General

Management/prevention of epilepsy

What is epilepsy?

Epilepsy is a disturbance of the central nervous system characterised by convulsive seizure. It is also a disorder in which there are recurrent episodes of altered cerebral function disassociated with paroxysmal (sudden attack) excessive and hyper-synchronic discharge of cerebral neurons which are caused by electrical disturbances in the nerve cell in a section of the brain (Matins, 2012).

The clinical accompaniment of these episodes seizures vary in manifestation from belief lapses of awareness to prolonged unconsciousness, limb and jerking. This disease, epilepsy is mostly common for those under the ages of 18 years and those over 65 years. It has been estimated that about 4% of the population has some form of epilepsy but some theories said that, the incidence may be much higher. In fact, a significant and measurable decline (say no) in cognitive function is known to be associated with epilepsy itself. Although it has not been entirely clear to what extent this is due to the epilepsy itself or the drug are considered by some to have less severe cognitive effect than order drugs.

On an individual level, a person’s reaction to epileptic seizure or anti-epileptic drug is considered by some to have less severe cognitive effects than order drugs. While on another individual level, a person’s reaction to epileptic seizure or anti-epileptic drug may be idiosyncratic, so it is sometime difficult to predict how a particular person might be affected but researchers indicate that epilepsy affects approximately 1% of population making it one of the most common neurological diseases.

Epilepsy can strike at any given time of life from infancy to old age. While epilepsy varies widely in types and severity, all form of this disorder are characterised by recurring seizure from abnormal cell in the brain. In approximately 30% of cases of epilepsy is caused by events such as head tumour, stroke, infections and as for those cases which there is no cause. Recent evidence suggests that, there may be genetic predisposition that is liability to suffer from a particular condition.

Epilepsy is a rare reflex syndrome in which seizures are triggered. Children exhibit behaviour that are easily mistaken for epilepsy seizures, but are not caused by epilepsy. This includes:

Inattentive starring
Benign shudder (among children younger than age 2, usually when they are tied or excited).
Self gratification behaviours (nodding, rocking, head benigning).

Conceptual framework

According to Bailliere Nurses Dictionary (2010), epilepsy is defined as a group of conditions causing convulsive attack due to disordered electrical activity of the brain cell. Christopher (2013) defined epilepsy as s group of disorder in which there are recurrent episodes of altered cerebral function associated with paroxysmal excessive and hyper-synchronous discharge of cerebral neuron. He also said that epilepsy exist when a series of seizures occur and this condition being life-threatening state and therefore need medical attention. He further said that epilepsy will be worsen during pregnancy, particularly during the third trimester when plasma anti-convulsant level will fall more frequently. Monitoring of blood level during pregnancy is therefore advisable.

Churchill (2011) defined epilepsy as a group of condition resulting from disordered electrical activity of the brain. This fits are caused by abnormal electrical discharge that disturbs cerebration and usually result in loss of consciousness. Neubrander (2010) said with a special interest in epilepsy that it is an injury to the brain from accident, stroke or lack of oxygen supply during birth, alcohol abuse, poisoning, a severe bacteria of even high fever may cause epilepsy.

Antonio (2012) said that in epilepsy, seizures are recurrent and are not caused by a non-neurological disorder such as fever. More than one million people in the world have epilepsy. It is also common in Africa, Nigeria to be precise where it is strongly believed that it can be contracted when there is direct contact with the saliva of the individual during a fit. Ejebe (2010) defined epilepsy as an excessive discharge of electrical impulse from the brain characterised by spasm/fits.

According to Merrian Websters (2012), epilepsy is defined as any of the various disorders marked by disturbed electrical rhythm of the various nervous systems and typically manifested by convulsive attacks usually with clouding of consciousness. Gordon (2012) defines epilepsy as a recurrent paroxysmal disorder starting suddenly and ceasing spontaneously due to occasional sudden excessive rapid and local discharge of the nerve cells in the grey matter of the brain.

Causes of epilepsy

According to Christopher (2013), the following are the causes of epilepsy:

Hereditary cause
Head injury cause
Pre-natal injury cause
Environmental cause

Hereditary cause: Epilepsy tends to run in some families and some have been traced to an abnormality and in the specific gene. These genetic abnormalities can cause subtle charge in the way the body process. The hereditary factors are not a direct cause of epilepsy but may influence the disease directly. Gene can affect the way people process drug or cause area of malformation of neurons in the brain.

Head injury: It causes seizure if the head injury is severe and mismanaged. The seizure may not begin immediately but later in the year it will start but if the injury is mild (not severe), the risk of having epilepsy is slight.

Pre-natal cause: This can be caused as a result of the foetus. The developing brain is susceptible to prenatal injuries that may occur if the pregnant mother has an infection like viral disease and does not eat properly do take excessive alcohol, abuse drug and smoke, etc. These conditions may cause cerebral palsy (hysterical term for paralysis).

Environmental cause: Epilepsy can be caused by environmental and occupational exposure to carbon monoxide and certain chemicals which are released in the atmosphere the influence or attack the brain.

Types of epilepsy

The types of epilepsy according to Matin and Barbara (2011) are:

Major epilepsy or grandmal
Minor epilepsy or pertimal

Major epilepsy or grandmal

In this type of epilepsy, the patient fall to the grand unconscious following an unpleasant sensation and it has four stages, i.e.

The warning stage
The tonic stage
The chronic stage
The coma

The warning stage: This stage is also known as predromal stage. It is usually marked or noticed with irritability, restlessness and uneasy feeling.

The tonic stage: In this stage, all muscles of the body are rapidly contracted including the respiratory muscles. Therefore the patient becomes suffocated due to lack of oxygen supply.

The chronic stage: In this Stage, the already contracted muscles go into spam. There is convulsion, twitching, the respiration becomes noisy, tongue may be bitten and saliva bubbles out, patient passes urine and stool and this last for about 2 – 4 minutes before he or she recovers from the attack.

The coma stage: In this stage, the twitching of the body and jerking ceased, the patient regains consciousness or may go into a deep sleep after a little while, he/she wakes up from the sleep or from the unconsciousness confused, ashamed and disoriented as a result of what has happened.

Minor epilepsy or pertimal

This type of epilepsy does not go into stages like that of the major. It is characterised as a momentary loss of consciousness only and it is common in children than adults and it is been diagnosed through electronocephalogram (E.E.G.) which helps to reveal the abnormality of the brain growth or wave.

Signs and symptoms of epilepsy

According to Ross and Wilson (2012), these are the physical and mental signs and symptoms that are general to the disease but it only comes from the person that is having the attack on that particular time or spot.

Aggressiveness
Paranoid idea
Self centeredness
Hostile behaviours
Depression
Depressive symptoms
Dizziness
Odd sound
Unpleasant odour
Highly irritable
Loss of consciousness

Diagnosis of epilepsy

In opinion of Neubrander (2010), the following are possible diagnosis and management of epilepsy:

Investigation

This process of carrying out finding on a particular thing to obtain proper information as to the solution or preventive method for it.

Good history taking or physical examination

Blood test may also be carried out.
Surgery may be considered if a single area of the brain is damage which is causing the seizure.

Electronecephalogram (E.E.G.) is a monitoring and neurological developmental and behavioural test. An electroencephalogram is a mechanical device which measures the electrical activities of the brain. It is among the most informative test for evaluating possible epilepsy.

Classification of epilepsy

Kwan (2012) classified epilepsy thus:

By their first cause (etiology).
By the observation manifestation of the seizures known as semiology.
By the location in the brain where the seizure originates.
As a part of the discrete, identifiable medical syndrome.
By the event that triggers the seizures as in primary reaching epilepsy or musicogenic epilepsy.

Children may exhibit behaviours that are mistaken for epilepsy seizures, but are not caused by epilepsy. This includes:

Inattentive starring
Benign shudders (among children younger than age 2, usually when they are tired or excited.
Self gratification behaviours (nodding, rocking and head banging).

Treatment/management of epilepsy

The treatment/management of epilepsy according to Neubrander (2010) includes:

Physical examination or treatment: The patient needs must be available to met disorder. Needs like dietary intake must be adequately balanced. Proper care must be given to the patient.
Social needs: Family members and friends should be taught to accept and show love and care to the patient. They should not neglect him or her from the family. He or she should also be recognised as an individual.
Personality or integrity: Personal integrity of patient should be well addressed accordingly not by the condition or sickness name and be treated as a human being.
Conservation of energy: The family members should be taught on what patient is capable of doing due to the knowledge of the disease condition.
Recreation activities: On no reason should epileptic patient climb high length, swim in a river or swimming pool.
Chemotherapy: Anti-convulse therapy or anti-epileptic drugs should be given, e.g. phenorbartitone, myusoline or epanutin.

Complications of epilepsy