INTRODUCTION
The purpose of Case Study: Epilepsy is to provide an understanding of the basic principles involved in the drug treatment of epilepsy, including factors to consider in the initiation and assessment of AED therapy. On 29th January 2014 around 2.15 am, there is a patient admitted in ward 7 (Medical) from A&E Department due to epilepsy. Basically, epilepsy is group of related disorders characterized by a tendency for recurrent seizures. Nurses play an important role in managing patients with Epilepsy. From teaching patients about how to modify their risk factors, administering various medications, and providing pre- and post- care to patients undergoing epileptic action, nurses are in an important position to improve the outcomes of patients experiencing it.
PATIENT’S DATA AND HISTORY
Patient C is a male and Malay, 21 years of age, with a history of seizures since birth. He is otherwise in good health. His current diagnosis is temporal lobe epilepsy. Patient C experiences focal seizures (“complex partial” and focal seizures that evolve bilaterally). He states the he is aware that a seizure is going to occur because he has a very brief “strange sensation”. This sensation is his aura. After the aura, the patient cannot recall any other events until the postictal period. During the postictal period, patient C is fatigued and confused and often experiences headaches. Witnesses have noticed a typical pattern to patient C’s seizures. First, he becomes very quiet and blank. He’ll not communicate or respond to other individuals. He experiences vocalizations and yell in a very loud voice, “Ya Allah”. During the vocalizations, patient C will experience automatisms that include pulling at her clothing. Usually, the seizure ends after approximately 60 seconds, and he regains consciousness within several minutes. At other times, the seizure will evolve, and he’ll experience tonic posturing followed by clonic movement. The tonic-clonic phase is quite severe and may last several minutes. The postictal period after the evolved seizure is prolonged and may last for several hours. Patient C experiences disorientation, confusion, and somnolence. He has experienced status epilepticus twice in the past. Status epilepticus is a continuous convulsion lasting longer than 30 minutes. At time, patient C’s seizures occur almost every day. However, some days will be seizure free, and he may have several days at a time with no seizure events. Unfortunately, this does not occur consistently. Most days he will experience at least one seizure, and often he has several during the same day. Patient C is very compliant with his medications. Patient C has no family history of epilepsy, and he has not had any surgical treatments. He is a very responsible man and does not use nicotine products, drink alcohol, or use illicit substances. Patient C has been on a number of AEDs in the past, including phenytoin, Phenobarbital, valproic acid and experimental medications. He also takes an over-the-counter multivitamin and Acetaminophen for headache.
PATHOPHYSIOLOGY
Clinical
Onset

When the electrical discharges of a large number of cells become abnormally linked together, creating a storm of electric activity in the brain
When a small group of abnormal neurons undergo prolonged depolarizations associated with the rapid firing of repeated action potentials

Spread to involve adjacent areas of the brain or through established anatomic pathways to other distant areas
Abnormally discharging epileptic neurons recruit adjacent neurons which they are connected into the process

EPILEPSY

Sign and symptoms: 1. Tonic phase a. Fall, loss of consciousness, yell or “tonic cry”, focal abnormalities b. Extension of arms, legs, and/or face, fingers and jaw clenched c. Autonomic symptoms: Increase in blood pressure, heart rate and bladder pressure, flushing, sweating, so that the increased salivation and bronchial secretion, be removed and apnea 2. Clonic phase d. Muscles relax completely, then muscle tone returns which causes rhythmic jerking of head and body 3. Postictal phase e. Biting of the tongue, cheek or lip, and urinary incontinence are common

MEDICAL MANAGEMENT 1. Neurologic examination * To test the behaviour, motor abilities, mental function and other areas to diagnose patient C’s condition and determine the epilepsy type 2. Blood tests * To check for sign of infections, genetic conditions or any other conditions which leads with seizures 3. Computerized tomography (CT Scan) * To obtain cross-sectional images of the brain, this can reveal abnormalities. 4. Medications a. Valproic acid * To treat temporal lobe epilepsy and tonic-clonic seizures * Check for hypersensitivity, and adverse effect b. Valium * To treat tonic-clonic seizures * Monitor patient for adverse reactions, increase in frequency, decreased drug effectiveness c. Carbamazepine 200 mg * To treat temporal lobe epilepsy * Observe for mental state changes, allergies and leucopenia