Epilepsy1 1

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
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)
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
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)
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)

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)

3.
Cryptogenic Epilepsy
presumed symptomatic nature in which the c

ause has not been identified
(Shorvon, 2011)
Epilepsy
Seizure
type
Etiolo
gy
Idiopathic
Generalize
d
Localized
Symptoma
tic
Cryptogeni
c
Idiopathic
Symptoma
tic
Post-traumatic
Cryptogeni
c
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
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
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

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)

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

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
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
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
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)
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
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

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
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
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
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
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
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
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
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
Lifestyle - home environment

Change home environment
possible hazards when seizure occurs
Replace furniture vacate some space
change risky furniture crush injury
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
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
Medication, surgery an d nursing alertness
Types and etiology of epilepsy
Diagnosis
Management except surgery part
Hung Wai Yan(13508969A)
Pathophysiology and nursing intervention
OUR POSTER~
References
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Epilepsy1 1

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Epilepsy1 1

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Epilepsy

Group members: Hung Ka Ying (13504160A)

Accident experience before

A minor head injury after a traffic

a sudden loss of consciousness

Seizure for 2 minutes

(Shorvon, Perucca & Jr, 2009

2. Minor division (Etiology)

2. Complex partial seizures (with impaired consciousness)

predominately genetic or presumed genetic origin

Classification of Epilepsy by Etiology

acquired or genetic origin

Classification of Epilepsy by Etiology

B . Predominately acquired causation

Classification of Epilepsy by Etiology

presumed symptomatic nature in which the c

(Shorvon, Perucca & Jr, 200

Post-traumatic Epilepsy (PTE)

Post-traumatic Epilepsy (PTE)

Post-traumatic Seizures (PTS)

Highest -> 1st week

Post-traumatic Seizures (PTS)

Signs and Symptoms

Body stiffening or shaking or jerking

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

(Epilepsy Foundation, 2013)

. Alcohol with drug use

(Epilepsy Foundation, 2013)

Abnormal function in brain after car accident

(Tufts University, 2014

Abnormal function in brain after car accident

Environmental: Abnormalities in the membrane properties of ne

(White, J., 2012)

Abnormal function in brain after car accident

Increase the potential for abnormal flow of electr

Abnormal function in brain after car accident

Abnormally discharging epileptic neurons

Recruit adjacent neurons

(Fischer, J., 1998

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

(Fisher, R. S., 2014

Chan Kwan Long (13512553A)

(National Institute of Neurological Disorders and Stroke, 20

3. About the seizures

4. Questions about past illness

(National Institute of Neurological Disorders and Stroke, 20

(Epilepsy Action, 2014

EEG Normal Brain Waves

relaxed with eyes

Attention with eyes

>13 waves per

Between waking and

under 1 year children,

26 100 waves per

(Epilepsy Society, 2007

EEG - Abnormal Brain Waves

Interictal epileptiform discharge(IED)

suffering from epilepsy)

Spikes are followed by a slow wave

Same as spike-and-wave but 2 more

1. Computed Tomography (CT)

(Adam & Dixon, 2008

2. Magnetic resonance imaging (MRI)