Epilepsy

This is a major mental disorder. It is an organic disorder where there is spontaneous paroxysmal discharge of excitation in the central nervous system. It develops suddenly and also spontaneously with the tendency to recur.

Epilepsy can therefore be convulsion with complete loss of consciousness or brief lapse of consciousness.

Causes of epilepsy

1. Hereditary: from one generation to the other
2. Neoplasm: new growth in the brain
3. Trauma: g. cerebral malaria etc.
4. Drug intoxication
5. Idiopathic meaning unknown

Types of epilepsy

There are two types of epilepsy namely

1. Major epilepsy or grand mal
2. Minor epilepsy or petit mal.

Major epilepsy

The Major epilepsy has four stages i.e.

• The warning stage
• The tonic stage
• The clonic stage

The warning stage: Is also known as prodromal stage it is usually market with irritability restlessness and uneasy feelings

The  tonic stage: In this stage all muscles of the body are rigidly contracted including the muscles of the respiration. Therefore patient becomes cyanosed i.e. there is lack of oxygen supply.

The clonic stage: The already contracted muscles go into spasm. There is convulsion twitching, the respiration becomes noisy, tongue may be bitten at this phase. Saliva bubbles out patient passes urine at this stool the stage last for about 2-3 minutes.

The comatous stage: Twitching ceases. The patient partially regains consciousness or he goes into a deep sleep. He may wake up confused, disorientated and deluded there may be epileptic automatism where the victim will act out and at the end he will no be able to account for what he has done e.g. raping killing people etc.

Minor epilepsy

This type of epilepsy does not go into stages. It is characterised with transient loss of consciousness this types of common in children it is diagnoses through electro  encephalograph, which will reveal abnormal brain wave.

General sign and symptoms of epilepsy

These are the physical and mental signs and symptoms that are general to the disease but it differ from the person having the attack on the spot

1. Aggressiveness
2. Hostile behaviours
3. Paranoid idea
4. Depressive symptoms
5. Self centeredness
6. High irritable

Management of epilepsy

• investigations
• good history taking
• Physical examination e.g. wounds at bony extremities of heels, elbow and occiput.
• Electro- encephalography – this is a mechanical device to measure wave potentials of the brain cell. To indicate where focus is and thus the need for further investigation and treatment.
• Treatment
• physical treatment: The need of the patient must be met nutritive food must be given; bed bath, mouth- toileting (if patient is unconscious) and patient should be nursed in low bed
• Social needs: Relatives should be thought to accept neglect him they should therefore pay him regular visit. Diversional therapy should be encouraged. He should be accepted and respect he should be recognised as an individual
• Personal integrity of the patient should be respected: He should be called by his proper name I.E. Mr, Dr. Chief and not EP patient. He should be accepted and respected and treated wholly as a man.
• Conservation of energy: The health workers should know what the patient could do on the personal knowledge of the disease. He must never be forced to carry out what he cannot do because of his disease condition and stage in which is sharp instrument should be discouraged in his environment generally. When eating care should be taking to make sure that the patient is given soft pieces of food at a time, to prevent suffocation if he has an attack. Avoiding of tight clothes around the neck and loin is very essential to prevent strangulation.
• Recreation: On no account should he be allowed to climb ropes, ladders or swim in a pool. He must not ride or drive vehicles for if there should be an attack during this period he is going to injure himself and other in the vehicle. The patient should not use soft pillows in order to prevent suffocation dentures should also be removed while going to bed to prevent choking

Chemotherapy

Anti convulsing drugs e.g. phenobarbitone, mysoline treatment during fit is more of emergency of first aid treatment the treatment there in according to the stage in which the patient is:

1. Loosing tight closing around the neck and lion very essential oxygen therapy is highly important and also the positioning of the patient (flat with head turned to one side).
2. Do not restrict the movement of the limbs of the patient. Remove any injuries of the limbs of the patient remove any injurious object or articles that are near to the patient.
3. Observe the vital signs of the patient i.e. pulse respiration, temperature and if possible the blood pressure. All these points should be noted and recorded in the observation note.

Advice to patient and relative on discharge

1. Importance of friendly attitude towards the patient
2. Taking of drugs regularly at home
3. Coming for check up at the appropriate time or coming to hospital for treatment if attack comes up early before the appointment time for treatment of check up social worker to advice the patient on his occupation which may be change completely or modified
4. He must accept his limitation and the relatives should accept him too.

Complications of epilepsy

1. Dementia
2. Intellectual deterioration
3. Fracture/ dislocations
4. Confusion
5. Sudden death.