Acknowledgement

I would like to express a deep sense of gratitude to the Almighty who is continuously giving the moral support and guidance required in all my deeds. I owe a great deal of thanks to my Principal Dr. Mrs. P.A. Chandekar, my guide Mr. T. Sivabalan (Associate Professor), and my teachers Mr. Eknath Gawade, (Lecturer), Mrs. Vimala S. (Lecturer), Mr. Pankaj Kale (Lecturer), Miss. Bharati Sajan (Lecturer), Mr. Sachin Mali (Lecturer), Mr. Sunil Phanse (Lecturer), Miss. Hira Jayasheela (Lecturer), Mr. Rajendra Lamkhade (Lecturer) who had at the very first request whole heartedly accepted to guide me throughout, while preparing this Self Instructional Module. I would like to express my gratitude to my friends and all my family members who gave continuous cooperation and valued assistance in bringing out this module.

INDEX
Sr 1 2 3 4 5 6 7 8 9 10 11 12 13 CONTENT Introduction History of Epilepsy Etiology of seizures Classifications Diagnostic measures Medical management Surgical management Nutritional management Home care management Complications Conclusion Key aspects Assignments Page no. 01 01 02 03 04 04 05 05 06 12 12 13 13

Introduction
Epilepsy is one of the non communicable disease it's , epilepsy is a neurological condition characterized by unprovoked recurring seizures that disrupt the nervous system and causes mental and physical dysfunction. It is a disability that negatively affects many aspects of lives, and living with this disability is frustrating and embarrassing. Epilepsy ranges from 40 to 70 per 1,00,000 population in developed countries and from 100 to 190 per 1,00,000 in developing countries ;around 2,00,000 new cases of epilepsy are diagnosed each year. It is estimated that there are 55,00,000 persons with epilepsy in India.

History of epilepsy
Ancient Babylonians thought that seizures were caused by demons Greeks believes epilepsy caused by offending the moon Ancient goddess, Ancient. Romans thought it's from demons and contagious discoveries allowed to make medicine that work better Scientific Hughlings Jackson (1870) understood what is epilepsy and Dr John why seizures occurs which helped the health care professionals to diagnose and treat he and his colleagues founded a National Society for the In 1892 Employment of Epilepsy advanced measures to diagnose and treat the disease Currently properly

Epilepsy
Is a condition characterized by two or more unprovoked seizures (involuntary contraction and relaxation of the voluntary muscles) and
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can be caused by a variety of pathologic processes in the brain

Etiology of seizures
Prenatal
l Infections

Intranatal
l Birth

Post natal
l Hypoxic

like meningitis, encephalities nutritional intake

trauma during delivery of oxygen brain structure

ischemic encephalopathy haemorrhage

l Intracerebral

l Poor

l Lack

l Cerebral

l Abnormal

malformation
l Head

l Smoking

, alcoholism and drug abuse factors brain

injury

l Tumors l Brain

l Genetic l Prenatal

injuries
l Inadequate

infections (Meningitis, Encephaliites) convulsions errors of metabolism

l Febrile l Inborn

brain development

Warning Symptoms of epilepsy

smell , taste, or feelings Unusual in sight Changes confused Feeling , numbness in the part of Tingling body Headache

Warning Symptoms

Generalized Seizures occurs usually with warning symptoms

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Classification of Eeilepsy
SL Type Clinical Symptoms 1 Generalized Tonic Clonic Seizures Tonic Phase appear with aura Seizures (Grand Mal) l roll upward Eyes l Sudden loss of Consciousness l If standing, falls to floor or Ground l Generalized Stiffness of Legs, head and neck extended arms usually flexed l Apneic, may become cyanotic l Increased salivation and loss of swallowing reflex l Chance of tongue bite Clonic Phase l Violent jerking movements as the trunk and extremities undergo rhythmic contractions and relaxations l foam at the mouth May l Incontinent of urine and feaes l event As ends, movements become less intense, then ceases entirely. 2 Absence l Appears without warning or aura Seizures l loss of consciousness Brief (Petit Mal l of muscle tone may cause Loss Epilepsy) child to drop object
l Minor

Duration 10 to 20 seconds

30 sec to 30 min

5 to 10 seconds

movements such as lip smacking, twitching of eyelids or face, or slight hand movements

Partial Seizures

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Able to maintain postural control, seldom falls l and head turn away from Eyes 1 to 3 min the side of the focus l Excessive Salivation l of speech Loss l Commonly occurs during sleep
l

Diagnostic Measures
History In relation to the cause of epilepsy and nature of epilepsy Physical Examination Look/observe for the presence of manifestation of epilepsy Laboratory Studies examination like CBC, S.electrolyte, S.Glucose, Blood S.creatinine level Urine examination for assessing the renal function PET for detection of the abnormalities in the brain CT ,MRI, EEG : finds the abnormal electrical activity of the brain Psychological Evaluation : for assessing the child's emotional function Use of advance technologies help to diagnosis the epilepsy

Management of epilepsy
1. Medical Management Hospitalization of the child Airway , Breathing and Assess Circulation cardiac rhythm Monitor oxygen and Monitor Administer oxygen saturation intravenous line with IV Establish Medication solution Draw blood for diagnostic measures Thiamine and Dextrose Administer history and perform examination Obtain antiepileptic drugs like Phenobarbital, Lorazepam, Administer diazepam and Phenytoin

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2. Surgical management Commonly epilepsy is treated with medical care, if needed the surgical procedure are performed based on the underlying cause diagnosed. The common surgical procedure used for treating the epilepsy are excision of Surgery intracranial tumor, temporal lobectomy, extra temporal lobectomy and vegal nerve stimulation .

Nutritional Management
Ketogenic diet Provide (Specialized diet for epileptic patients) in carbohydrate, Diet is low moderate in protein and high in fat Nutrition fat and low Very high carbohydrate diet causes the body to make ketones. Which helps to minimize the occurance of epilepsy the diet for two years, then slowly change to regular Continue diet food includes butter, cream, oil and cheese High fat High carbohydrate food includes fruits and fruits juices, bread and cereals, vegetables ( corn, peas and potatos) , beans, milk, snack food like(chips, snack cakes) , and sweets small and frequent diet Provide diet based on the likes and dislikes of the child Provide hygienically Serve food

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Home Care Management

Most of the diseases are handled well in the home, provided family members have adequate knowledge on care of the disease, which plays major role in treating and coping with epilepsy. Home care management of epilepsy includes; Care of airway, breathing, Home Care circulation, various safety measures, and Complications of seizures.

Care of Airway, Breathing and Circulation

Airway Problem in airway Block in the airway due to secretions l Cardio respiratory compromise l Relaxed respiratory muscles Assessment l Assess respiratory rate and heart rate (decreases) l Bluish discolouration of the skin and mucous membrane Care l the childs Turn head towards
l

Breathing Problem in Breathing l Chocking l Difficulty in breathing l Respiratory arrest Assessment l Decreased respiratory rate l Cyanosis Pale, and Puffiness of face Care l Maintain open and clear airway l the child Lay on one side to prevent chocking l Assess breathing by observing the chest rise and fall

Circulation Problem in Circulation l Decreased respiratory rate and BP l Changes in heart rate (Irregular) Assessment l Assess / palpate the pulses l Cyanosis Care Perform the care of airway and breathing problems

Head towards one side

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one side to drain out the secretions and prevent tongue fall l not force Do any thing inside the mouth during the attack l Loosen cloths around the neck to make breathing easier l not attempt Do to take the food out of the mouth

Put on the fan and open the windows l Dont be anxious/panic. l Remove the sharp instruments around the child l for Call emergency help
l

Remove Sharp Instruments

Call for Emergency

Do not Attempt

Care of Airway, Breathing and Circulation (ABC) is vital for the survival of child.

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Safety measures for the children with epilepsy

Floor and Furnishing slippery floor in the house Make non mat or soft cover over the floor Keep the , round edged utensils and Use soft furniture furniture and material in safe Keep the place.

Adequate light source

Non slippery Floor

Fire Safety let the child go inside the Do not kitchen, if so accompany them leave an open stove on the Do not floor or kitchen area Gas Stove allow the child to stand near Do not kerosene/gas stove the chulla immediately after Put off cooking food allow the child to stand near Don't Wires while cooking Electronic heaters and wires should not be left hanging safety measures in the home like sand and water Keep fire source

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Water tanks leave tanks open, cover it always Do not allow a child to go for swimming Do not with out supervision develops seizure in the water , If child support him and keep his head above water ;Get him out of water as soon as possible first aid services Provide Medication Keep medication away from the child's reach antiepileptic medication in Keep the separate box Check everyday medicine of the child , Medication whether tablets are getting over colour , consistency, presence of precipitation and expiry Check the date before using Administer child's medication on time If Medication was missed , do not double the dose of the potential side effects of the medication like, gastric Be aware distress, Dizziness and hypotension Bedroom child to sleep over mattress Make the on floor of cot; if so use side rails Avoid use without fail Do not allow child to sleep alone, parents should sleep with the child Do not allow the child to lock the door 09

Swimming

Use Side Rails

from inside when he is sleeping alone noise to minimize disturbed sleep Avoid loud light in bedroom while sleeping Use dim strong perfumes/ spray in the room Don't use kit with medication, roller gauge should be kept ready in First aid the house Medication chart must be stuck in the bedroom electrical boards should be above the reach of the child Latch and Do not give feeding during sleep hours Safe Bathing Never allow the child to lock the door of bathroom from inside while bath Never make the child to sit in the tub for long time while taking bath Be watchful while the child is taking bath Safe Bathing water for bath avoid use of hot use warm water use soap and shampoo that are irritating and may Do not precipitate seizures Exercise , play and sports safety other children about his Inform condition with whom he is playing play that is dangerous for the Avoid child, like cycling, parallel bar play etc sharp toys, sports articles in Never give his hands and comfortable environment Provide safe

Safe Play

Inform child that as soon as he gets aura signs while playing , immediately he should inform one of his friend and sit down on safe place

Never allow a child to ride a bicycle in traffic with epilepsy must avoid fights with other children Children

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School School teacher, driver and friends should be notified about the child's condition Phone number must be given to the teachers to contact in case of Call for Help emergency needs medication administer during school hours with If the child supervision of the teacher to have a bracelet tag made about your child's condition It is good teacher about the first aid measures and referral services Inform the Follow the safety measures to avoid injuries and complications Psychosocial needs Psychosocial support to the child and parents is important honest communication is Open and necessary Child must be motivated , to participate Psychological Support in sports that are less harm to him child to participate in recreational activities ,like play Allow the and games positive attitude in parents of epileptic child Build the needs of child regularly like bathing, brushing, Meet the toileting, and feeding etc spiritual support based on their religion Provide skills and coping abilities of the child with the disease Develop Consider the psychosocial needs to improve the quality of life and well being of the child

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After seizure care

Allow child to take rest and have sleep Do not give any thing by mouth till the child is fully conscious child recovers fully from the attack ask if he has Once the headache, abdominal pain, and nausea/vomiting lasts for more than 10 min seek for medical help If seizures the injury of child after recovery Take care Care for febrile convulsions because of increase in temperature It occurs above 40o c plenty of fluids to drink (juices) Provide cold applications like cold compress Provide and tepid sponge the clothing ,don't cover with blanket Loosen windows and put on the fans Open the Administer antipyretics,(syrup paracetamol,) as prescriped Complications of the seizures Aspiration loss Memory Fractures , lip or cheek injury Tongue Be watchful , Be prepared and Be proactive to prevent complications Conclusion Epilepsy is a seizure disorder that involves loss of consciousness and motor control. Children with epilepsy may face many challenges in their life's , both medically and psychosocially. The aim of treatment is to

Cold Compress

Syrup

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control seizures and to minimize the complications. Through education , support and counseling the child and family adjust to live with a chronic disorder. This Self Instructional Module will enable the parents to make the child to lead a improved quality of life. Key Aspects Make the child to lie flat and turn the head on side to prevent aspiration F the sharp objects and furniture around the child during Remove all epileptic episode F Be with child always (during sleeping, bathing, play and games) F occurs in the water, support him and keep his head If seizures above water. Get him out of water as soon as possible F child's medication on time as prescribed Administer F Keep the record of child epilepsy episode, nature and duration etc F plays like cycling, parallel bar play. Avoid the F Have a bracelet tag/Identity card with the child always F child to participate in all recreational activities like play Allow the and home functions F Provide adequate rest and sleep F temperature, febrile convulsions develop due to Control the increased temperature F child skill in coping with the disease Develop the F home environment to avoid injuries Provide safe Assignments 1 A seizure is an event that involves loss of . 2 Drug of choice for seizure is . 3 Epilepsy develops from abnormal activity. 4 diet controls seizures. 5 is the prenatal cause for developing epilepsy.

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