LECTURE NOTES

EPILEPSY
EPILEPSY

Epilepsy, also called seizure disorder,

is a chronic brain disorder that briefly

interrupts the normal electrical activity

of the brain to cause seizures.

CAUSES OF
EPILEPSY
Causes of epilepsy
 1. Hereditary
 2. Body build
 3. Endocrine disorders
 4. Degenerative diseases
 5. In most cases of epilepsy, the
cause is unknown (idiopathic).
TYPES OF
EPILEPSY
PARTIAL
SEIZURES/FOCAL
EPILEPSY
:
Partial seizures/Focal epilepsy:

 In this type of epilepsy, the seizure

activity originates in one part of the
brain and the victim is usually still
conscious. Only a particular part of the
body is involved. The electrical
discharge is usually localized to a part
of the brain and only the body part
controlled by that part of the brain is
affected.
Signs/symptoms

 1. Unusual sensations such as

uncontrollable jerky motions of a
body part
 2. Sight or hearing impairment,
 3. Sudden sweating or flushing
 4. Chewing of teeth and smacking
of lips
CONT
 5. May be preceded by an aura (a warning
sensation characterized by feelings of fear,
abdominal discomfort, dizziness, or strange odors
and sensations)
 6. Victim may stare ahead blankly, drops things
in hands and appears to be in a daydream.
 7. There may be “Déjà vu” phenomenon. A
strong feeling of knowing unfamiliar persons,
places or events.
MANAGEMENT OF PARTIAL
SEIZURES
Management of Partial Seizures

1. 1. Protect casualty from endangering himself such as

crossing busy roads

2. 2. Talk to him quietly

3. 3. Stay with patient until fully recovered

4. 4. Advise him to seek medical advice or inquire if

already on drugs.
TONIC-CLONIC/MAJOR /
GENERALIZED SEIZURES
Tonic-clonic/Major / Generalized
seizures

 Formerly known as grand mal

seizures, this type of epilepsy is
non-specific in origin and affects the
entire brain simultaneously. It usually
comes on unexpectedly. This is
usually characterized by convulsions
and tends to occur in four phases:
Aura stage:
 This stage turns to affect most epileptic cases.
It serves as a warning that something is going
to happen. Casualty may experience:
 Feelings of fear,

 Abdominal discomfort,

 Dizziness and flashes of light

 Strange odors or taste.

2. Tonic stage:
 This stage is characterized by:
 The entire body becomes rigid with

hands and teeth clenched.

 Breathing stops or becomes

obstructed.
 There is cyanosis and the back

arches.
CONT
 This stage lasts longer than the aura stage and
lasts about 15-30 seconds.
 The victim stares bluntly.

 Contraction of respiratory muscles forcing air

out of the respiratory tract to produce a

sound commonly termed as an “Epileptic Cry”.
You may hear sounds like “Aaaaaah!!!” and
immediately after the sound, the victim falls
to the ground and that ends the first stage.
Coma stage:

 After the muscles relax and

convulsion subsides, the person is
exhausted and may sleep heavily.
Noisy breathing gradually returns to
normal and patient falls into coma
which may last between 15min to
1hour.
Final stage:
 Casualty recovers from
unconsciousness. Confusion,
disorientation, headache, nausea,
and sore muscles are often
experienced on awakening. The
individual may have no memory
of the seizure
cont
 The partial consciousness, loss of
memory about the attack and the
confusion after epileptic attacks is
usually termed as post epileptic
automatism. This can occur in three
forms:
Epileptic Fugue.
 In this type, the victim wanders about
his/her environment in a confused
state. For example, the victim may
move aimlessly from one corner of
the room or yard to the other and
may try to remove his or her clothes.
Any restraint within this period may
be met with violent attacks.
Post Epileptic Furor/Terror.

 Post Epileptic Furor/Terror. With this

type of post epileptic automatism,

the victim becomes very violent and

destructive after the attack.

Epileptic Twilight state.

 Epileptic Twilight state. This is

a period of serious confusion
where victims are usually
confused and disoriented for
hours to days.
MANAGEMENT OF FITS
AT SPECIFIC STAGES
AURA STAGE:
Aura stage:
 The patient who has an aura
[warning of an impending seizure]
may have time to seek a safe,
private place. If aware, assist him/her
in this direction.
TONIC STAGE:
Tonic stage:
 1. Provide privacy and protect the
patient from curious on-lookers.
 2. Ease the patient to the floor, if
possible.
 3. Protect the head with a pad to
prevent injury (from striking a hard
surface).
 4. Loosen constrictive clothing.
Cont
 5. Push aside any furniture, fire or water
that may injure the patient during the seizure.
 6. If the patient is in bed, remove pillows
and raise side rails.
 7. If an aura precedes the seizure, insert a
pad (e.g. a clean handkerchief) between teeth
to reduce the possibility of the tongue being
bitten.
CLONIC STAGE:
Clonic stage
 Do not attempt to force open the jaws that
are clenched in a spasm to insert anything.
Broken teeth and injury to the lips and tongue
may result from such an action.
 No attempt should be made to restrain the

patient during the seizure because muscular

contractions are strong; and restraint can
produce injury.
Clonic stage
 3. If possible, place the patient on
one side with head flexed forward,
which allows the tongue to fall
forward and facilitates drainage of
saliva and mucus (foam).
 4. Clean foam from mouth.
COMA STAGE:
Coma stage:

1. Keep the patient on one side (recovery

position) to prevent aspiration.

2. Make sure the airway is patent and do not

wake him up.

FINAL STAGE:
Final stage:

 The patient, on awakening, should be

reoriented to the environment.
 If the patient becomes agitated after a seizure

(postictal/ post epileptic terror), use calm

persuasion and gentle restraint.
 Observations made on patient should be

reported to medical team if possible.

GENERAL FIRST AID
MANAGEMENT OF EPILEPTIC
FITS.
General First Aid Management of Epileptic
Fits.

 1. Rush to the aid of the victim and assist

victim to a safer place.
 2. If already collapsed, remove victim from
danger or danger from victim.
 3. Protect the head with a soft padded
material. If not feasible, put your legs together (if
not wearing shoes that have metals or articles that
can hurt victim) and place victim’s head on them.
cont
 4. Loosen tight clothes around neck, chest
and waist.
 5. Allow victim to fit freely,
 6. Protect tongue with a padded spatula
where applicable
 7. Never force to open the victim’s mouth
 8. Note and time duration of fits
cont
 9. Immediately fitting subsides, turn
victim’s head to one side for secretions to
drain out.
 10. Stay with victim till full recovery

 11. Assess for any injury and treat

appropriately
 12. Send victim for further management.
CONVULSIONS
CONVULSIONS
 A convulsive attack is an involuntary
contraction and relaxation
(paroxysms/spasms) of the voluntary
muscles resulting from an abnormal
cerebral stimulation.
STAGES OF
FIT/CONVULSION
Prodromal stage:
 This lasts for a few seconds and may
pass unnoticed. Patient is restless,
the eyeballs roll sideways, or
upwards, the head may be drawn to
one side, breathing appears labored,
saliva oozes from the mouth and
twitching of the facial muscles
occurs.
2. Tonic stage:
 This stage lasts 10 -20 seconds. The
whole body is rigid; the teeth usually
are tightly clenched, sometimes
causing serious bites to the tongue and
the cheeks and because the diaphragm
is in spasms the respiration is
momentarily arrested and cyanosis
occurs.
3. Clonic stage:
 It lasts for about a minute. Violent
contractions of the muscles produce
convulsive movements with profusely
secreted saliva (foaming). The saliva may
be blood-stained if the tongue or cheeks
are bitten. Unconsciousness and
obstructed breathing set in with bounding
pulse. Gradually, the convulsion subsides.
CAUSES OF FITS
In adults:

1. Brain tumor/abscess

2. Apoplexy

3. Epilepsy

4. Poisons (e.g. chemicals)

5. Infection (e.g. CSM, TT, cerebral malaria,

In children

1. High fever and severe dehydration (febrile

convulsion)

2. Teething

3. worm infestation

4. Poisoning (e.g. lead poisoning)

FIRST AID MANAGEMENT

DURING THE FIT

First Aid Management
During the fit

1. Protect patient from injury

2. Maintain patent airway

3. Stay with patient during attack

4. Time the fit - make a note of the exact

time and duration of the fitting.

Cont
 5. Loosen tight clothing around the neck to
help breathing.
 6. Avoid restraining the victim.
 7. Avoid unnecessary movement of the
victim.
 8. Avoid placing anything in the victim’s
mouth.
 9. Call for help if fit lasts more than 3
minutes.
AFTER THE FIT
After the fit

1. Check airway and breathing.

2. Clear the airway of any secretions and vomitus.

3. Clean victim of any soiling - thus urine or stool.

4. Place victim in the recovery position.

5. Constantly monitor airway and breathing.

cont
 6. Move bystanders away before
victim wakes (up to protect
modesty)
 7. Tepid sponge (if febrile)
 8. Transport victim to hospital or
call for help if you cannot wake
victim up within 10 minutes.
HOW TO PUT AN UNCONSCIOUS
PATIENT IN A RECOVERY
POSITION
How to put an unconscious patient in a
recovery position

• With the person lying on their back,

kneel on the floor at their side.
• Extend the arm nearest you at a
right angle to their body with their palm
facing up.
• Take their other arm and fold it so
the back of their hand rests on the cheek
closest to you, and hold it in place.
cont
• Use your free hand to bend the
person's knee farthest from you to a
right angle.
• Carefully roll the person onto their
side by pulling on the bent knee.
• Their bent arm should be
supporting the head, and their extended
arm will stop you rolling them too far.
cont
• Make sure their bent leg is at a right
angle.
• Open their airway by gently tilting
their head back and lifting their chin, and
check that nothing is blocking their
airway.
• Stay with the person and monitor
their condition until help arrive
How to put an unconscious patient in a
recovery position
END OF LESSON

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