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Epilepsy-Surgery, First aid, status epilepticus

Surgical management

Common surgical procedure for treatment of seizure is cortical exicision i.e lobectomy

When temporal lobe epilepsy, then resection of the antero-medial temporal lobe called mesial temporal lobectomy

If scar tissue or other focal epileptogenic area exists the identified lesion (lesionectomy) can be removed

A corpus callosotomy has been helpful in patients with tonic clonic seizures

A hemispherectomy is reserved for selected catastrophic infant and early childhood epilepsies

Other therapies

Vagal nerve stimulation

An electrode is surgically placed around the left vagus nerve in the neck. It is connected to a battery placed beneath the skin in the upper chest. This device is programmed to deliver intermittent electrical stimulation to the brain to reduce the frequency and intensity of seizures. Exact mechanism is unknown.

Biofeedback

It is aimed at teaching the patients to maintain a certain brain wave frequency that is refractory to seizure activity.

First Aid for Seizures

If you see someone having a seizure, take the following steps

  • Time the seizure with your watch.
  • Clear the area of anything hard or sharp.
  • Loosen anything at the neck that may impair breathing.
  • Turn the person onto his or her side.
  • Put something soft beneath the head.
  • Do not place anything inside the mouth.
  • Call Area Emergency Number, if a seizure lasts more than 5 minutes, recurs, or the person is pregnant or injured.

 

Patients with epilepsy may still have seizures due to

  • Failure to take medication correctly
  •  Variation in medication effectiveness
  •  Sleep deprivation
  •  Stress/ Illness
  •  Hypoglycemia/dehydration
  •  Alcohol/drug use or withdrawal
  •  Hormonal fluctuations
  •  Flashing lights or other triggers

Status epilepticus

Status epilepticus (acute, prolonged, repetitive seizure activity) is a series of generalized seizures without return to consciousness between attacks. The term has been broadened to include continuous clinical and/or electrical seizures lasting at least 5 minutes, even without impairment of consciousness. Status epilepticus is considered a serious neurologic emergency. It has high mortality and morbidity (permanent brain damage, severe neurologic deficits). Factors that precipitate status epilepticus in patients with preexisting seizure disorder include medication withdrawal, fever, metabolic or environmental stresses, alcohol or drug withdrawal, and sleep deprivation.

Management of status epilepticus

Medical management of Status epilepticus

  • Secure airway
  • Administer O2
  • Establish IV access
  • Regular monitoring
  • Administration of glucose ( 50ml of 50% solution) for hypoglycemia
  • Emergency AED (Automated Electrical Defibrillator) therapy
  • Treating cause
  • Involve anaesthetic

MANAGEMENT OF SEIZURES AND STATUS EPILEPTICUS IN AN ACUTE CARE SETTING

Before and during seizures

  • If the patient is seated when major seizure occur ease him or her to floor, if possible
  • If the patient experiencing aura have him or her to floor to prevent injury that might occur from falling to the floor.
  • Remove the patient eyeglassess and loosen nay constricting clothing.
  • Do not try to force any thing into mouth
  • Guide the movement to prevent injuries: do not try to restrain the patient
  • Stay with patient throughout the seizure to ensure the safety

After seizure

  • Position the patient on the side to facilitate drainage of secretion
  • Provide for adequate ventilation by maintaining the patent airway: suctioning may be neccessay to prevent aspiration
  • Allow the patent to sleep after seizure
  • On, awakening orient the patient (he or she may be amnesic about the event)

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