EPILEPSY Lesson Plan
EPILEPSY Lesson Plan
EPILEPSY Lesson Plan
LESSON PLAN
ON
EPILEPSY
Mr.Vijay.K
Tutor in CHN Dept,
ICON
GENERAL OBJECTIVE:
The student will acquire knowledge about the topic “Epilepsy” and develop desirable attitude and skills towards the topic
and in future practice.
SPECIFIC OBJECTIVES
Before entering into the topic I will give you some clue so that you can guess today topic.
A condition in which muscles contract and relax quickly and cause uncontrolled shaking of the body
YES!!!! SEIZURE
EPILEPSY
1 2mins discuss the INTRODUCTION Teacher : Black Discuss the
overview of Teaching Board overview of
The word convulsion (or seizures) describes an involuntary violent
epilepsy Learner : epilepsy?
spasms, or a series of jerking of face, trunk, or extremities with or Listening
without loss of consciousness, sensory, autonomic or behavioural
disturbances.
The word epilepsy describes a syndrome of recurrent unprovoked,
seizure unrelated to fever or to acute “ cerebral insult.”
In general: a convulsive or seizure is a paroxysmal manifestations of
neurological dysfunction.
2 5 mins define DEFINITION Teacher : Black Define
epilepsy Teaching Board epilepsy?
Epilepsy is a chronic disorder characterized by recurrent
Learner :
unprovoked paroxysmal seizure. Listening
Seizure is transient occurrence of signs and or symptoms due to
abnormally excessive or synchronous neuronal activity in the brain
Seizures or convulsion are paroxysmal episodes involve sudden,
violent, involuntary contraction of a group of the skeletal muscles
and disturbances in consciousness, behavior, sensation and
autonomic functioning.
Seizures are sudden, abnormal electrical discharges from the brain
that result in changes in sensation, behavior, movements,
perception, or consciousness.
Electrolytes imbalance
5 5 mins list out the ETIOLOGY: Teacher : Black List out the
causes of Teaching Board causes of
Acute (Non-recurrent)
epilepsy Learner : epilepsy?
Febrile episodes Listening
Intracranial infection
Intracranial hemorrhage
Cerebral edema
Brain tumors
Space occupying lesions (cyst &tumor)
Anoxia
Toxins &drugs
Shigella, Salmonella organisms
Tetanus
Chronic(recurrent)
Idiopathic
Epilepsy secondary to
Trauma
Hemorrhage ,anoxia
Infections
Toxins
Congenital defects
Epilepsy stimulating states such as,
Narcolepsy & catalepsy
Psychogenic
Uremia
Allergy
Migraine
Characterized by :
Onset usually between 4 and 12 years of age.
More common in girls than in boys.
Usually cease at puberty.
Brief loss of consciousness.
Abrupt onset ; suddenly develops 20 or more attacks daily.
Day dreaming
Events possibly precipitated by hyperventilation ,
hypoglycemia, stresses ,fatigue or sleeplessness.
Manifestations :
Brief loss of consciousness .
Appear without warning or aura.
Usually last about 5 to 10 seconds.
Slight loss of muscle tone may cause child to drop objects.
Minor movements such as lip smacking , twitching of
eyelids or face or slight hand movements.
Amnesia for episode.
Characterized by :
Onset usually between 2 and 5 years of age.
Sudden , momentary loss of muscle tone and postural
control.
Events recurring frequently during the day, particularly in
the morning hours and shortly after awakening.
Manifestations:
Loss of tone causing child to fall to the floor violently;
unable to break fall by putting out hand; may incur a
serious injury to the face ,head or shoulder.
Loss of consciousness only momentary.
Myo-clonic Seizures
A variety of seizures episodes
May be isolated as benign essential myoclonus.
May occur in association with other seizure forms.
Characterized by :
Sudden, brief contractures of a muscle or group of
muscles
Occur singly or repetitively.
No post- ictal state.
May or may not be symmetric.
May or may not include loss of consciousness.
Infantile Spasms:
Also called infantile myoclonus, massive spasms, salaam
episodes or infantile myoclonic spasms.
Mostly commonly occur during the first 6 to 8 months of
life.
Twice as common in boys as in girls.
Numerous seizures during the day without post-
ictaldrowsiness or sleep .
Poor outlook for normal intelligence.
Manifestations:
Possible series of sudden, brief, symmetric ,muscular
contractions.
Head flexed ,arms extended and legs drawn up.
Eyes sometimes rolling upward or inward.
May be preceded or followed by a cry or giggling.
May or may not include loss of consciousness .
Sometimes flushing, pallor or cyanosis.
8 2 mins outline the DIAGNOSTIC EVALUATION: Teacher : Black Outline the
diagnostic Teaching Board diagnostic
Establishing a diagnosis is critical for establishing a prognosis &
evaluation Learner : evaluation?
planning proper treatment . Listening
The process of diagnosis includes :
1. Determining whether epilepsy and seizures exist & not an
alternative diagnosis .
2. Defining the underlying cause if possible.
o History collection about age at onset, time ,child’s
behavior during the event etc.
o Family history, labour and delivery history
o Physical and neurological examination.
o Lab investigations
o EEG , CT and MRI
o Lumbar puncture
9 13 mins describe about MANAGEMENT: Teacher : Black Describe about
the Teaching Board the
THERAPEUTIC MANAGEMENT:
management Learner : management
of epilepsy The goal is to control the seizures or to reduce their frequency and Listening of epilepsy?
severity , discover and correct the cause when possible and help the child
live as normal life as possible.
It has four treatment options:
i) Drug Therapy :
- Administration of appropriate antiepileptic drugs.
Phenobarbitone
15 - 20mg / kg IV loading dose
3.5 - 5mg / kg / day maintenance dose
Phenytoin
15 - 20 mg / kg IV at 1mg / kg / min 4 - 8 mg / kg day maintenance dose
Midazolam
0.02 - 0.4 mg/kg IM
0.02 - 0.1mg/kg IV
0.06 - 0.4mg/kg/hr
Others: Lorazepam, diazepam, Paraldehyde
- 75% of children achieved complete control with epilepsy.
(ii) Ketogenic Diet :
It is a high fat , low carbohydrate & adequate protein diet
.Consumption of such a diet forces the body to shift from curing from
using glucose as the primary energy source to using fat & child may
develop a state of Ketosis
Potential side effects of the diet are constipation, weight
loss, lethargy&kidney disease. It is unknown whether long term effects
such as increased blood lipids will occur.
About 90% of children had decrease in seizure after
instituting the ketogenic diet.
(iii) Vagus Nerve Stimulation
Vagus Nerve Stimulation uses an implantable device that reduces
seizures in individuals who have not had effective control with drug
therapy.
A programmable signal generator is implanted subcutaneously
in the chest Electrodes tunneled underneath the skin deliver electrical
impulses to the left vagus nerve. The device is programmed non
invasively to deliver a precise pattern of stimulation to left vagus nerve.
Caregiver can activate the device using magnet at the onset of seizures.
About 1/3 rd of patients have 50% or greater reduction in
seizures after 1 year of therapy.
(iv) Surgical Therapy :
Surgical removal in case of hematoma, cyst ,tumor is the cause.
Removal of epileptogenic area ,corpus callosotomy, Temporal
and lobectomy.
10 2 mins list out the COMPLICATIONS Teacher : Black List out the
complications Teaching Board complications
Cranial nerve palsies
of epilepsy Learner : of epilepsy?
Raises ICP Listening
Subdural effusion
Cerebral palsy
Hydrocephalus
Mental-physical handicaps
Learning disability
Recurrence of epilepsy
11 5 mins explain about PREVENTIONS Teacher : Black Explain about
the prevention Teaching Board the prevention
Regular ANC check up
of epilepsy Learner : of epilepsy?
Treatment of infections during ANC period Listening
Correction of anemia and control of Gestational Diabetes
Training of local Dias or paramedics about proper delivery and
referral system
Raising awareness about institutional delivery
Manage actively fetal distress
Ensuring proper training of neonatal resuscitations.
SUMMARY
So far we have discussed about definition, causes, types, pathophysiology, clinical manifestation, diagnostic evaluation and management in epilepsy
CONCLUSION
Epilepsy , in general the more frequent and more severe the seizures, the more likely that neurobehavioral disorders will develop.
RECAPTIUALIZATION:
1. Define epilepsy?
2. Enlist the risk factors of epilepsy?
3. List out the causes of epilepsy?
4. State the pathophysiology of epilepsy?
5. Enumerate the classification of epilepsy?
6. List out the complication of epilepsy?
Bibliography
Book references
1. “Dorothy R. Marlow, Barbara A Redding “ ” Textbook of paediatrics nursing,” 6th edition; Sounder’s publication; 2009; pg.no- 947-56
2. “ A Parthasarathy” “IAP textbook of pediatrics” 3rd edition; 2006; Jaypee publication pg no – 128
3. “Marliyn Jhonkenberry, Wilson Winkelstein” “ Wong’s ‘Essentials of Pediatric nursing’”, 7th edition, elseveir publications pg no-
159,.231
4. Parul data, “Pediatric Nursing”, 2nd edition, elseveir publications pg. No-264.
5. Dutta p. Pediatric nursing 2nd ed. New Delhi: Japypee brothers, 2009. P-282 – 86.
6. Ghai P.O., Paul K.V, Bagg. A essential ;paediatrics. 7 th ed. New Delhi: CBS publishers; 2010. Pg.no – 1302-08
NET REFERENCES
www.pediatric.com , indianpediatrics.net