The Epilepsies PDF

10/24/23, 3:38 PM Realizeit for Student The Epilepsies Epilepsy is a group of syndromes characterized by unprovoked, recurring seizures (AANN, 2016a). Epileptic syndromes are classified by specific patterns of clinical features, including age at onset, family history, and seizure type. Epilepsy ca...

10/24/23, 3:38 PM Realizeit for Student The Epilepsies Epilepsy is a group of syndromes characterized by unprovoked, recurring seizures (AANN, 2016a). Epileptic syndromes are classified by specific patterns of clinical features, including age at onset, family history, and seizure type. Epilepsy can be primary (idiopathic) or secondary (when the cause is known and the epilepsy is a symptom of another underlying condition, such as a brain tumor). Epilepsy affects an estimated 3% of people during their lifetime, and most forms of epilepsy occur in children and older adults (Hickey & Strayer, 2020). The improved treatment for cerebrovascular disorders, head injuries, brain tumors, meningitis, and encephalitis has increased the number of patients at risk for seizures after recovery from these conditions. In addition, advances in EEG have aided in the diagnosis of epilepsy. The general public has been educated about epilepsy, which has reduced the stigma associated with it; as a result, more people are willing to acknowledge that they have epilepsy. Although some evidence suggests that susceptibility to some types of epilepsy may be inherited, the cause of seizures in many people is idiopathic (unknown). Epilepsy can follow birth trauma, asphyxia neonatorum, head injuries, some infectious diseases (bacterial, viral, parasitic), toxicity (carbon monoxide and lead poisoning), circulatory problems, fever, metabolic and nutritional disorders, or drug or alcohol intoxication. It is also associated with brain tumors, abscesses, and congenital malformations. Pathophysiology Messages from the body are carried by the neurons (nerve cells) of the brain by discharges of electrochemical energy that sweep along them. These impulses occur in bursts whenever a nerve cell has a task to perform. Sometimes, these cells or groups of cells continue firing after a task is finished. During the period of unwanted discharges, parts of the body controlled by the errant cells may perform erratically. Resultant dysfunction ranges from mild to incapacitating and often causes loss of consciousness (Hickey & Strayer, 2020). If these uncontrolled, abnormal discharges occur repeatedly, a person is said to have an epileptic syndrome. Epilepsy is not associated with intellectual level. People who have epilepsy without other brain or nervous system disabilities fall within the same intelligence ranges as the overall population. Epilepsy is not synonymous with intellectual or developmental disabilities, but many people who have these types of disabilities, because of serious neurologic damage, also have epilepsy. Patients with epilepsy, particularly those with generalized events that are medically refractory, are at serious risk for Sudden Unexpected Death in Epilepsy (SUDEP), defined as nontraumatic, nondrowning unexpected death of a patient with epilepsy. These events may be witnessed or unwitnessed and https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 1/2 10/24/23, 3:38 PM Realizeit for Student postmortem examination reveals no anatomic or toxicologic cause of death. Cardiac and respiratory abnormalities have been implicated in these deaths. SUDEP may or may not be related to a seizure event (Barot & Nei, 2019). Epilepsy in Women More than one million American women have epilepsy, and they face particular needs associated with the syndrome. Women with epilepsy often note an increase in seizure frequency during menses; this has been linked to the increase in sex hormones that alter the excitability of neurons in the cerebral cortex. The effectiveness of contraceptives is decreased by anticonvulsant medications. Therefore, patients should be encouraged to discuss family planning with their primary provider and to obtain preconception counseling if they are considering childbearing (Stephen, Harden, Tomson, et al., 2019). Women of childbearing age who have epilepsy require special care and guidance before, during, and after pregnancy. Many women note a change in the pattern of seizure activity during pregnancy. The risk of congenital fetal anomaly is two to three times higher in women with epilepsy. Maternal seizures, anticonvulsant medications, and genetic predisposition all contribute to possible malformations. Women who take certain anticonvulsant medications for epilepsy are at risk and need careful monitoring, including blood studies to detect the level of anticonvulsant medications taken throughout pregnancy. Mothers who are at high risk (teenagers, women with histories of difficult deliveries, women who use illicit drugs [e.g., “crack” cocaine, heroin], and women with diabetes or hypertension) should be identified and monitored closely during pregnancy, because damage to the fetus during pregnancy and delivery can increase the risk of epilepsy. All of these issues need further study (Stephen et al., 2019). Because of bone loss associated with the long-term use of anticonvulsant medications, patients receiving anticonvulsant agents should be assessed for low bone mass and osteoporosis. They should be educated about strategies to reduce their risks of osteoporosis (AANN, 2016a). Gerontologic Considerations Older adults have a high incidence of new-onset epilepsy (Hickey & Strayer, 2020). Cerebrovascular disease is the leading cause of seizures in the older adult but they are also associated with head injury, dementia, infection, alcoholism, and aging. Treatment depends on the underlying cause. Because many older adults have chronic health problems, they may be taking other medications that can interact with medications prescribed for seizure control. In addition, the absorption, distribution, metabolism, and excretion of medications are altered in the older adult as a result of age-related changes in renal and liver function. Therefore, older adult patients must be monitored closely for adverse and toxic effects of anticonvulsant medications and for osteoporosis. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUAYD8aTcEKqA9iFsBPwk2RFvtNozNlLKTVk0W5HMqg… 2/2