epilepsy & brain neoplasm

CARE OF PATIENT WITH
EPILEPSY & BRAIN NEOPLASMS

BY
PUAN WAN NAPISAH BINTI WAN

OMAR
NUR 2173

LEARNING OBJECTIVES

At the end of this session, students will be able
to:
1. Define the term of epilepsy, seizure & status

epilepticus.
2. Describe the etiology of epilepsy and brain neoplasms.
3. Identify the types of seizure.
4. Elaborates the characteristic of Grand Mal seizure.
5. Identify the diagnostic test & complications of epilepsy.
6. Describe the classification, signs & symptom of brain

neoplasms.
7. Explain the important of proper management in order

to reduce the motility & morbidity due to brain
damage.

EPILEPSY

• “A seizure results when a
sudden imbalance occurs
between the excitatory and
inhibitory forces within the
network of cortical neurons
in favor of a sudden-onset
net excitation”

Pelepasan saraf excitatory,

• sebagai contoh, neurotransmiter glutamatergik yang
mengikat kepada reseptor dalam neuron selepas
sinaptik dan mencetuskan perubahan positif dalam

potensi membran di neuron tersebut.

Pelepasan saraf inhibitory,

• sebagai contoh, neurotransmiter g-Aminobutiric
(GABA) yang mengikat kepada jenis reseptor yang
berlainan dalam neuron post sinaptik dan
mencetuskan perubahan negatif dalam potensi
membran.

EPILEPSY

• Epilepsy occurs when permanent changes in
brain tissue cause the brain to be too excitable
or jumpy.

• The brain sends out abnormal signals.
• This results in repeated, unpredictable

seizures.

ETIOLOGY OF EPILEPSY

• The exact cause of a seizure can be extremely
difficult to pinpoint. John Hopkins Epilepsy Center
divides seizures into two categories: provoked and
unprovoked.

• The etiology of provoked seizures can include:
trauma, drugs or alcohol, tumors, medications, drug
withdrawal, progressive brain disease, and more.

• The etiology of unprovoked (or “natural”) seizures
can include: fever, infection, metabolic issues,
genetics, Alzheimer’s disease, and more

TYPES OF SEIZURE

1. Generalized Seizures:
– Tonic-clonic (grand mal)- most common subtype, arms
and legs get stiff, and may stop breathing for a bit. Then
limbs will jerk around and head will move about, as well.
– Absence seizures (petit mal)- lose awareness briefly.
Incidence in children are more often than adults.
Typically, it will last only a few seconds.
– Febrile seizures - These are convulsions a child may have
from a high fever caused by an infection. They can last a
few minutes but are usually harmless.

TYPES OF SEIZURE

2. Partial (Focal) Seizures:
Focal onset aware seizure
– patient will remain conscious. The seizure is very brief
(usually less than 2 minutes). Patient may or may not be
able to respond to people while it's happening.
Focal onset impaired awareness seizures
– can cause unconsciousness. Patient may also do things
without knowing it, like lip smacking, chewing, moving
your legs, or thrusting your pelvis.

GRAND MAL SEIZURE

• Characterized by three phases:

1. Preictal phase.
2. Tonic-clonic phase.
3. Postictal phase.

PREICTAL PHASE

• Consists of vague emotional changes (depression,
anxiety, nervousness).

• Lasts for minutes to hours. Followed by an "aura."
• Aura is usually a sensory "cue" (odor or sound) or

sensation "cue" (weakness, numbness). It is related
to the anatomical origin of the seizure, and warns
the patient that a seizure is imminent.
• Preictal phase may or may not be present in all
patients.

TONIC-CLONIC PHASE

• Loss of consciousness.
• Skin may become cyanotic, breathing is spasmodic,

jaws are tightly clenched, and tongue and inner teeth
may be bitten.
• Urinary and fecal incontinence usually occur.
• Phase may last one or more minutes.
• Tonic activity is characterized by rigid contraction of
the muscles.
• Clonic activity is characterized by alternate
contraction and relaxation of muscles, causing
jerking movements of the arms and legs.



POSTICTAL PHASE

• Phase will vary in symptoms.
• Many patients fall into a deep sleep which

may last for several hours.
• Patient may experience headache, fatigue,

confusion, and nausea.

STATUS EPILEPTICUS

• Status Epilepticus was define as a condition
which “more than 30 minutes of continuous
seizure activity or two or more sequential
seizures without full recovery of
consciousness between seizures.”
(Epilepsy Foundation, 2012)

DIAGNOSTIC TEST FOR EPILEPSY

• EEG
• Blood chemistry
• Blood sugar
• CBC (complete blood count)
• Kidney function tests
• Liver function tests
• Lumbar puncture (spinal tap)
• Head CT or MRI

MANAGEMENT OF EPILEPSY

• Medication : Anticonvulsant
• Surgery
: to remove the abnormal brain
cells causing the seizures.

: to place a vagus nerve
stimulator (VNS) that help to
reduce the number of
seizures.

COMPLICATIONS OF EPILEPSY

• Difficulty learning
• Aspiration pneumonia
• Injury
• Permanent brain damage
• Side effects of medications

NURSING MANAGEMENT OF

EPILEPSY

• Advice patient that medication:

– Anticonvulsant is taken orally.
– Dosage may need to be changed from time to time.
– need regular blood tests to check for side effects.
– Compliance on medication’s regime.
– Never stop or change the medications without doctor’s

order.

• Instruct patient to keep record of events surrounding
his/her seizures (number, duration, time,
sleep/eating patterns).

NURSING MANAGEMENT DURING
EPILEPSY

• Place a padded tongue blade and oral airway.
• Turn patient on his side to provide for

drainage of oral secretions.
• Perform suctioning.
• Provide oxygen.
• Do not forcibly restrain patient during seizure.
• Remove objects that may obstruct breathing

or cause injury to patient.

NURSING MANAGEMENT DURING
EPILEPSY

• Protect patient's head from injury with pillow,
blanket, etc.

• Keep bed flat and patient turned on his side
until he is alert.

• Room lighting should be dim and noise kept to
a minimum.

• Loosen restrictive clothing (if not done during
seizure).

NURSING MANAGEMENT DURING
EPILEPSY

• Check vital signs immediately following
seizure and every 30 minutes (or as ordered)
until patient is alert.

• Check lips, tongue, and inside of mouth for
injuries.

• If patient is incontinent, change clothing and
bedding with as little disturbance as possible.

NURSING MANAGEMENT DURING
EPILEPSY

• Document all precautions taken.
• Document all activity observed during a

seizure, to include the time, location,
circumstances, length of seizure activity, and
vital signs.
• Document any injury sustained during a
seizure.

BRAIN NEOPLASMS

• Brain tumors may originate from neural
elements within the brain, or they may
represent spread of distant cancers.

• Primary brain tumors are commonly seen in
children under 15 years of age and in middle-
aged adults.

• Secondary brain tumors are commonly seen in
adults.

CLASSIFICATION OF BRAIN

NEOPLASMS

• 40% of all brain neoplasms originate from cells called
glial cells, giving the name gliomas.

– E.g. astrocytoma, glioblastoma, oligodendroglioma,
ependymoma, and medulloblastoma.

• 20% of brain neoplasm called meningioma and
schwannomas originate from the brain's supporting
connecting cells.

• 25% of brain tumors have spread from another
location.

Brain Neoplasm

ETIOLOGY OF BRAIN NEOPLASMS

• Idiopathic Being
• Radiation studied, but
• Genetic damage no definite
• Inheritance
• Defective immune system data are
• Viruses known at this
• Chemicals exposure
time

SIGNS & SYMPTOMS OF BRAIN
NEOPLASMS

• Headache (usually occur in the early morning

hours, sometimes waking the patient up, and worsen

with coughing or sneezing)
• Seizure
• Change in behavior
• Difficulty with speech, memory, or

concentration
• Confusion

MANAGEMENT OF BRAIN
NEOPLASMS

• Surgical removal of primary brain tumors is
the usual recommendation.

• Radiation is another form of treatment for
primary brain tumors.

• Antiseizure medication, such as phenytoin.
• Steroid medication such as Dexamethasone

(help to reduce cerebral edema)