EPILEPSY IN CHILDREN- ENGLISH
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EPILEPSY
IN CHILDREN-
•
Epilepsy is a central nervous system
(neurological) disorder in which brain activity becomes abnormal, causing
seizures or periods of unusual behavior, sensations, and sometimes loss of
awareness. Epilepsy is the most common childhood brain disorder. The seizures
are triggered by changes in the electrical and chemical activity in the
brain.
CAUSES
OF EPILEPSY-
•
Seizures
can be caused by anything that injures the brain, including head injuries,
infections, poisoning or even brain development problems prior to birth. Often
exact cause for the seizures and epilepsy cannot be found.
•
Predisposing
factors in children includes- Prenatal complications, electrolyte imbalance,
errors of metabolism, developmental defects, infections, trauma etc.
•
Prenatal
complications such as birth asphyxia and intracranial injury during delivery
together account for about 50 % of neonatal and childhood seizures.
•
Acute
and severe electrolyte imbalances can manifest with seizures, which may be the
sole presenting symptom. Seizures are more frequently observed in patients with
sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia.
•
Several
inborn errors of metabolism can cause epilepsy including ceroid lipofuscinosis,
sialidosis type 1, Gaucher disease type III, mitochondrial cytopathies, and
Lafora disease .
•
Infections
such as neonatal septicemia, meningitis, tetanus neonatrum can cause seizures.
•
Developmental
defects (congenial anomalies of brain) such as microcephaly, dysgenesis of
brain tissue, microgyria and agenesis of corups callosum may result in
epilepsy .
•
Traumatic
injury to the brain during delivery or there after such as home and road
accidents can cause seizures.
TYPES
OF EPILEPSY-
•
Epileptic
seizures they are classified into two main groups-
•
1.
Focal seizures
•
2.
Generalized seizures
FOCAL
SEIZURES-
•
The
term focal is used instead of partial to be more accurate when talking about
where seizures begin. Focal seizures can start in one area or group of cells in
one side of the brain.
•
Partial
seizures are further classified as
•
Simple
partial seizure and
•
Complex
partial seizure.
•
Simple partial
seizure -
During these seizures, the child awake and aware. Some people may not be able
to respond during the seizure, but they're still aware of what's going on.
Focal aware seizures can last from just seconds up to a couple of minutes and
may involve muscle jerking, stiffening, or limpness; only one area or side
of your body is affected.
•
Complex partial
seizure
- When a person is confused or their awareness is affected in some way during a
focal seizure, it’s called a focal impaired awareness seizure. This used to be
called a complex partial seizure. The child may have a blank stare and repeat
the same action over and over like chewing, rubbing your fingers together, or
lip smacking, known as automatism, or he/she may simply freeze.
GENERALIZED
SEIZURES-
•
Generalized
seizures are characterized by the sudden onset of abnormal electrical activity
involving both sides of the brain. There are six different types of generalized
seizures.
-Absence
seizures: -Tonic
seizures: .
-Atonic
seizures: -Myoclonic seizures:
-Clonic
seizures:
-Tonic-clonic
seizures:
•
Absence seizures: Historically known as petit mal
seizures, absence seizures involve a short period of time in which you lose a
sense of awareness or "space out.“In absence seizure the child blank out or stare into space for a
few seconds This type is most common in children between the ages of 4 and 14
and usually lasts 20 to 30 seconds.
•
Tonic seizures: These seizures cause your muscles to
suddenly stiffen, which can prompt you to fall if you're standing
up. Tonic seizures often happen during sleep and usually involve a loss of
consciousness. After the seizure, the person may feel tired
or confused.
•
Atonic seizures: Atonic seizures are a type of seizure that
causes sudden loss of muscle strength. These seizures are also
called akinetic seizures, drop attacks or drop seizures. The sudden
lack of muscle strength, or tone, can cause the person to fall to the ground.
•
Myoclonic seizures: If someone
suddenly woken up because one of the muscles suddenly jerked, it is known as
myoclonic seizure. These seizures involve sudden, quick jerks in your arms or
legs. You may have a number in a row or just one on occasion.
•
Clonic seizures: Similar to myoclonic seizures, clonic
seizures involve sudden, jerky muscle movement, only in this case, it's
repetitive. Clonic seizures are characterized by repeated jerking movements of
the arms and legs on one or both sides of the body, sometimes with numbness or
tingling. Usually, clonic seizures are involved in a tonic-clonic seizure.
•
Tonic-clonic seizures: Previously called grand mal
seizures, these seizures are the type that most people associate with epilepsy.
First, in the tonic stage, your muscles stiffen, then you lose consciousness
and fall to the ground. Next is the clonic stage, in which your arms and
sometimes legs begin jerking or twitching quickly and repeatedly. These
seizures typically last for a few minutes.
DIAGNOSTIC
INVESTIGATIONS-
•
History
and exact description of onset of a seizure.
•
Electroencephalography(EEG)
•
Megnatic
Resonance Imaging (MRI)
•
CT scan
•
positron
emission tomography (PET)
•
single-photon
emission computerized tomography
TREATMENT
OF EPILEPSY-
•
The
first-line treatment for epilepsy is antiseizure medication. These drugs help
reduce the frequency and severity of seizures. Common epilepsy medications
include:
•
levetiracetam
, lamotrigine , topiramate , valproic acid, carbamazepine, ethosuximide etc.
These medications must be taken consistently and as prescribed.
•
If
medication can’t decrease the number of seizures, another option is surgery.
The most common surgery is a resection. This involves removing the part of the
brain where the seizures start. Most often, the temporal lobe is removed in a
procedure known as temporal lobectomy. In some cases, this can stop seizure
activity
CARE
OF EPILEPTIC CHILD-
•
Nursing
care of an epileptic child involves two phases. One is care at the time of
seizure and second is general management of child.
•
At
the time of seizure we should- Keep the seizing person away from obstacles that
may harm them.
•
Remove
glasses, sharp objects or other harmful
objects in the area.
•
Place
a pillow, blanket, jacket, or other soft, preferably flat, object under the
person's head if available. Be sure that the person is not face down to prevent
suffocation.
•
Do
not try to stop the person's movements or hold them down, but turn the person
onto one side if possible.
•
Observe and record the type of convulsions
duration , part involved and frequency .
•
Warning
signs for seizures should be noted. Nurse should make sure to make arrangement
for safety precautions in advance and give medication as ordered.
•
After
the seizure vital signs are checked and recorded. Biting of toungue and
incontinence are also reported
•
.Provide
psychological support to parents to reduce their anxiety level.
•
Continued
and carful reporting of the incidence of fits and their description is very
important in deciding medication and other therapeutic measures for epileptic
patient.
•
Special
attention is given for diet plan of the client to maintain proper nutrition.
•
During a fit , the most important duty of a
nurse is to prevent any type of injury to the child.
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