Epilepsy

Epilepsy is a neurological disorder characterized by recurrent unprovoked seizures (Blume et.al, 2001) due to abnormal, excessive or synchronous neuronal activity in the brain (Fisher et.al, 2005). Epilepsy can be best understood as a group of syndromes with vastly divergent symptoms all involving episodic abnormal electrical activity in the brain. Nurse care in Epilepsy is useful in assessing symptoms, diagnosis, tests and risk management (Ridsdale et.al, 2002).

Epilepsy Nurse Role

Epilepsy Nurses are modern day professionals who play a pivotal role in providing coordinated care and education to patients with complex uncontrolled Epilepsy. Recently, Specialist Epilepsy Nurses have become an integral part of the Epilepsy care team. These Specialist Nurses advise patients on diagnosis and antiepileptic drug changes (Hosking, 2003). Investigations on the effectiveness of Epilepsy Nurses in primary care also suggest that Epilepsy Nurse Interventions are highly useful (Scambler et.al, 1996).

Epilepsy Nurses identify and document seizure activity, perform appropriate interventions, recognize signs of AED toxicity and share the responsibility of taking care of Epilepsy patients (Long and McAuley, 1996). A study to demonstrate the effectiveness of the implementation of the Acute Care Nurse Practitioner (ACNP) role in the management of patients with seizure disorders in an Epilepsy Monitoring Unit has shown that the ACNP can make a substantial contribution to patient outcomes through patient satisfaction and reduction in the number of laboratory tests performed, hospital length of stay, and overall costs (Sarkissian et.al, 1999). Evidence from controlled clinical trials suggests that Epilepsy patients cared by a nurse are well informed and have a high degree of satisfaction (Greenhill, Betts and Pickard, 2002).

Epilepsy Nurse Care

Since, Epilepsy patients receive chronic treatment from a primary care provider rather than a neurologist, an understanding of the fundamental aspects of Epilepsy diagnosis and treatment can provide optimal patient care (McElroy-Cox, 2007). Epilepsy nurse care includes dissemination of accurate information to the clients, performing Epilepsy Audit towards creation of a profile of Epilepsy in general practice to improve care and devising treatment plans and goals (Smith, 1995). A study to test the hypothesis that structured Epilepsy nursing improves quality of life in one hundred fourteen adult patients with uncontrolled Epilepsy has shown that nurse-led intervention programs in Epilepsy care has a significant effect in quality of life of patients with Epilepsy (Helde et.al, 2005).

Care for Epileptic Adults

Epilepsy is a chronic condition in adults and the nurse plays an advisory and educational role acting as a facilitator to assist adults to self-manage their Epilepsy (Hayes, 2004). The risk of seizure recurrence is greatest in the first six months after the initial episode and hence it is important for the nurse to take into account differential diagnosis, factors that induce symptomatic seizures and risk factors for Epilepsy (Long and Adams, 2000). The aim of any Epilepsy nurse intervention is rapid and complete control of seizures without or minimum antiepileptic drug (AED) side effects. AEDs cause paradoxical reactions and AED dose changes often worsen seizures (Hosking, 2004).

Acute repetitive seizures, also known as Cluster or Serial Seizures, pose serious health risks, including Death. Drugs such as rectal diazepam, phenytoin and valproate sodium solution are used typically in such conditions (Shafer, 1999).  Non-compliance with antiepileptic medication regimens has been identified as a leading cause of treatment failure. A Health Promotion Model called Pender's Model has been evaluated recently to provide a framework for nurses to identify factors that interfere with the patient's ability to practice medication compliance and develop suitable treatment plans (Lannon, 1997). Status Epilepticus refers to a life-threatening condition in which the brain is in a state of persistent seizure. During the acute phase of Status Epilepticus, the nurse needs to constantly assess neurological and collaborative interventions to complete the treatment regimen for the patient. Nurse interventions are directed toward maintaining optimal physiological functioning and preventing psychological stress (Waddell, 1983).

Care for Epileptic Women

In woman, Epilepsy affects sexual development, menstrual cycle, contraception, fertility and reproduction. The use of antiepileptic drugs (AEDs) alters the menstrual cycle and fertility. Pregnant woman with seizure disorder face possible risks of increased seizure frequency, reduced anti-epileptic drug levels and life-threatening Status Epilepticus (Gaffney, 1990). The lowest effective dose of the most appropriate AED should be used during pregnancy with preference to monotherapy. Women with Epilepsy have additional concerns and face special challenges during pregnancy and postpartum period. Nurse care for this special population help and provide for the safety of these women and their infants. Nurse care includes management of medication, providing additional rest, seizure precautions and implementation of discharge instructions (Rousseau, 2008).

Although the total amount of drug transferred to infants via breast milk is usually much smaller than the amount transferred via the placenta during pregnancy, repeated administration of a drug such as lamotrigine via breast milk often leads to drug accumulation in the infant. Such women may experience worsening of their seizure disorder during menopause and hormone replacement therapy has been shown to be significantly associated with an increase in seizure frequency during menopause, especially in women with Catamenial Epilepsy. Women with Epilepsy are also at increased risk of Fractures, Osteoporosis and Osteomalacia (Crawford, 2005).

Pediatric Epilepsy Care

In the Pediatric Epilepsy Monitoring Units (PEMU), patient care is optimized through the design of the unit, nurse and family education, communication, and medication administration (Perkins and Buchhalter, 2006). Recent research to establish frequency and type of Epilepsy, time of duration and efficacy of treatment in hospitalised children in a sample of 1505 children with Epilepsy, aged 1 month to 18 years between 1996 and 2004 has shown that the majority of cases of Epilepsy in hospitalised children are related to Epilepsy during first two years of life and to first year duration of the illness. Continuous access to pediatric neurologists and experienced nurse teams reduces the frequency (Kroczka et.al, 2005).

Recent Trends

Nurse run Epilepsy Clinics and Services have become a trend setter for all Nurse led services. A randomised controlled trial study to test the feasibility and effect of Nurse run Epilepsy Clinics in primary care has shown that such clinics for patients with Epilepsy are feasible, well attended and significantly improve the level of advice and drug management (Ridsdale et.al, 1997).

Conclusion

Epilepsy is a chronic condition with a profound effect on the quality of life. Dorothea Orem defines nursing with emphasis on client's self-care needs. Self-management techniques for Epilepsy should include interventions that enhance seizure control, minimize side effects and risks, promote adaptation and enhance quality of life involving assessment of a variety of factors. Nurse-led intervention programs in Epilepsy care have a significant effect in quality of life of patients with Epilepsy. By identifying and addressing the needs of Epileptic clients, nurses can make a difference in the care process.

 

References

• Amy M. Perkins; Jeffrey R. Buchhalter (2007). Optimizing Care in the Pediatric Epilepsy Monitoring Unit. The Journal of Neuroscience Nursing. Posted 03/29/2007.
• Annette Scambler, Graham Scambler (1996). Towards An Evaluation of the Effectiveness of an Epilepsy Nurse in Primary Care. Seizure. 5(4); 255-258.
• Blume W, Lüders H, Mizrahi E, Tassinari C, van Emde Boas W, Engel J (2001). Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology.. Epilepsia 42 (9): 1212-8.
• Crawford P (2005). Best Practice Guidelines for the Management of Women with Epilepsy. Epilepsia.46 Suppl 9:117-24.
• Fisher R, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J (2005). Epileptic seizures and epilepsy: definitions proposed by the International League against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46 (4): 470-2.
• Gaffney SE (1990). Seizure Disorders and Pregnancy. NAACOGS Clin Issu Perinat Womens Health Nurs. 1(2):146-53.
• Greenhill L, Betts T and Pickard N (2002). The Epilepsy Nurse Specialist--Expendable Handmaiden or Essential Colleague? Seizure.11 Suppl A: 615-20; quiz 623-4.
• Hayes C (2004). Clinical Skills: Practical Guide for Managing Adults with Epilepsy. Br J Nurs.13(7):380-7.
• Helde G, Bovim G, Bråthen G and Brodtkorb E (2005). A Structured, Nurse-Led Intervention Program Improves Quality Of Life In Patients With Epilepsy: A Randomized, Controlled Trial. Epilepsy Behav. 7(3):451-7.
• Hosking (2003). Prescribing and the epilepsy specialist nurse.  Seizure. 12(2); 74.
• Hosking PG (2004). The Specialist Nurse Role in the Treatment of Refractory Epilepsy. Seizure.13(5):303-7.
• Kroczka S, Lankosz-Lauterbach J, Wesołowska E and Kaciński M (2005). Status Epilepticus in Hospitalized Children. Przegl Lek.. 62(11):1253-7.
• L Ridsdale, D Robins, C Cryer and H Williams (1997). Feasibility and Effects of Nurse Run Clinics for Patients with Epilepsy in General Practice: Randomised Controlled Trial. BMJ .314:120.
• Lannon SL (1997). Using a Health Promotion Model to Enhance Medication Compliance. J Neurosci Nurs.29(3):170-8.
• Long L and Adams C (2000). Evaluation of a Single Seizure: Guidelines for Advance Practice Nurses. J Am Acad Nurse Pract. 12(4):141-5.
• Loughran S and O'Brien D (2002). Epilepsy Liaison Nursing. Nurs Times. 13; 98(10):32-4.
• McElroy-Cox C (2007). Caring For Patients with Epilepsy. Nurse Pract. 32(10):34-40; quiz 40-1.
• Perkins AM and Buchhalter JR (2006). Optimizing Patient Care in the Pediatric Epilepsy Monitoring Unit. J Neurosci Nurs.38(6):416-21, 434.
• Ridsdale L, Kwan I and Morgan M (2002). How Can Nurse Intervention Help People With Newly Diagnosed Epilepsy? A Qualitative Study. Seizure. 11(1):1-5.
• Rousseau JB (2008). Meeting the Needs of the Postpartum Woman with Epilepsy. MCN Am J Matern Child Nurs.33(2):84-9.
• Sarkissian, Sonia, Wennberg and Richard (1999). Effects of the Acute Care Nurse Practitioner Role on Epilepsy Monitoring Outcomes. Outcomes Management for Nursing Practice. 3(4):161-166.
• Shafer PO (1999). New Therapies in the Management of Acute or Cluster Seizures and Seizure Emergencies. J Neurosci Nurs.31(4):224-30.
• Smith K (1995). Bringing Epilepsy Care into the 1990s. The Epilepsy Liaison Service. Prof Nurse.10(4):255-8.
• Waddell GH (1983). Status Epilepticus: Nursing Management. Adv Neurol. .34:405-9.

 

Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved