Professional Documents
Culture Documents
Chapter 2 Case Discussion/Presentation Chapter Overview This chapter presents the case discussion/presentation and the overview of related literature and studies on the subjects made by the researcher during exploration stage of the case finding. Review of Anatomy and Physiology of the Nervous System
igure !" Picture of the #rain" (www.images-search/yahoo.com) The Nervous of ystem feelings is responsible initiate for sensory and and
perception
and
voluntary
14
involuntary actions based on signals transmitted through the nerves to the brain. The functions brain that and are the vital nervous for system have multiple of the
normal
functioning
body. ! nerve impulse is essentially an electrical stimulus that travels over the cell"s membrane. #t passes through
the axons and dendrites of the neurons. #t travels via the dendrites from the s$in and then reaches the cell body% axon% axon terminals and the The ynapse of the neuron.
the impulse moves from one to the other. !t the synapse neurotransmitters are present These are chemical
transmitters of messengers that transmit the impulse. They include !cetylcholine and Noradrenaline. The impulse continues to the next dendrite% in a chain reaction till it reaches the brain that in turn instructs the s$eletal muscles to wor$. These reflexes are automatic% involuntary responses. They may or may not involve the brain for example blin$ing does not involve the brain. The &eflex arc is the main functional unit of the nervous system that helps a person reacts to a stimulus.
15
The
brain
is
one
of
the
largest
and
most
complex
organs in the human body. #t is made up of more than '(( billion nerves that communicate in trillions of connections called synapses. The brain is made up of many speciali)ed areas that wor$ together* The Thin$ing cortex and is the outermost movements layer begin of in brain the cells. cortex.
voluntary
The brain stem is between the spinal cord and the rest of the brain. +asic functions li$e breathing and sleep are controlled here. The basal ganglia are a cluster of
structures in the center of the brain. The basal ganglia coordinate messages between multiple other brain areas.
The cerebellum is at the base and the bac$ of the brain and is responsible for coordination and balance.
The brain is also divided into several lobes* The frontal lobes are responsible for problem solving and judgment and motor function. and The body parietal position. and lobes The manage temporal The sensation% lobes are
handwriting% involved
with
memory
hearing.
occipital
lobes
contain the brain"s visual processing system. The brain is surrounded by a layer of tissue called the meninges. The s$ull (cranium) helps protect the brain from injury (,ssentials of !natomy and -hysiology% .((/).
16
ei)ure activity
igure 2" Pathophysiology of Sei*ure" %oo+,#ased" &is$ factors are the $ey factors that will determine if a person will have sei)ure or not. #f you have one or more of the ris$ factors% your brain cells tend to function abnormally when it send electrochemical signals. 0nce the erratic cells perform the erratically% chemical there will for be an
abnormality
with
responsible
brain
activity. This will now lead to abnormal brain activity which will cause sei)ure activity. !nd if the sei)ures
17
occur repeatedly% then the client will be diagnosed with epileptic syndrome. Pathophysiology $client,#ased)
&is$
1actors*
taring into space and appeared confused and irritable. 7nusually sleepy (abnormal brain activity)heart racing% strong pulse.
3ontinous sei)ure
,pilepsy
igure -" Pathophysiology" $Client,#ased) The client has a family history of sei)ure disorder. !side from having familial tendencies% what triggered the sei)ure disorder in the client was having a very high fever of 4/.' degrees 3elsius after the first vaccination of
5epatitis + 6accine. #t made the brain perform erratically by sending an abnormal signal. The client experienced the signs and symptoms of sei)ure activity. #t is called
febrile sei)ure because the sei)ure was triggered by the very high body temperature.
18
Signs and Symptoms ,pilepsy signs and symptoms vary from person to person but there are symptoms that are generali)ed. .a#le /" Signs and Symptoms %oo+ #ased $%runner and Suddhart&s' 2(!2) Aura,a sensation at the start of a sei*ure' may involve the perception of an odd smell or sound' spots appearing in front of the eyes' or unusual stomach sensations0 an aura is a sei*ure Staring +efore the start of sei)ure% mother claims that the client was staring into space. 1oss of consciousness The client lost consciousness a few moments after they noticed that the client was staring into space. Repeated 2er+ing of a single lim# The mother did not notice any jer$ing movement made by the client 3and ru##ing The mother did not notice any The client was unable to verbali)e if there has been a feeling of aura. Client %ased
19
hand rubbing 1ip smac+ing The mother notice a lip smac$ing which sometimes lead to lips bleeding Pic+ing at clothing The mother did not notice any pic$ing at clothing ear/Panic The client did not exhibit any fear or panic 3eart racing' Palpitations The mother claimed that the client exhibit heart racing and the strong pulse Perception of an odor' taste or smell 1oss of #owel or #ladder control Postictal state a state of drowsiness' alteration in responsiveness' and or confusion oot stomping 4na#le to move #ody parts Nothing was noted The client was unable to move as noted by the mother before he lost consciousness The client seemed irritable and confused and unusually sleepy. Nothing was noted None as claimed by the client
20
This table shows the signs and symptoms exhibited by the client on the onset of sei)ures as explained by her mother. The 3lient experiences loss of consciousness few moments after the noticing staring into space% then jer$ing of the extremities then he will pass out. Ris+ actors The ris$ factors include genetic factors% childhood abuse or head trauma% environmental factors% drug overdose% chemical sei)ures. #f you already have an epilepsy% the following factors can increase your chance of having an epilepsy*
abnormalities%
and
history
of
complex
febrile
leep deprivation !lcohol 5ormonal changes (such as those that occur at points during the menstrual cycle)
tress 1lashing lights% especially strobe lights 7se of certain medicines 8issing doses of anti-epileptic medicines
21
!n ,lectro ,ncephalo 2ram (,,2) is a non-invasive and painless diagnostic test used to measure electrical
impulses between brain cells. +y placing electrodes on your scalp% the fre9uency of these impulses can be measured and recorded on a graph. !bnormalities in your regular brain waves can be used to identify the presence% location and severity of your sei)ures. #t will locate the focus of abnormal electric discharges% if present: to establish a diagnosis of epilepsy: and identify the specific type of sei)ure. ! SP5C. ingle--hoton ,mission 3omputed Tomography ( -,3T)
is a diagnostic imaging techni9ue that measures blood flow through your brain. ! small amount of a radioactive tracer will be introduced into your body that will emit particles measured by a more -,3T camera. The greater the blood flow% the are emitted. This allows doctors to
particles
visuali)e the functions of certain parts of your brain. !s the data is collected% an image of the brain is generated
22
with different coloured areas to represent varying amounts of blood flow. This information will indicate if certain areas of your brain are getting too much or too little blood (and oxygen). !reas where sei)ures occur usually show increased blood flow. This test is not usually necessary for diagnosing epilepsy. #f your doctor recommends a -,3T
test% you will li$ely also re9uire an 8&#. ! P5. ,mission Tomography (-,T) is an imaging
-ositron
techni9ue that measures your brain;s activity through its use of sugar and oxygen. &adioactive tracers are introduced into your body These which release react tiny with particles electrons are using called in able the This your to data data
positrons.
positrons
releasing of your
3omputers activity%
images from
measuring
released
energy.
! 3omputed !xial Tomography scan (3!T or 3T scan) is a non-invasive and painless test. 3T scans produce cross-
23
will be examined by doctors to loo$ for abnormalities (eg. scar tissue% blood clots or tumours). 1or epilepsy% this usually involves a scan of your head to loo$ for possible origins of sei)ures. The machine loo$s li$e a large box with a donut shaped hole in the middle (a gantry). <ou will lie on a platform that slides in and out of the gantry as the x-ray rotates around you. =ow radiation x-rays pass through your body and are captured by detectors. 3omputers use this information to produce a .-> image of the area. 7R8
! 8agnetic &esonance #maging (8&#) is a noninvasive diagnostic magnetic test that uses in a powerful brain. magnet 8&#s to measure many
field
changes
the
produce
detailed cross-sectional images (?slices@) of the brain;s internal structure. These images can be used to detect
structural abnormalities and may help pinpoint the cause of sei)ures. This is considered to be the most important scan when diagnosing epilepsy because it produces a very
accurate representation of your brain. This procedure is generally non-invasive% by a although to a contrast the dye may with be a
administered clearer
needle
provide
doctor monitor
image.
1unctional
8&#s
(f8&#s)
neural
24
756
! 8agneto ,ncephalo 2raphy (8,2) is a new tool used to generate a representation of your brain;s magnetic fields. +y analy)ing brain activity% the 8,2 can help locali)e
areas in your brain causing the sei)ures. >octors can then use this information to help determine what is provo$ing your sei)ures. Diagnostic .est $Client %ase) These are the diagnostic tests that are needed to
determine the final diagnosis of the client. The client had undergone the following diagnostic test* The client was supposed to have a =umbar -uncture done but the family refused. Prevention To prevent sei)ures% the patient must avoid activities that trigger sei)ure activities. The client must record
every sei)ure activity and record all the things that the client did before the sei)ure occurred. #t is essential for a client to $now the things that could trigger sei)ure activities such as extraneous activities and alcohol
25
drin$ing. #t is advisable for a client to continue drin$ing the medications as prescribed by the doctor. !dvice the client to rest in between activities so that the client will not be too tired but at the same time% the client can function as well as a normal person can. ! person with sei)ure should warn the people around her to be aware of his/her condition since there is a safety
precaution to be followed if a person did have a sei)ure disorder. Complications 5ypoxic brain damage and mental retardation may follow repeated =ong-term sei)ures. social >epression interaction and may anxiety also may develop. &epeated
occur.
sei)ures can lead to epileptic syndrome% wherein the person can experience sei)ure with serious complications such as tatus ,pilepticus. Nursing 7anagement/8nterventions $%oo+ #ase) 6eneral Care and 8n2ury Prevention -erform periodic physical examinations and laboratory tests for patients ta$ing medications $nown to have toxic hematopoietic% genitourinary% or hepatic effects.
26
8onitor patient.
the
sei)ure
type
and
general
condition
of
Turn
patient
to
side-lying
position
to
assist
in
draining pharyngeal secretions. 5ave suction e9uipment available if patient aspirates. 8onitor sei)ures. -rotect patient from injury during sei)ures with #6 line closely for dislodgment during
padded side rails% and $eep under constant observation. >o not restrain patient;s movements during sei)ure
activity. >o not insert anything in patient;s mouth. Controlling ear of Sei*ures
&educe fear that a sei)ure mat occur unexpectedly by encouraging compliance with prescribed treatment.
,mphasi)e
that
prescribed
antiepileptic
medication
27
!ssess lifestyle and environment to determine factors that precipitate sei)ures% such as emotional onset to of
environmental or fever.
stressors% patient
,ncourage
avoid
patient in
to
follow
regular
and
lifestyle% exercise
diet and
(avoiding rest
(regular
patient
to
avoid lights%
photic
stimulation viewing):
(e.g. dar$
flic$ering
television
glasses or covering one eye may help. ,ncourage management. 8mproving Coping 7echanisms 7nderstand alienation% that epilepsy imposes feelings of fear% social patient to attend classes in stress
depression%
discrimination
and
isolation% and uncertainty. -rovide counseling to patient and family to help them understand the condition and limitations imposed.
28
,ncourage
patient
to
participate
in
social
and
recreational activities. #nstruct patient to avoid over-the-counter medications unless approved by health care provider. -rovide patients comprehensive who exhibit mental symptoms health of services to or
schi)ophrenia
impulsive or irritable behavior. Promoting 3ome and Community,%ased Care .eaching patients of Self,care #nstruct patient and family about medication side
effects and toxicity. -revent or control gingival hyperplasia% a side effect of -henytoin (>ilantin) therapy% by teaching patient to perform thorough oral hygiene and gum massage and see$ regular dental care. -rovide specific guidelines to assess and report signs and symptoms of medication overdose. #nstruct patient to $eep a drug and sei)ure chart% noting when medications due to illness.
29
Teach patient to $eep a drug and sei)ure chart% noting when medications are ta$en and any sei)ure activity.
Teach patient to $eep a drug and sei)ure chart% noting when medications are ta$en and any sei)ure activity.
#nstruct patient to ta$e showers than to tub baths to avoid drowning and never swim alone.
,ncourage
realistic
attitude
toward
the
disease:
identification card or wear an identification bracelet. !dvise patient if to see$ preconception (inherited and genetic of
counseling
desired
transmission
epilepsy has not been proved). 7edical 7anagement $%oo+ #ase) The management of epilepsy and status epilepticus is planned according to immediate and long-range needs and is tailored to meet the patient;s needs because some cases arise from brain damage and others are due to altered brain
30
chemistry. The goals of treatment are to stop the sei)ures as 9uic$ly as possible% to ensure ade9uate cerebral
oxygenation% and to maintain a sei)ure-free state. !n airway and ade9uate oxygenation as (intubate is an if
necessary)
are
established%
#6 line for administering medications and obtaining blood samples for analysis. Pharmacologic .herapy 8edications are used to achieve sei)ure control. The usual treatment is single-drug therapy. #6 dia)epam% lora)epam% slowly in an or fosphenytoin to halt is the
attempt
anesthesia
with
short-acting
barbiturate may be used if initial treatment is unsuccessful. To maintain a sei)ure-free medications phenytoin% state% other
anticonvulsant primidone%
(carbame)ipine% -henobarbital%
ethosuximide% and valproate) are prescribed after the initial sei)ure is treated.
31
intracranial tumors% abscess% cysts% or vascular anomalies. urgical removal of the epileptogenic focus is done for sei)ures area that of originate the brain in that a wellcan be
circumscribed excised
without
producing
significant
neurological effects.
29
!3T#0N =ong-acting barbiturate . edative and hypnotic effects of barbiturate s appear to be due primarily to interferenc e with impulse transmissio n of cerebral cortex by inhibition of reticular activating system. 3N depression may range from mild sedation to coma% depending on dosage% route of administrat ion% degree of nervous system excitabilit y% and drug tolerance. #nitially%
3=!
#1#3!T#0N #N>#3!T#0N =ong-term management of tonicclonic (grand mal) sei)ures and partia l sei)ures: status epilepticu s% eclampsia% febrile convulsion s in young children. !lso used as a sedative in anxiety or tension states: in pediatrics as preoperati ve and postoperat ive sedation and to treat pylorospas m in infants.
30NT&!#N>#3!T#0N !cute intermittent porphyria% oversensitivity for barbiturates% prior dependence on barbiturates% severe respiratory insufficiency and hyper$inesia in children are contraindication s for phenobarbital use.
!>6,& , ,11,3T >rowsi ness or di))in ess: proble ms with memory or concen tratio n: excite ment% irrita bility % aggres sion% or confus ion
31
32
Assessment
Diagnosis
8ntervention
5valuation
ubjective* ?Bapag inaata$e ng sei)ure Cyung ana$ $o $ina$abahan a$o hindi $o alam ang gagawin@% as verbali)ed by the client;s mother.
To improve the $nowledge of the client;s mother regarding the disease process
Dithin E hours of nursing interventions % the mother of the client will verbali)e understanding of the disease process
5ealth Teaching about ei)ure. >emonstrate what to do first then letting the mother do it by himself. >emonstrate what to do before% during% and after the sei)ure then let the mother do it so he will clearly understand what to do if sei)ure occurs.
!fter E hours of nursing interventions% the client;s mother verbali)ed understanding of the disease process. 5e demonstrated understanding of what to do before% during% and after the sei)ure.
2oal met
33
Nursing Care Plan .a#le ; !ssessment ubjective* ?+igla na lang >iagnosis &is$ for Trauma 0utcome #dentification -atient will demonstrate -lanning Dithin F hours of #ntervention ,xplore with the patient ,valuation !fter F hours of nursing
34
0bjective* Dea$ness 1acial grimace #rritability 6/ ta$en as follows* +- '.(//( T 4G.4 -& ''( && .(
behaviors% lifestyle changes to reduce ris$ factors and protect itself from injury.
nursing the -atient will demonstrat e behaviors% lifestyle changes to reduce ris$ factors and protect itself from injury.
interventions % the patient was able to demonstrate behaviors% lifestyle changes to reduce ris$ factors and protect her son from injury.
35
36
syndromes characteri)ed by additional conditions that coexist with sei)ures and impacts over H( million people worldwide.
3ognitive% emotional% and behavioral comorbidities are common. ei)ures are typically divided into two main categories* partial (focal) and generali)ed. 2enerali)ed sei)ures affect both
ei)ures
produce loss of consciousness% either for long periods of time or temporarily% and are sub-categori)ed into generali)ed tonicclonic% myoclonic% absence% or atonic subtypes. -artial sei)ures affect an area within one cerebral hemisphere of the brain and are the most recurring type of sei)ure experienced by patients with epilepsy. -artial sei)ures are further subdivided into
simple partial sei)ures% where consciousness is retained: and complex partial sei)ures% where consciousness is diminished or lost.#n the treatment of epilepsy% no one anti-epileptic drug (!,>) has been shown to be the most effective% and all !,>s have published side effects. !,>s are selected following
consideration of side effects% ease of use% cost% and physician $nowledge. -atients with newly diagnosed epilepsy who re9uire treatment can be started on standard% first-line !,>s such as
37
carbama)epine%
phenytoin%
valproic
acid%
or
phenobarbital.
!lternatively% newer !,>s introduced in the past decade may be used. These include gabapentin% lamotrigine% oxcarba)epine% or topiramate. +etween G(I and F(I of individuals are successfully treated with one of the !,>s now available and success rates primarily 5owever% depend the or on the etiology .(IJ4(I of of the sei)ure disorder. either
remaining
patients or suffer
have
intractable
uncontrolled
sei)ures
significant
adverse side effects to medication. !s with the selection of first-line treatment therapy% of choosing the appropriate must be drug based for on the the
refractory
epilepsy
appreciation of each drug;s characteristics and ris$s for each individual patient. !n emerging mar$et economy is defined as an economy with low-to-middle per capita income. uch countries
constitute approximately F(I of the global population% are often rapidly-growing and represent about .(I of the world;s
economies. !lthough the term emerging mar$et is loosely defined% countries that fall into this category% range from big to small% and are often considered emerging because of development and reform programs that have been put in place to launch their mar$ets globally. 3onse9uently% although 3hina is considered one of the world;s foremost economic leaders% it is grouped into the emerging mar$et category together with much smaller economies with fewer resources% such as udan or +ulgaria. ,pilepsy is
38
common
in
patients there
admitted are
to
hospitals
in
emerging in the
mar$ets.5owever%
reported
differences
epidemiology% economic burden% and outcome of epilepsy in these regions compared to high-income countries: although few data
from the former regions exist. !pplying the #nternational =eague !gainst ,pilepsy definition of epilepsy is problematic in these areas% as patients often arrive at health facilities without ade9uate documentation of the sei)ure duration. The goal of
treatment for patients with epilepsy is no sei)ures with little to no side effects. 5owever% due to variabilities in clinical presentation and available resources% treatments are highly
individuali)ed and vary widely. The objective of this study is to systematically review the literature on epilepsy to identify incidence and prevalence rates% economic data% unmet needs% and treatment patterns in those emerging mar$ets which contain the majority of the world;s population. (!ngala$uditi% .('') ,pilepsy is a chronic disease characteri)ed by the ris$ of recurrent sei)ures. #n developed countries% an average of E or H of every '%((( people has epilepsy. #n developing countries% this rate can be as high as E4 per '%((( people. !ccording to the Dorld 5ealth 0rgani)ation% the disability caused by epilepsy accounts for about (.HI of the global burden of the disease measured by disability-adjusted life-years. !s a result%
39
epilepsy ran$s just after psychiatric conditions such as alcohol dependence. comparable The to global of health breast care or bur-den of epilepsy ome is
that
lung
cancer.
cultures
believe that epilepsy represents demonic possession. !lthough epilepsy arises from a transient dysfunction in the brain% fear and ignorance still lead to discrimination and feelings of
shame. #n the public mind and in the laws of some countries% epilepsy cognitive is strongly associated K with mental illness and that
disabilities
unfortunate
generali)ations
stereotyping is difficult to overcome. -revious surveystesting $nowledge% epilepsy atitudes% have focused beliefs on and treatment of people students with or
the
general
public%
teachers. >entists and other health care wor$ers% who represent one of the more highly have educated been and influential groups in
society%
however%
not
surveyed.
7ndoubtedly%
their
perspectives about people with epilepsy have an impact on their professional interactions with this patient population. Their social response to this population% independent of their
provision of medical care% may influence the way their community views people with epilepsy. +ecause the dental care of patients with epilepsy is important% there may be and some reports in in the care%
literatureindicate
disparities
their
40
the dentists in =ondon% 0ntario% to determine their $nowledge about and attitudes to epilepsy% and their willingness to
provide dental care to people with epilepsy. (!ragon% .((F) ,pilepsy is the second most occurring neurological disorder with an incidence rate of ' I of the entire population. #n >enmar$ alone approximately E.((( new cases are seen every year. To be diagnosed with epilepsy often means a big change in a persons life% and affects the daily rutines of the entire
family. =uc$ily% it is today possible to treat most epileptics and to $eep them sei)ure free% but around .HI will have to find a way of living with the sei)ures to a smaller or larger degree. 5pileptic sei*ures There exists a high number of different types of epilepsy% and also an e9ually high number of sei)ure types. These sei)ures range from the common muscle spasms% many people would recognise as an epileptic sei)ure% to a short term% almost undetectable% loss of awareness. 8ost epileptic individuals
however will experience the same sei)ure type from time to time. Dhat is common for all epileptic sei)ures is that during the sei)ure the affected person is unable to fully control his or her body. The loss of control is sudden and unexpected.
,pi-3are is produced with an aim of warning relatives or medical personal when nightly sei)ures or spasms% with muscle activity occur.The majority of people suffering from epilepsy can be
41
brain surgery% however this is only a minority.The best care is decided from an individual and thorough description of sei)ures% sei)ure types% as well as sei)ure duration and fre9uency. ! thorough sei)ure description will often mean that the time from diagnose to the optimal sei)ure treatment is significantly
shortened. ,pi-3are can be of significant help in creating a thorough sei)ure description. The ,pi-3are log can $eep trac$ of the numbers of nightly sei)ures% and at the same time% warn if or when a major sei)ure should occur.( http*//danishcare.d$/u$/L pageMidN4G) The li$elihood of young people ta$ing their epilepsy medication as prescribed might be improved by ensuring they have a good understanding of their condition and its treatment% research
suggests. cientists at the 7niversity of 8ichigan carried out a study involving FF adolescents with epilepsy and their
parents. urveys were carried out to assess both patients; and parents; $nowledge of epilepsy and expectations of treatment% as well as their adherence to medication.The findings show that young people with a good understanding of epilepsy tended to adhere to their treatment regimes more closely than those with poor $nowledge of the condition.! good understanding among
42
in the journal ,pilepsy O +ehaviour.The researchers concluded* ?#nterventions that enhance adolescents; $nowledge of epilepsy and their treatment plan% while ensuring that teens and parents are in agreement with regard to epilepsy treatment% might
contribute to better adherence.@,ncouraging young people to ta$e their medication is vital for improving outcomes% as non-
adherence is associated with a high fre9uency of sei)ures and a worsened prognosis.<et a study in the Pournal of the !merican 8edical !ssociation% published in .('' by researchers at
3incinnati 3hildren;s 5ospital% found evidence that more than half of children with newly diagnosed epilepsy do not ta$e their sei)ure ( medications as prescribed.
http*//www.epilepsyresearch.org.u$/improving-youngsters-
$nowledge-of-epilepsy-may-boost-treatment-adherence/) 1ocal 1iterature -eople with epilepsy in the -hilippines suffer from anxiety and from depression. affecting =iving many with aspects epilepsy of presents many
challenges
life%
including
relationships with family and friends% school% employment and leisure activities (5a)el -atagua% .('.). The !nnual held on Neuroscience '(% .((/ >epartment &esearch at the >epartment 3ontest was 3onference
eptember
43
&oom. the
There were ten original papers that were presented from ections of 3ase !dult and -ediatric eries% Neurology in three and
categories*
&eport/3ase
>escriptive%
Neurologic
!ssociation research forum was held on 0ctober 'G% .((/ at 7 T 5ospital. 1our finalists -ediatric by original their papers from -25 >r. were presented !dajar as of
primary won
authors. in
Panet
Neurology
4rd place
the
>escriptive
category
with her paper on the ,,2 findings of patients with 3omplex 1ebrile ei)ures while >r. Pude +ayana of -ediatric Neurology
won Eth place in the same category with his paper on the use of newer antiepileptics of !dult her for neonatal won sei)ures. in >r. the Natasha =.
1abiaQa 3ategory
Neurology paper
for
entitled%
1actors
>evelopment of in a Tertiary
3ohort
!loysius >omingo of !dult Neurology won Ethplace for his metaanalysis% econdary -revention !fter 3erebrovascular ,vents* The
Dill !ngiotensin &eceptor bloc$ers -rotectL ( -!3,-D!&-). other original papers which submitted was held were 9ualified the for -N!
poster !nnual
during
#n the said event% the paper of >r Phaphet !gunias as se9uela of cyanide poisoning by
-ar$insonism
44
intentional silver jewelry cleaner ingestion* ! 3ase &eport won .nd place in poster presentation. (pgh.gov.ph) Treating the patient at home is appropriate when the
patient is $nown to experience sei)ures% and if his sei)ures are brief. !ccording to the -hilippine =eague !gainst ,pilepsy% the following steps can be done when helping out a patient during an acute sei)ure episode*
tay calm. =oosen clothing around nec$. Turn the patient"s head to one side to avoid cho$ing and/or aspiration.
>o not hold the patience down or sha$e and slap in an attempt to rouse him% as they can injure the patient.
>o not put anything inside the patient"s mouth. 3all a doctor when it is a first time sei)ure% of if the sei)ure recurs or is prolonged (more than H minutes)
Ta$ing prescribed anti-sei)ure medication regularly can help prevent recurrent sei)ures. The removal of brain tissue where sei)ures ta$e place is also a preventive measure. 1or those with severe cases of epilepsy% a special diet is advised to alter body chemistry. !voiding conditions $nown to trigger sei)ures
45
(such as bars with rapid% flashing lights% sleep deprivation) can help prevent sei)ures from occurring. ei)ures in the -hilippines% The following medical centers in the -hilippines have available Neurology/ ei)ure clinics*
Pose &eyes 8emorial 5ospital 8a$ati 8edical 3enter -hilippine 3hildren"s 8edical 3enter ei)ure 3linic
t. =u$e"s 8edical 3enter* 3omprehensive ,pilepsy -rogram 7,&8 7---25 ei)ure 3linic ei)ure 3linic ei)ure 3linic (health.com.ph)
7 T 5ospital
that they are not as familiar about specific aspects of epilepsy as they should be and that they need more training in management of the disease. everal recent surveys of health care professionals who care for children with epilepsy revealed what epilepsy specialists would consider to be misconceptions about treatment and management of pediatric epilepsy. #n a survey that focused on surgery practices for intractable epilepsy% nearly two-thirds of responding
46
physicians (HFI were pediatricians) were unsure whether surgical intervention anticonvulsant should drug be considered for patients who $now fail that
therapy%
although
specialists
surgery is the current guideline. !nother survey of pediatricians in 3anada found that only 4EI of respondents said they $new of sudden unexplained death in
epilepsy ( 7>,-)% a rare but serious complication of fre9uent sei)ures% and just HGI $new that children with epilepsy are at increased ris$ for sudden% unexpected% unexplained death.
health
children with epilepsy found that FEI wanted more training in managing the psychopathologies of pediatric epilepsy in order to play a more effective role in multidisciplinary care for such patients.(!merican ,pilepsy 0ut of all subjects% ociety% .('.) FF.HI (nNHH.) had a postgraduate
education% while ''.HI (nNG.) had only an undergraduate degree. The authors found that physical lower educators% scores on nutritionists their and
physiotherapists
received
epilepsy
$nowledge than other health professionals. 5ealth professionals are considered with better-educated regards to group inside issues. the society% it is
especially
healthcare
Thus%
47
epilepsy.
The
findings
of
the
present
study
indicate
an
imperative improvement in education about epilepsy% as well as an inclusion for of formal programmes for epilepsy !n an education in in
especially epilepsy
non-medical might
professionals. contribute to
improvement improvement
education
epilepsy care and management. (6ancini% .('.) #n the arm of the survey that focused on physician
attitudes toward referral of children for surgical evaluation% only H'I of respondents agreed that epilepsy surgery after 4 years of failed antisei)ure medication should be considered: E/I either disagreed or were unsure. !bout a 9uarter (.HI) felt patients in whom the $etogenic diet fails should be considered for surgery% with more than half (HEI) being unsure and .4I not thin$ing this would be helpful. 0nly E4I agreed that patients should be evaluated for surgery after failed vagus nerve
stimulation. -erhaps most concerning was that A4I of the survey population was unsure whether surgery would be effective for children with partial (or focal) epilepsy and GI didn"t thin$ this would be an effective option. RThis one really bro$e my heart%R said >r. -er$ins. R1ocal epilepsy surgery has the
highest positive response rates% and having two thirds plus of respondents saying they don"t agree with it or aren"t sure that it would be beneficial% tells me that we have completely failed
48
in
communicating
what
we
do
to
professionals
who
would
be
referring to us.R 7p to /(I of patients with partial epilepsy respond to surgery% noted >r. 5ovinga. !ll $ids with epilepsy should be considered for surgery% but that doesn"t mean all of them should get it% >r. -er$ins stressed. R#t"s important to identify children with intractable epilepsy who might benefit from surgery. De need to go bac$ to our baseline and reevaluate% especially as evolving technologies have rolled in% and we have better imaging and better diagnostic procedures determining if a particular person 9ualifies for surgery or not.RPust because a patient comes to an epilepsy center for an evaluation doesn"t mean that patient is removed from primary care. RDe"re here as an augmentation% if others want us to comanage or guide%R said >r. -er$ins. RThese patients need to be getting the evaluations and there"s a bloc$ in that process.R !s$ed about referring patients with generali)ed epilepsy for surgery% A'I of survey participants were unsure and .EI disagreed. !lthough such
referrals are Ra bit tric$ier than focal epilepsyR because the surgery may be for palliative care reasons% the surgery would still Rvastly improve 9ualify of life for many of patients and their families%R said >r. -er$ins. #ronically% more than half of the doctors agreed that surgery might improve 9uality of life for children. R#t"s another one of those discordancesR where doctors might thin$ a particular intervention might help but
49
they"re not sure about the specifics% said >r. -er$ins. 3hanging attitudes can be accomplished only through education% perhaps using webinars or other electronic tools% but most li$ely
through old-fashioned Rshoe leatherR -- getting in your car and visiting doctors in the field% said >r. -er$ins. R0n a local basis% it"s incumbent on us to reach out to our referral sources outside of neurology and neurosurgery who are nonepileptologists -- into the pediatrician and family practice offices -- and ma$e sure they understand these things.R(!nderson% .('.) 5ealth professionals need good s$ills in communication and patient education They play an essential role in educating
patients and families about the epilepsies and in directing them to accurate and s$ills% reliable and resources and tools #n to improve poor
$nowledge%
self-management.
contrast%
clinician-patient communication is a major barrier to patients" ability to successfully navigate the health care system% act on basic health health instructions% tudies and self-manage that chronic or other as
conditions.
indicate
patients
recall
little as half of what their physicians tell them during an outpatient appointment. -hysicians need to confirm that patients understand their condition (e.g.% specific sei)ure type%
epilepsy syndrome% sei)ure triggers)% how to carry out treatment and medication instructions% and ris$s associated with their
50
condition and nonadherence or discontinuation of their treatment regimen. 5owever% in one diabetes study% physicians assessed
patients" recall and comprehension of new concepts in only one in five patient encounters% even though such practices have been shown to improve clinical outcomes. Therefore% it is critically important that health professionals provide patients and their families with written information about their specific sei)ure type% epilepsy syndrome% and treatment plan to augment
discussions that happen in the clinical setting. #n order to educate patients and families effectively% health care providers and must be $nowledgeable information of and that ! s$illed meets 7B to in the
conveying and
preferences of both
patients. with
survey have
desire are
patients
epilepsy and
$nowledgeable
effective
communicators. #n addition% patient-rated 9uality of care also increases when health care providers use patient-centered
communication and shared decision ma$ing. it is important that health professionals learn how to
recogni)e
the
critical
junctures
for
patient
and
family
educationKat diagnosis% during the first year% when there is a change% in treatment options (e.g.% introduction%
51
understand the specific information needs and preferences of patients and their families and ta$e into consideration factors related to health literacy and culture% including cultural differences that may exist between them and their patients:
listen actively and put the patients and their needs first when providing education and counseling:
be
competent
in
patient
and
family
education to
and the
communication%
including
targeting
education
be
comfortable
discussing
ris$s
associated
with
the
7>,-% suicide%
and status epilepticus be aware of informational resources for patients and families that are available online and through local epilepsy organi)ations: and
promote
the
use
of
self-management
tools
and
programs.
!bout
.H
percent
of
individuals
begin
to
have
sei)ures
during puberty. There are also studies pointing to higher rates of sei)ures >r. osa among advised ?low-functioning@ her audience persons to treat with the
autism.
52
underlying cause of sei)ure in order to have good sei)ure control and thus improve the 9uality of life of the person affected. Dith other pediatric neurologists li$e her% 3N promotes and provides access to 9uality neurological
3N -
conducts
teaching
and
training
seminars
to
the
physicians as a way to improve the level of child neurology practice. #n partnership with organi)ations li$e !utism
ociety -hilippines% 3N - 3aravans already reached Naga% >agupan% amar and =ucena. >octors% parents% rural health
physicians% midwives and nurses are the target audience in each identified locality. The thrust of the caravan project is to teach the participants in in identifying and then to
disability
children
developmental
intervention
techni9ues
#n the -hilippines alone% F( percent of the population $now little about the disease. >espite affordable medicines%
some people resort to alternative solutions li$e exorcism or herbs from traditional healers. (www.thepoc.net)
8ore than two million people in the -hilippines -- about ' in 'H( -- have experienced an unprovo$ed sei)ure or been diagnosed with a sei)ure disorder. 1or about F( percent of
53
those diagnosed with a disorder% sei)ures can be controlled with modern medicines and surgical techni9ues.
5owever% about .( percent of people with a disorder will continue available to experience sei)ures >octors even call with this the best
treatment.
situation