Nursing Care and Epilepsy
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.