[Concept].
Epilepsy is a chronic disease in which sudden abnormal discharges of neurons in the brain cause transient brain dysfunction. Seizures are clinical phenomena caused by abnormal and excessive hyper-synchronous discharge of neurons in the brain and are characterized by sudden and transient symptoms. The abnormal discharge of neurons in the brain can be manifested in a variety of ways, depending on the location of the neurons, with or without changes in consciousness or alertness.
Triggering factors]
1, fever, excessive drinking, hyperventilation, alcohol consumption, lack of sleep, overwork and hunger (patients should be careful to avoid) can trigger seizures. Certain drugs such as meprobamate, promethazine, pentazocine or sudden withdrawal of antiepileptic drugs can also lead to seizures.
2, sensory factors: some patients are more sensitive to certain sensations such as vision, hearing, smell, taste, vestibular, somatosensory, etc., when stimulated can cause different types of seizures, called reflex epilepsy.
3, mental factors: some patients in strong emotional activity, mental excitement, frightened, calculation, chess, playing cards, etc. can promote seizures, called mental reflex epilepsy.
Clinical manifestations
According to the seizure situation, it can be divided into grand mal, petit mal, psychomotor seizure, restrictive seizure and complex partial seizure.
( 1) Grand mal seizures, also known as generalized seizures, half of them have aura, such as dizziness, confusion, epigastric discomfort, visual and auditory and olfactory disturbances. During the seizure (spasmodic seizure period), some patients first let out a sharp cry, then both lose consciousness and fall, there is general muscle tonicity, respiratory arrest, head and eyes can be deviated to one side, a few seconds later there is a clonic jerk, jerk gradually aggravated, lasting several seconds, the clonic period breathing recovery, foaming at the mouth (if the tongue is bitten to appear blood foam). Some patients have urinary and fecal incontinence, general relaxation after convulsions or go into lethargy (lethargic phase), after which consciousness gradually returns.
( 2) Petit mal seizures, which can be brief (2~15 seconds) with impaired consciousness or loss of consciousness without generalized spasms. There may be multiple seizures per day, sometimes with rhythmic blinking, head bowing, direct eye gaze, and upper limb twitching.
( 3) Psychomotor seizures may be sudden, with blurred consciousness, irregular and uncoordinated movements (e.g., sucking, chewing, searching, shouting, running, struggling, etc.). The patient’s movements are unmotivated, aimless, blind, and impulsive, and the seizures last for hours or sometimes days. The patient has no memory of the seizure.
( 4) Restricted seizures are usually seen in patients with organic damage to the cerebral cortex and are characterized by episodic twitching or sensory abnormalities in the corners of the mouth, fingers or toes, which may spread to one side of the body. When the seizure involves both sides of the body, it can be manifested as a grand mal seizure.
( 5) Complex partial seizures, subtype of seizures with impaired consciousness, can not recall the seizure, can also be manifested as staring and automatic symptoms such as smacking, chewing, groping, wandering, fiddling, humming, mumbling or other symptoms and signs
Care]
I. General care
Keep the environment quiet and safe. Keep indoor hot water kettles, stoves, sharp instruments, etc. away from the patient and avoid bright light stimulation. During a seizure, there should be someone to take care of the patient and protect him/her from falling out of bed and bruises. During the interval, you can get out of bed and rest in bed immediately after the onset of aura.
Eat a light diet with less spicy food and avoid overfeeding. If you are unable to eat due to frequent seizures, give nasal feedings of fluids and provide a daily caloric intake of 12,500 kJ (3,000 kcal). Salt intake should be low, and water intake should be limited to no more than I 500ml in 24 hours.
Psychological care
Epileptic patients are often distressed by taking medication, and if they take one less medication there is a possibility of morbidity, so the mental burden is increased, so they often have low self-esteem, loneliness, pessimism and other abnormal mentality. The patient should face the reality and be prepared to fight with the disease for a long time, encourage the patient to understand himself correctly, have good psychological quality, try to eliminate the triggering causes, and accept the treatment with optimism.
Third, the condition of observation
Closely observe the patient’s seizure type, observe the time, number, duration and interval of seizures, respiratory rate and state of consciousness during seizures. Record in detail the site and sequence of seizures in order to provide a basis for diagnosis and treatment.
Closely observe the aura manifestations of seizures. If an aura is found, quickly have the patient lie flat on the bed or lie down on a flat floor nearby. If it is too late to make the above arrangement, when you find that the patient is going to fall, you should quickly help the patient and let him/her fall down in a cis style to prevent him/her from falling down suddenly by himself/herself.
After the grand mal convulsions stop, the patient can only return to normal for a few hours. The patient is in a sleeping state and needs quiet rest.
IV. Therapeutic care
Some anti-epileptic drugs have damage to liver and kidney function, such as phenobarbital, sodium phenytoin, sodium valproate, etc. After taking the medication as prescribed, the patient should be observed for drug side effects after medication, such as nausea, vomiting, decreased appetite, general malaise, weakness, lethargy, etc., suspected liver damage. Blood biochemistry should be checked promptly.
Anti-epileptic drugs are mostly organic compounds synthesized by industry and should be observed for allergic reactions. In mild cases, skin rash, drug rash, and urticaria may appear 1 to 2 weeks after taking the drug. The rash is more frequent on the face, itchy, red and discolored by pressure. In severe cases, metabolic reactions can occur, hypothermia, leukopenia, and even exfoliative dermatitis.
[Care of grand mal seizures]
1. In case of grand mal seizure, first of all, protect the tongue and place the gauze wrapped pressure plate between the upper and lower molars of the patient to avoid biting the tongue and cheek and avoiding posterior tongue drop. If you fail to put it in before the seizure, put it in when the patient opens his mouth in the tonic phase, and do not force it in the clonic phase to avoid hurting the patient.
2. Immediately give anti-epileptic drugs or sedative drugs.
3, immediately give the seizure period to lie down, loosen the collar, head turned to the side, dentures should also be removed to facilitate the discharge of respiratory secretions and vomit, to prevent choking and suffocation caused by inflow into the trachea. The respiratory secretions are more during grand mal seizures, which can easily cause respiratory obstruction or aspiration pneumonia. Do not stuff anything in the mouth during convulsions and do not instill drugs to prevent asphyxiation. And give oxygen continuous inhalation. If there is respiratory distress, those who do not breathe on their own should do artificial respiration, and if necessary, perform tracheotomy.
4, the patient’s head is tilted back excessively during the ankylosis period, and the jaw is over-opened, which can cause cervical compression fracture or dislocation of the jaw. At this time, one hand should hold the patient’s occipital area with slight force to stop the neck from hyperextending, and one hand should hold the jaw to counteract the jaw from hyperextending.
5. Do not press the patient’s limbs to avoid artificial injury or fracture of muscles and joints. Strengthen protection to avoid accidents due to falling from the bed. Record the form and frequency of seizures and medication in detail on the care sheet.
[Health education].
Pay attention to avoid the following points.
①Sudden change in climate.
②Sudden mental stimulation.
③Strong sound stimulation.
④Strong light stimulation.
⑤Drug stimulation, etc. These factors are very likely to cause sudden seizures.
The active cooperation of the patient and family members is the basic guarantee for the treatment of epilepsy. They are encouraged to adhere to the treatment and take long-term medication under the guidance of the physician. It is also necessary to further search for the cause of the disease in order to treat it symptomatically.
The patient should be advised not to engage in overhead work or diving, driving, or working beside dangerous machines, etc., and to maintain an optimistic mood. Life and work should be regular and avoid overexertion. If there is any change in the condition, the patient should be rechecked at any time.
If not treated in time, cerebral edema, brain herniation, respiratory and circulatory failure and death may occur. Therefore, family members should be informed that once a patient is found to have persistent epilepsy, he or she should be sent to the hospital immediately.