Epilepsy - How It Can Be Diagnosed and Managed

There are different ways of diagnosing epilepsy; some of which when added together give a better and clearer picture of the existence of the disease condition. It is usually advisable to carry out a comprehensive investigation before trying to make a diagnosis because of the social importance of the condition.

Diagnosis
i. The presenting signs and symptoms can give a clue to diagnosis.
ii. Electro-encephalogram (EEG): This will help detect the electrical discharges of the brain.
iii. Blood test: To determine the glucose and calcium levels of the blood.
iv. Lumbar puncture: To detect if there is any infection that may have likely spread to the brain.
v. X-ray of the skull: This will help in detecting any tumour of the brain.
vi. Physical and neurological examination.

First Aid management of Epilepsy
a. Give a helping hand to the patient quickly to prevent him from injury during a fall.
b. Loosen tight clothing from around the neck, chest and abdomen.
c. Place a spatula in-between the teeth to prevent him biting his tongue or lips.
d. Remove dangerous instruments around the patient
e. Allow enough air to reach patient by controlling the crowd around him
f. Do not restrict patient during fit/jerking to prevent injury/fracture
g. Reassure on-lookers
h. Observe vital signs
i. Note whether patient sustained injury or had incontinence. Also note the time the fit stopped and how long it lasted.
j. Remove his clothes if they are soiled and give him a bath

Medical management
1. Anti-convulsants: e.g. Phenobarbitone, Epanutin (Phenytoin Sodium), Mysoline, Tegretol, etc. may be given as recommended by the doctor.
2. Tranquilizers: e.g. Chlorpromazine (Largactil), Diazepam (Valium).
3. Electroconvulsive therapy (ECT)

Nursing management
i. Admit patient into epileptic ward
ii. Nurse in a low bed with adequate ventilation and good lighting
iii. Observe vital signs and maintain a proper record
iv. Provide comfort measures
v. Give easily digestible, semi-solid diets to prevent choking
vi. Patient should be encouraged to have enough rest and sleep. Soft pillows should be removed from him to prevent suffocating himself with the pillows during fits
vii. Personal hygiene should be encouraged
viii. Give psychological support.

Advice to patients
1. Patients should not swim, climb or operate machinery
2. Patients should have an identity card to show they are epileptic
3. Patient must guide against open fire
4. Take prescribed drugs regularly
5. Remove dentures before sleeping
6. Avoid sleeping with soft pillows
7. Do not bath alone especially if you have to use the bath tub
8. Do not go to River, stream, pond or well to fetch water alone. You must be accompanied by somebody
9. Avoid sharp instruments or corrosive liquids if fit is frequent
10. Don't drive if fit is frequent.

Epilepsy - What Is It, and How Is It Classified?

Epilepsy is a paroxysmal and transitory disturbance of the brain function characterized by abnormal electrical discharges in the brain, resulting in disturbance of movement, feeling or consciousness.

Epilepsy can also be defined as a convulsive attack which is as a result of abnormal electrical discharge of the brain.

Epilepsy is not infectious neither is it contagious. It cannot be transmitted through a bite from the sufferer.

Incidence
About 4-8 people in every 1000 have epilepsy. The incidence is more in infancy, childhood and adolescence.

Causes
1. Heredity: It has a familiar tendency
2. Cerebral tumour (tumour of the brain)
3. Infection e.g. Meningitis, ecclampsia, encephalitis.
4. Brain injury/damage especially during childhood
5. Sudden withdrawal of some drugs such as anti-convulsants e.g. phenobarbitone
6. Brain disease e.g. Cerebral arteriosclerosis
7. Metabolic disturbance e.g. Hypoglycaemia
8. Idiopathic (of unknown cause)

Epileptic personality

The epileptic person usually is very aggressive, impulsive, egocentric (self-centred), moody, very religious and isolates himself/herself.

Types of epilepsy

1. Grand mal or major epilepsy: The grand mal or major epilepsy is the very serious type of epileptic attack. It usually passes through recognizable stages which include:

a. Stage 1 or aural stage: This is the stage of warning of an imminent attack. This warning may come in form of flash light, peculiar taste, smell or noise, headache or other sensation.

b. Stage 2 or tonic stage: This is the stage of loss of consciousness. Patient falls to the ground after loosing consciousness, and there is muscle rigidity, muscle spasm, clenched teeth, dilated pupils, apnoea (ceasation of respiration), cyanosis (bluish appearance of the skin and mucous membrane); and the patient lets out a peculiar cry/shout known as epileptic cry.

c. Stage 3 or clonic stage: The patient remains unconscious but there is contraction and relaxation of the muscles. This is accompanied by jerking or muscle twitching, biting of the tongue or lips, frothing (foaming) from the mouth, incontinence of urine or faeces or both. Clonic stage lasts for about 1-5 minutes.

d. Stage 4 or comatoid stage: The individual has not recovered from unconsciousness. He breathes heavily through blowing of the lips; the body becomes flaccid and patient goes into a state of deep sleep. The sleep may last up to 30-45 minutes.

e. Stage 5 or recovery stage: This stage which is also referred to as the 'Post Ictal Stage' is characterized by the patient awakening from sleep. There is confusion, headache, vomiting and exhaustion, and in some cases patient may become very violent.

2. Petit Mal Epilepsy: In this type of epilepsy there is transient loss of consciousness for few seconds. Loss of consciousness is not accompanied by fits, muscle spasm or other signs of Grand mal epilepsy. Patient may stare blankly into space, show slight twitching of the face, may be cyanosed or may drop whatever object held in hand. It may occur several times a day. Petit Mal epilepsy is common in children.

3. Focal or jacksonia epilepsy: The seizures are usually localized and sometimes progress from one part to another. Jacksonia epilepsy is often a symptom of cerebral lesion or injury.

4. Temporal lobe epilepsy: This is caused by disease of the temporal or parietal lobe of the brain. It is characterized by hallucination of sight, hearing, smell and taste; paroxysmal disorders of memory and automatism, negativism, confusion and amnesia. The patient may wander aimlessly and may have illusion. Attack usually lasts for about 2 seconds to 2 minutes.

5. Status epilepticus: In Status Epilepticus, one fit succeeds another without the patient recovering from unconsciousness. It is very common in people who suddenly