Epilepsy and Nursing Care

Nursing Care and Epilepsy

Causes,Remission of Epilepsy,Medication and Nursing Care,Epilepsy and Quality of Life,Guide line For Epilepsy Care.

Epilepsy

    Epilepsy refers to a chronic condition characterized by recurrent seizures. A seizure is a temporary alteration in functioning caused by abnormal discharge of neurons in the central nervous system (Holmes, GH, 1987). 

    The exact nature of the seizure depends on the function of the brain cells that are affected by the abnormal discharge. Seizures are classified into two major types: partial and generalized. 

    Partial seizures, which occur when the electrical discharge remains in a circumscribed area of the brain, can be broken down further into elementary or complex divisions. With elementary partial seizures, the person's consciousness is not impaired. 

    With complex partial seizures, there is some impairment of consciousness. In some people with partial seizures, the abnormal discharge spreads throughout the brain and is referred to as a partial seizure with secondary generalization.

Causes 

    Generalized seizures occur when the discharge affects both brain hemispheres and results in a loss of consciousness. The two most common types of generalized seizures are generalized tonic colonic (grand mal) and absence (petit mal). 

    In generalized tonic colonic seizures, the person typically stiffens all over in the tonic phase, has jerking movements of the arms and legs in the colonic phase, and is incontinent of urine. Following the seizure, the person is commonly sleepy. In absence seizures, there are a few seconds of loss of consciousness. 

    The person generally stares blankly and sometimes rotates the eyes upward. An absence seizure begins and ends abruptly ( Dreifuss & Nordli, 2001). Epilepsy affects over 2 million people in the United States. 

    The cumulative incidence to age 80 years is 1.3% to 3.1%. Incidence rates are highest among those under 20 years of age and over 60 years of age. The trend is for the frequency of epilepsy to be decreasing in children and to be increasing in the elderly. 

    Rates are slightly higher for men than for women. The prevalence of active epilepsy, defined as having had a seizure in the past 5 years or taking daily antiepileptic medication, is between 4.3 and 9.3 per 1,000. 

    In approximately 70% of new cases of epilepsy there is no specific identified cause. In the remaining 30% the risk factors for epilepsy are severe head trauma, infection in the central nervous system, and stroke. 

    In the United States the prevalence of epilepsy is lower in Whites than in non-Whites, although the reasons for these differences are not clear (Hauser & Hesdorffer , 1990).

Remission of Epilepsy

    Remission of epilepsy, defined as 5 years without seizures, is more common among persons with generalized seizures, those with no neurological deficits, and those with a younger age of onset. Approximately 70% of people with epilepsy can be expected to enter remission (Hauser & Hesdorffer , 1990).

Medication and Nursing Care

    The best treatment of epilepsy is antiepileptic medication. Most epilepsy is well controlled with such treatment, but approximately 20% of people continue to experience seizures despite treatment with medications. 

    When partial seizures originate from a well-defined focus in an area of the brain that could be excised without serious neurological deficits, surgery to remove the affected part of the brain is an option. 

    Other treatments for epilepsy have been tried with some success. The ketogenic diet, which consists of foods high in fat and low in carbohydrates, has been used since the 1920s. 

    Recently, there has been increased interest in the ketogenic diet as a treatment. Another recent treatment is the vagus nerve stimulator, which sends electrical energy to the brain via the vagus nerve (Epilepsy Foundation, nd).

Epilepsy and Quality of Life

    Most nursing research has been devoted to the impact of epilepsy on the quality of life. Some people have severe quality-of-life problems that prevent them from engaging in fully productive lives. 

    The exact prevalence of these problems is difficult to establish because most studies have been carried out on clinic samples, that is, on persons with seizures that are more difficult to control. 

    Problems most commonly found in children include anxiety, poor self-concept, social isolation, depression, behavior problems, and academic underachievement (Austin & Dunn, 2000). 

    The most common problems found in adults with epilepsy are unemployment, depression, social isolation, and problems with adjustment. Unemployment may be twice as high in persons with epilepsy as in the general population (Hauser & Hesdorffer , 1990). 

    Factors generally associated with quality-of-life problems are severe and frequent seizures, presence of other conditions or deficits, chronic condition, negative attitudes towards having epilepsy, and lack of a supportive family environment.

Guide line For Epilepsy Care 

    Research to guide the nursing care of persons with epilepsy is limited. Research is needed to understand the factors that lead to quality-of-life problems. A recent study with children suggests that behavior problems are already evident at the time of the first recognized seizure (Austin et al., 2001). 

    Furthermore, research that tests nursing interventions is needed to guide nursing care designed to prevent and reduce the development of adjustment problems. More nursing research is needed on teaching self-management to persons with epilepsy. 

    Dilorio and colleagues (2003) are studying self-management in adults with epilepsy. Nurses should play a major role in developing knowledge to provide a research base for nursing practice with persons with epilepsy.