You are on page 1of 44

13

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.

ynapse is the junction between two neurons where

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

Pathophysiology $%runner and Suddhart&s' 2(!2)

&is$ 1actors* 2enetics 3hildhood abuse or trauma to the head ,nvironmental

3ells send electrochemica l signals even after the tas$ is done

The brain sending out abnormal signals to the erratic cells

ei)ure activity

ending abnormal brain signals/chemic al disturbance

,rratic cells perform erratically

3ontinuous sei)ures% ,pilepsy

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*

! very high fever of 4/.'

2enetics ei)ure !ctivity &igid body parts and loss of consciousness

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

Diagnostic .est $%oo+ %ase) 556

!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

bloodstream% generate gathered

releasing of your

energy. brain the

3omputers activity%

images from

measuring

released

energy.

enables doctors to determine where your sei)ures occur. C. Scan

! 3omputed !xial Tomography scan (3!T or 3T scan) is a non-invasive and painless test. 3T scans produce cross-

sectional images (tomographs) of areas in your body that

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

signals through changes in blood flow.

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

-rovide ongoing assessment and monitoring of cardiac and respiratory functions.

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

must be ta$en on a continuing basis and is not habitforming.

27

!ssess lifestyle and environment to determine factors that precipitate sei)ures% such as emotional onset to of

disturbances% menstruation% such stimuli. ,ncourage routine

environmental or fever.

stressors% patient

,ncourage

avoid

patient in

to

follow

regular

and

moderate excessive sleep

lifestyle% exercise

diet and

(avoiding rest

stimulants)% patterns). !dvise bright

(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.

#nstruct patient to notify physician if unable to ta$e medications due to illness.

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:

provide facts concerning epilepsy. #nstruct patient to carry an emergency medical

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

administered sei)ures. 2eneral

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

Surgical 7anagement urgery is indicated when epilepsy results from

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

.a#le 9" Drug Study

>&72 N!8, -henobarbit al A(mg 'tab/day

!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

N7& #N2 30N #>,&!T#0N


30 +efore ta$ing phenobarbital % tell your doctor or pharmacist if you are allergic to it: or to other barbiturates (such as primidone% secobarbital) : or if you have any other allergies. This product may contain inactive ingredients% which can cause allergic reactions or other problems.

3,NT&!= N,&607 < T,8 !2,NT: !NT#30N67= !NT : ,>!T#6,5<-N0T#3: +!&+#T7&!T,

31

Nursing Care Plan .a#le :

32

Assessment

Diagnosis

Outcome Planning 8dentification

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.

Bnowledge >eficiency of the >isease -rocess

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.

0bjective* 0verprotection of the client tressed out as manifested by restlessness

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

nanginig Cyung ana$ $o@% as verbali)ed by the client;s mother.

related to loss of large muscle coordination .

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.

the various stimuli that may precipitate sei)ure activity.

>iscuss sei)ure warning signs and usual sei)ure signs

interventions % the patient was able to demonstrate behaviors% lifestyle changes to reduce ris$ factors and protect her son from injury.

2oal met. ,valuate need for protective head gear

8aintain strict bed rest if prodromal signs or aura experienced

35

&eorient patient following sei)ure activity

3ollaborative * !dminister medications as prescribed

36

Review of Related 1iterature oreign 1iterature ,pilepsy is recogni)ed as a collection of heterogeneous

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

cerebral hemispheres from the onset of the sei)ure.

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

unfairly affect many people with epilepsy.

uch pervasive social

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

compared with that of the general population% we surveyed all

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

treated with medicine.

ome will even improve from complicated

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

parents was also found to be beneficial% according to a report

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%

!nalytical. The !nnual -hilippine

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

4rd place &is$

!nalytical for the

for

entitled%

1actors

>evelopment of in a Tertiary

ei)ures and ,pilepsy among -ost 5ospital* ! &etrospective

tro$e -atients tudy. >r

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

presentation 3onvention. entitled

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

oreign Study -rimary care physicians% including pediatricians% admit

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.

pecialists say that awareness of ! third survey of behavioral

7>,- is vital. professionals who treat

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%

important they also have an accurate and correct $nowledge about

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

communicating individual highlighted physicians

conveying and

needs the who

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%

switch% discontinuation)% or when a new concern develops:

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

specific needs of the patient:

be

comfortable

discussing

ris$s

associated

with

the

epilepsies and their treatments including

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.

( tuart% 8uir% .((F) 1ocal Studies

!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

healthcare for 1ilipino children.

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

neurodevelopmental providing basic

disability

children

developmental

intervention

techni9ues

the community(8anila +ulletin% .('.).

#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

intractable epilepsy (-hilippine 3enter for ,pilepsy% .('.).

You might also like