin
No specific drug interaction

(Shorvon, 200
(Shorvon, Perucca & Jr, 200

GABA Analogues
Function
Passing through blood-brain barrier
Increase level of GABA
Regulates neuronal excitability
Most common type: Gabapentin
binding to the 2 subunit of presynaptic
voltage-gated Ca2+ channels in the brain

the influx of Ca2+ at nerve terminals


release of excitatory neurotransmitters
(eg, glutamate)

(Bardal, Waechter & Martin, 2010


(Levy, 2002

GABA Analogues
Side Effect
Clumsiness
Drowsiness
Dizziness
Somnolence
Nystagmus
Weight gain

(Shorvon, 2005
(WebMD LLC, 2014

Contraindication
Benzodiazepines

GABA Analogues

Alcohol intoxication
Depression

Hypersensitivity
visual field
defects( Vigabatrin)

Glaucoma
Hypersensitivity
Pregnancy
Respiratory depression,
severe

(Department of Health, 2014


(Pagliaro, Pagliaro, 1998

Nursing Alertness

Before taking drugs


Patients history

Liver or renal disease


Eg. Neurontin

Dosage
modification when
using Neurotin for
patient with renal
impairment

CrCl >60
mL/min

Renal impairment
Hemodialysis (CrCl <15 mL/min)
CrCl 30-60
Administer supplemental dose
mL/min
(range 125-350 mg) posthemodialysis,
CrCl 15-29
After each 4 hr dialysis interval;
mL/min
Further dose reduction should be in proportion to CrCl

Hypersensitivity for any drugs


Hung Ka Ying (13504160A)

300-1200 mg
PO TID
200-700 mg
q12hr
200-700 mg
qDay

CrCl <15
100-300 mg
mL/min
qDay
(Lippencott Williams & Wilkins, 201
(WebMD LLC, 201

Nursing Alertness
After taking drugs
Hypersensitivity
Sign of overdose
Eg. Neurontin
up to 49 grams
double vision, slurred speech, drowsiness

Aware of side effect


E.g. serious tremor, hyperplasia, depression, dizziness, vomiting

Be sure to document your monitoring of the patient

(Lippencott Williams & Wilkins, 2012


(WebMD LLC, 2014

Nursing Intervention
Side Effect

Sedation

Weight gain
Hung Wai Yan (13508969A)

Drug Affected

Nursing
Intervention
Benzodiazepines
Monitor
respiratory
function, prevent
hypotension
Encourageto eat
GABA Analogues
balanced and
regular meals

(Forren & Watson, 2005


(Nursing File, 2010

Nursing Intervention
Side Effect

Dizziness

Depression
Hung Wai Yan (13508969A)

Drug Affected

Nursing
Intervention
When dizziness
continues over a
period of time,
some GABA
MAY consider to
analogues
prescribe another
AED
Encourage
expression of
feelings
(American
Association ,
of promote
Neuroscience Nurses, 2

(Nurseslabs, 2014

Flow
Epilepsy
Pathophysiolo
gy
Diagnosis
Medication
Chu Wai Ting (13510258A)

Management

Risk problems
Epileptics at risk of developing

Risk problem
Injuries
Mood disorders or problems with depression and anxiet
y
Coordination problems
Side effects of medicine
Reproductive or hormonal problems
Dying from complications of seizures or injuries.
SUDEP

(Steven, 2013)

Sudden Unexpected Death in Epilepsy (S


UDEP)
Epileptics dies unexpectedly
Occurs more frequently in epileptics whose seizures a
re poorly controlled

manage seizure
properly

Management
The process ofdealingwith
orcontrollingthings orpeople

(Oxford dictionary, n.d.)

Non-emergency

Manageme
nt
Process
ofdealingwith
orcontrollingthing
s orpeople

Clinical
management
Selfmanagement

Conscious
Emergency
Unconscious

(Angelique, 2011)

Clinical management
Aims at
Ascertain the epileptic type
Tailor an effective management plan
View the effectiveness of treatment
Standard testing review
(Serological test, EEG, imaging studies)

(Angelique, 2011)

Self-management

Selfmanagemen
t
Treatment

Seizure

Lifestyle

(Angelique, 2011)

Treatment
Regular medication
Missed medicines
seizure
status epilepticus
falls, injuries

Medicine
schedule
(Steven, 2013)

Treatment
Withdraw seizure medicine under doctors supervision
Abrupt withdrawal
severe rebound seizures & withdrawal symptom
E.g. Tail off is used instead of abrupt withdrawal

(Steven, 2013)

Treatment-Surgery
Not main treatment
Aim:
remove the seizure-producing area of the brain
limit the spread of seizure activity
Five main types of surgical approach
1.Focal resections for hippocampal sclerosis
(e.g. temporal lobectomy, amygdalohippocampectomy)
2.Focal resections for other lesions
3.Non-lesion focal resections
4.Hemispherectomy, hemispherotomy and multi-lobar resections
5.Functional procedures(e.g. corpus callosectomy, multiple subpial
transection)

(Shorvon, 2005
(Shorvon, Perucca & Jr, 200

Treatment-Surgery
Reasons for consideration of surgery:
After failure of a few
appropriate drug trial
Continue to experience
psychological and social
deterioration
Increase risk of morbidity
and mortality as a result
of persistent seizure
Pre-surgical evaluation

(Shorvon, 2005
(Shorvon, Perucca & Jr, 2009

Treatment-Surgery
Pre-surgical evaluation
Aim:
To define the outcome goals
Estimate the successful rate
determine the person is medically fit for surgery

Evaluation:
Estimating the seizure outcome after surgery
Risks of surgery
Frequency and duration of epilepsy
Quality of life gain
Learning disability, behavioral disorder and psychosis
Medical fitness and age

(Shorvon, 2005
(Shorvon, Perucca & Jr, 200

Treatment-Surgery
Cost:
1.
2.
3.
4.

Monetary cost
Human cost of premature death
Morbidity
Social and psychological comprise

64% patients
free of disabling seizure 1 year after surgery

(Shorvon, 2005
(Shorvon, Perucca & Jr, 2009

Seizure
Proper responding skills
Prepare for seizure episodes
Emphasizes preparation & prevention

Follow the medicine schedule strictly

My seizure plan
Seizure first aid
Personal info. Including seizure info.
Conditions that need emergency medical
attention
(Angelique, 2011)
(Schachter, S., & Shafer, P. 2013)

Lifestyle
Ability to identify seizure triggers
Reduce frequency
Acceptance of limitation that accompany epilepsy
Changes in cognition

(Angelique, 2011)

Lifestyle

Why/what
triggers?

Modification

Remarks

Sleep

Meals

Seizure: sensitive to
sleep patterns
Insufficient times,
intensity & length of
seizures
Low lv. of blood sugar,
minerals(calcium,
sodium, magnesium):
cause seizure
Vit B6 deficiency:
worsen seizures

Keep consistent sleep


hours
Keep favorable(dark
& quiet) sleeping
environment
Maintain balanced
diet
Consume vary type of
food:
Take Vit B6 as
supplement in
diagnosed deficiency

Good sleep:
7-8hrs
duration,
good quality
of sleep
Food:
alter brain
function

Alcohol
intake

Alcohol ( 3 alcoholic
beverages )
high risk of seizure

3 drinks
drink in the
duration of seizure
medicine

Alcohol
seizure drugs
(aspect of
side effect)

(Epilepsy Foundation,

Lifestyle - bath
Take showers instead of bath
Prevent drown in bathtub

Use shower chair & flexible shower hose


Prevent falls

(Fisher, 201
(The Hong Kong Epilepsy Guideline, 200

Lifestyle - swimming
Swim safely
person with epilepsy can drown if seizure occurs in water
Wear a life jacket with any water activities
Ensure someone nearby has lifesaving skills & know how to
respond to seizures

(Fishier, 2013
(The Hong Kong Epilepsy Guideline, 2009

Lifestyle - home environment


Change home environment
possible hazards when seizure occurs
Replace furniture vacate some space
change risky furniture crush injury

(The Hong Kong Epilepsy Guideline, 200

Lifestyle - driving matter


Avoid driving
seizure lose control of vehicle traffic accidents & injuries
epileptics = legally prohibited to drive in HK (Transport department)

For Jem
Try to request for transferring post
e.g. Airport bus driver secretary

(Fisher, 201
(The Hong Kong Epilepsy Guideline, 200

Non-emergency

Manageme
nt

Clinical
management
Selfmanagement

Conscious
Emergency
Unconscious

Conscious

(awake seizure)

With warning signs


Usually vacant, wander around or confused.
Keep them in a safe place(w/o sharp object).
Do not let them wander away
Make sure they are alert, oriented and safe; repeat instr
uctions on what they should do next after the event.

Warning
signs

Unusual smells, tastes, or feelings


'out-of-body' sensations, feeling
detached
(Dekker, 2002)
Periods of forgetfulness or memory(Epilepsy Foundation,

Unconscious
Usually with jerking movement of limbs
Loss of awareness
Loosen tight clothing
Protect the patient from injury but dont restrain their m
ovements.
Put something soft under patients head / protective hel
met

(Seizures and Traumatic Brain Injury, n.

Unconscious
Place the patient in coma position (head to side)
: risk of obstruction / inhalation of vomit
Dont put anything into patients mouth / stop the jerki
ng
:self-protection
Check heart beat; listen to breathing; time the seizure
Call 999 / use CPR in emergency situation

(Dekker, 2002)

Complementary and Alternative Med


icine (CAM)
- A group od diverse medical and health care
systems, practices and products that are not
presently considered to be part of conventional
medicine

(National Institutes of Health, n.d

TCM & Acupuncture

Act as supplement
Restore the unimpeded flow of qi (energy) throughout the human bo
dy (Qi flows along pathways known as meridians which play a role in the worki
ngs of the body)
Normal person: the flow of qi is believed to be balanced.
Epileptics: the flow of qi is believed to be impeded.

Acupunctures:
Access meridians by inserts tiny needles into certain points of the body

In epileptics:
acupuncturist manipulate key points within the body believed to increase t
he flow of qi to the head restore qi flow to the head

TCM(given afterwards):
aid in restoring qi in its natural state

(Patel & Welborn, n.d.)


(Pacific College of Oriental Medicine, n.d.)

Work distribution
Hung Ka Ying (13504160A)

Medication, surgery an d nursing alertness

Chan Ka Kam (13505410A)

Types and etiology of epilepsy

Chan Kwan Long (13512553A)

Diagnosis

Chu Wai Ting (13510258A)

Management except surgery part

Hung Wai Yan(13508969A)

Pathophysiology and nursing intervention

OUR POSTER~

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