Epilepsy is a Greek word meaning to "seize" or "attack".
Epilepsy is the most common neurological disorder in the world with some 50 million people affected.
The condition crosses all geographical boundaries and onset may occur at any age; although the condition is most common in children and the elderly.
John Hughlings Jackson first recognised a seizure as being due to abnormal electrical activity in the brain in 1875. An epileptic seizure results from the abnormal synchronisation of electrical activity in neurons; this causes the temporary disruption of normal firing of regions of the brain. There are two main types of seizure; partial and generalised. The type of seizure will determine the individual's experience of epilepsy since different regions of the brain are involved in controlling different functions.
Treatment
Epilepsy has a generally good prognosis with around 70% of patients becoming seizure free (with or without treatment) over a period of time. The most common treatment for epilepsy is with anti-epileptic drugs which have been found to be extremely effective at stopping seizuresHistory and physical examination
Be sure to record the patient's seizure activity in detail; your data may be critical in locating the lesion in the brain. Does the patient turn his head and eyes? If so, to what side? Where does movement first start? Does it spread? Because a partial seizure may become generalized, you'll need to watch closely for loss of consciousness, bilateral tonicity and clonicity, cyanosis, tongue biting, and urinary incontinence. (See “Seizures, generalized tonic-clonic,” page 552.)After the seizure, ask the patient to describe exactly what he remembers, if anything, about the seizure. Check the patient's LOC, and test for residual deficits (such as weakness in the involved extremity) and sensory disturbances.
Then obtain a history. Ask the patient what happened before the seizure. Can he describe an aura or did he recognize its onset? If so, how—by a smell, a vision disturbance, or a sound or visceral phenomenon such as an unusual sensation in his stomach? How does this seizure compare with others he has had?
Also, explore fully any history—recent or remote—of head trauma. Check for a history of stroke or recent infection, especially with fever, headache, or stiff neck.
Perform a complete neurologic examination.
Medical causes
Brain abscess.Seizures can occur in the acute stage of a brain abscess formation or after resolution of the abscess. A decreased LOC varies from drowsiness to deep stupor. Early signs and symptoms reflect increased intracranial pressure and include a constant, intractable headache; nausea; and vomiting. Later signs and symptoms include ocular disturbances, such as nystagmus, decreased visual acuity, and unequal pupils. Other findings vary according to the abscess site and may include aphasia, hemiparesis, and personality changes.Brain tumor.Focal seizures are commonly the earliest indicators of a brain tumor. The patient may report a morning headache, dizziness, confusion, vision loss, and motor and sensory disturbances. He may also develop aphasia, generalized seizures, ataxia, decreased LOC, papilledema, vomiting, increased systolic blood pressure, and widening pulse pressure. Eventually, he may assume a decorticate posture.
Head trauma.Any head injury can cause seizures, but penetrating wounds are characteristically associated with focal seizures. The seizures usually begin 3 to 15 months after injury, decrease in frequency after several years, and eventually stop. The patient may develop generalized seizures and decreased LOC that may progress to coma.
Stroke.A major cause of seizures, a stroke may induce focal seizures up to 6 months after its onset. Related effects depend on the type and extent of the stroke, but may include decreased LOC, contralateral hemiplegia, dysarthria, dysphagia, ataxia, unilateral sensory loss, apraxia, agnosia, and aphasia. A stroke may also cause visual deficits, memory loss, poor judgment, personality changes, emotional lability, headache, urinary incontinence or urine retention, and vomiting. It may result in generalized seizures.
Nursing considerations...........
▪ Institute seizure precautions.▪ Stay with the patient during seizure activity and reassure him.
▪ Monitor neurologic status.
▪ Prepare the patient for such diagnostic tests as a computed tomography scan and EEG.
Patient teaching
▪ Explain the disorder and treatment plan.▪ Explain that no emergency care is necessary during a focal seizure, unless it progresses to a generalized seizure. (See “Seizures, generalized tonic-clonic,” page 552.)
▪ Teach the family how to record seizures.
▪ Tell the patient to carry medical identification.
Pictures
Read more at http://www.wrongdiagnosis.com/t/temporal_lobe_epilepsy/book-diseases-16e.htm?ktrack=kcplink
Epilepsy resource pack for general practioners
Epilepsy is the most common serious neurological condition seen in general practice but unfortunately its management is often less than ideal.
With effective management of the condition, about 70 per cent of people with active epilepsy could become seizure free, but at present only 52 per cent of patients are seizure free.
http://www.biomedresearches.com/root/pages/researches/epilepsy/types_of_seizure.html
With effective management of the condition, about 70 per cent of people with active epilepsy could become seizure free, but at present only 52 per cent of patients are seizure free.
- Toolkit For Epilepsy [177KB, 52 pages]
- Information Booklet: The Role of Primary Care in Epilepsy Management [167KB, 36 pages]
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'Contrary to popular folk belief, nothing should be placed in the mouth during the seizure. Severe injury could occur.'
Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).
During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds, and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually lasts less than a minute.
Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements; still others may have a tonic-clonic-tonic pattern.
Figure at right: A generalized tonic clonic seizure. Here the whole brain is affecting from the beginning. In (a) there is a cry and loss of consciousness, arms flex up then extend in (b) and remain rigid (the tonic phase) for a few seconds. A series of jerking movements take place (the clonic phase) as muscles contract and relax together. In (c) the jerking is slowing down and will eventually stop. In (d) the man has been placed on his side to aid breathing and to keep the airway clear.
Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).
During the tonic phase, breathing may decrease or cease altogether, producing cyanosis (blueing) of the lips, nail beds, and face. Breathing typically returns during the clonic (jerking) phase, but it may be irregular. This clonic phase usually lasts less than a minute.
Some people experience only the tonic, or stiffening phase of the seizure; others exhibit only the clonic or jerking movements; still others may have a tonic-clonic-tonic pattern.
Incontinence may occur as a result of the seizure. The tongue or inside of the mouth may be bitten during the episode; breathing afterwards may be noisy and appear to be labored. Contrary to popular belief, nothing should be placed in the mouth during the seizure; turning the patient on one side will help prevent choking and keep the airway clear.
Following the seizure, the patient will be lethargic, possibly confused, and want to sleep. Headache sometimes occurs. Full recovery takes minutes to hours, depending on the individual.
First Aid for Generalized Tonic-Clonic Seizures
- Prevent further injury. Place something soft under the head, loosen tight clothing, and clear the area of sharp or hard objects.
- Do not force objects into the person’s mouth.
- Do not restrain the person’s movements unless they place him or her in danger.
- Turn the person on his or her side to open the airway and allow secretions to drain.
- Stay with the person until the seizure ends.
- Do not pour any liquids into the person’s mouth or offer any food, drink, or medication until he or she is fully awake.
- If the person does not resume breathing after the seizure, start cardiopulmonary resuscitation.
- Let the person rest until he or she is fully awake.
- Be reassuring and supportive when consciousness returns.
- A convulsive seizure is usually not a medical emergency unless it lasts longer than five minutes, or a second seizure occurs soon after the first, or the person is pregnant, injured, diabetic, or not breathing easily. In these situations the person should be taken to an emergency medical facility.
http://www.biomedresearches.com/root/pages/researches/epilepsy/types_of_seizure.html
- eMedicine - Mesial Temporal Sclerosis : Article by Scott Trepeta, MD
- MRI in Temporal Lobe Epilepsy
- eMedicine - Temporal Lobe Epilepsy : Article by David Y Ko, MD
Read more at http://www.wrongdiagnosis.com/t/temporal_lobe_epilepsy/references.htm?ktrack=kcplink
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