1 / 67

Problems of the Central Nervous System

Problems of the Central Nervous System. EPILEPSY, SPINA BIFIDA, CEREBRAL PALSY 2009. SEIZURE DEFINED . Episodes of abnormal sudden, excessive, uncontrolled electrical discharge of neurons within the brain May result in alteration in consciousness, motor or sensory ability and/or behavior.

jwinkler
Download Presentation

Problems of the Central Nervous System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Problems of the Central Nervous System EPILEPSY, SPINA BIFIDA, CEREBRAL PALSY 2009

  2. SEIZURE DEFINED • Episodes of abnormal sudden, excessive, uncontrolled electrical discharge of neurons within the brain • May result in alteration in consciousness, motor or sensory ability and/or behavior

  3. EPILEPSY • Chronic disorder • Characterized by recurrent unprovoked seizure activity CAUSE OF EPILEPSY • abnormal electrical neuronal activity • Imbalance of neurotransmitters: Gamma aminobutyric acid (GABA)

  4. CAUSE OF SEIZURES • Inherited • Cause is unknown (idiopathic) Can follow: • Birth trauma • Asphyxia during birth • Head injuries • Infectious disease • Toxicity (carbon monoxide and lead poisoning) • Fever • Drug/alcohol intoxication • Brain tumors

  5. INTERNATIONAL CLASSIFICATION OF SEIZURES • Classified by the part of the brain involved • PARTIAL SEIZURES beginning in one part of one cerebral hemisphere • Complex partial seizures • Simple partial seizures • GENERALIZED SEIZURES involving both cerebral hemispheres • UNCLASSIFIED SEIZURES: • Unclassified • Idiopathic

  6. PARTIAL SEIZURES • Simple partial seizures • Complex partial seizures

  7. PARTIAL SEIZURES • SIMPLE PARTIAL SEIZURES: • Unilateral movement of extremity • Unusual sensations • Autonomic or psychic symptoms (heart rate, flushing, epigastric discomfort) • May experience unusual or unpleasant sights, sounds, odors, tastes (aura) occurring before seizure • No loss of consciousness

  8. COMPLEX PARTIAL • Automatism: Person remains motionless or moves automatically, but inappropriately for time and place (eg: lip smacking, patting, picking at clothes) • May experience excessive emotions of fear, anger, elation, or irritability • No memory of episode, loss of consciousness, black out 1-3 min

  9. GENERALIZED SEIZURES (previously GRAND MAL) • TONIC-CLONIC SEIZURE • Lasts 2-5 min • Starts with tonic movements: stiffening or rigidity of the muscles of arms and legs • Loss of consciousness • Clonic movements follow: rhythmic jerking of all extremities • May bite tongue, incontinent of urine/feces • Followed by an hour of fatigue, confusion, lethargy

  10. GENERALIZED SEIZURES CONTINUED • Tonic seizures: • Abrupt increase in muscle tone • Loss of consciousness • Loss of autonomic signs for 30 sec to several minutes • Clonic seizure: • Lasts several minutes • Muscle contraction and relaxation

  11. GENERALIZED SEIZURES CONTINUED • Absence seizure • Common in children • Runs in families • Brief (seconds) loss of consciousness • Blank starring, returning to normal • May occur frequently throughout day • Myoclonic seizure: • Brief jerking/stiffening extremities • Singly or in groups • Lasts few seconds

  12. GENERALIZED SEIZURES CONTINUED • Atonic(akinetic)seizure • Sudden loss of muscle tone for a few seconds, may fall • Followed by POSTICTAL(after seizure) confusion

  13. POST-ICTAL STATE • POST-ICTAL STATE: after seizure Pt is confused and hard to arouse, may sleep for hours

  14. ASSESSMENT AND DIAGNOSTIC TESTS • History • Identify causes • MRI • EEG • SPECT (single photon emission computed tomography) – helps identify zone giving rise to seizures, can then be removed surgically

  15. TREATMENT • Remove or treat cause • Surgically remove/excise the part of the brain that is causing the problem as long as it doesn’t produce neurologic deficits • Pt is alert • Generator may be implanted under the clavicle: helps control the seizure

  16. MEDICATIONS: antiepileptics (AED’s) • Unknown why they work • Control seizures, do not cure • Starts with one med, dosage gradually increased looking for SE, may add another drug • Therapeutic blood levels: Blood levels checked, absorption varies among patients • Dosage changed with illness, weight changes, stress • Sudden withdrawal avoided • Lots of drug/drug interactions and drug/food interactions

  17. SIDE EFFECTS OF DRUGS • Allergic reaction (skin) • Acute toxicity (seen initially) • Chronic toxicity (seen later in therapy) • REACTIONS seen in an organ • Common SE of Dilantin: gingival hyperplasia (swollen and tender gums)

  18. ASSESSMENT DURING SEIZURE • Assess for preseizure behavior, aura, loss of consciousness • Assess seizure activity • Record the time the activity began • Assess for fecal or urinary incontinence • Assess for post seizure behavior (memory loss, loss of consciousness, lethargy)

  19. RECORD SEIZURE ACTIVITY • Include onset time • Include focus of seizure (part of body involved) • Identify duration of seizure (time) • Identify change in respirations • Define progression of movement through body • Identify changes in neurological status • Describe post-ictal activity (duration, status, behavior)

  20. IMPLEMENTATION • Gently lower the standing or sitting patient to the floor (supine) • Turn the head to the side, hyperextend neck and pull jaw slightly forward • Maintain patent airway • Have oxygen and suction available whenever a patient indicates they have a history of seizures!!! • PLACE NOTHING IN THE MOUTH!

  21. IMPLEMENTATION CONTINUED • Do not restrain the patient • Remove dangerous objects the might injure the patient • Loosen tight or restrictive clothing • Record seizure activity

  22. TEACHING • Wear Medic Alert • Avoid stimulant drugs (caffeine) may cause a seizure to break through the anticonvulsant medication • Avoid alcohol – can cause overdose of medications • Teach family/patient triggers to seizures: hypoglycemia, fatigue, exhaustion, hormonal changes, illness, stress, alcohol, caffeine, constipation, hyperventilation, excessive activity

  23. TEACHING CONTINUED • High fiber diet/high fluid diet to prevent constipation caused by anticonvulsant meds • Adequate rest, stress reduction, good diet • Anticonvulsant meds cause gingival hyperplasia: need good dental care • Provide name of local Epilepsy Foundation • Assist in dealing with feelings

  24. RESTRICTIONS until seizure free for 3 months to 1 year • No driving motor vehicles • No operating heavy machinery • No working in potentially dangerous situations • No swimming, no water sports • Possibly no tub bathing • LENGTH OF RESTRICTION DEPENDS UPON STATE REGULATIONS

  25. MEDICATIONS Dilantin (phenytoin) Therapeutic drug level 5-20 ug/dl • Cannot be withdrawn suddenly • Watch for toxicity (nystagmus, ataxia, dysarthria, encephalopathy) • Do not combine with warfarin (Coumadin) SIDE EFFECTS: • Lethargy, abnormal movements, Gingival hyperplasia, mental confusion, cognitive changes

  26. MEDICATIONS FOR STATUS EPILEPTICUS Fosphenytoin (Cerebyx) Diazepam (Valium); give slowly, drug of choice for status epilepticus, have ventilatory support available Lorazepam (Ativan) Given IV during status epilepticus

  27. MEDICATIONS • Ethosuximide (Zarontin): N & V, gastric distress, gradually withdraw • Carbamazepine (Tegretol): expensive, watch effects on heart and lungs • Valproate (Depakene): effects liver, causes tremors, alopecia • Galbapentin (Neurotonin): dizziness, somnolence, wgt gain

  28. MEDICATIONS Clonazepam (Klonopin): drowsiness, palpitations Felbamate (Felbatol): cognitive impairments Lamotrigine (Lamictal): tremor Levetiracetam (Keppra): somnolence Oxacarbazepine (Trileptal): tremor, loss of coordination

  29. MEDICATIONS • Phenobarbitol (Luminal): sedation • Primidone (mysoline): lethargy, impotence • Tiagabine (Gabitril): dizziness, buckling knees • Topiramate (Topamax): fatigue, anorexia, depression • Zonisamide (Zonegran): somnolence, agitation

  30. STATUS EPILEPTICUS • Series of generalized seizures tht occur without full recovery of consciousness between attacks • Also includes continuous electrical seizures lasting at least 30 minutes even without impairment of consciousness

  31. RISKS OF STATUS EPILEPTICUS • Respiratory arrest at height of each seizure leading to hypoxia which can lead to brainb damage

  32. FACTORS THAT TRIGGER STATUS EPILEPTICUS • Withdrawal of seizure meds • Fever • Concurrent infection

  33. STATUS EPILEPTICUS MEDICAL EMERGENCY • cerbyx, Ativan, Valium IV • Oxygen & Airway device/intubation inserted between seizures • Suction • Hydration IV using glucose for hypoglycemia (high metabolic demand during seizure)

  34. TREATMENT FOR STATUS EPILEPTICUS CONTINUED • May have to anesthetize with short acting barbiturate to stop seizure • Serum levels of anti- seizure meds • Cardiac/respiratory depression may be lifethreatening • Cerebral edema can occur

  35. CEREBRAL PALSY

  36. CEREBRAL PALSY • DEFINED AS: • A neurologic problem • Characterized by impaired movement and posture • It involves a lack of motor control of voluntary muscles • Comes from a lesion in the brain that occurred prenatally, at birth or postnatally

  37. CAUSE OF CP • PRIMARY CAUSE: ANOXIA • SECONDARY CAUSE: INFECTION

  38. CLINICAL MANIFESTATIONS • Delayed gross motor development: universal symptom • Abnormal motor performance • Alterations muscle tone: rigidity, stiffness • Abnormal postures: scissoring • Reflex abnormalities: persistance of primitive infantile reflexes

  39. ASSOCIATED DISABILITIES • May have mental retardation • Common to have seizures • Attention deficit/hyperactivity • Sensory impairment

  40. CLASSIFICATION • Spastic: increased muscle tone • Dyskinetic (athetoid): abnormal writhing movements, drooling, dysarthria, • Ataxic: difficulty with balance • Mixed: athetoid and spastic

  41. DIAGNOSIS • Know growth and development • Observe in newborn nursery • Early recognition important

  42. TREATMENT • TEAM APPROACH Goals: • Establish locomotion, communication, self-help • To gain optimum function • To correct associated defects • To provide educational opportunities

  43. MOBILIZING DEVICES • Braces • Ambulation devices • Scooter boards • Wheeled go carts • Strollers • w/c

  44. SURGERY • Orthopedic • TAL (tendon achilles lengthening) • release of tight wrist and hip muscles

  45. NURSING CARE • FEEDING: • Avoid semi-reclining • Place in flexed position • Gentle upward stroking of the neck 2. DIET: high calorie diet 3. MAINTAIN SKIN INTEGRITY 4. PROMOTE SELF-CONCEPT

  46. NURSING CARE CONTINUED 5. PROMOTE KNOWLEDGE 6. USE THE PARENTS AS BEST RESOURCE 7. PROVIDE REST 8. PREVENT/TREAT RESPIRATORY INFECTIONS 9. DENTAL PROBLEMS 10. PROVIDE PARENTAL SUPPORT

  47. SPINA BIFIDA

  48. SPINA BIFIDA DEFINED: incomplete fusion of one or more vertebral laminae and defective development of the spinal cord ETIOLOGY: • Environmental • Genetic • Vitamin deficiency

  49. CATEGORIES • MENINGOMYELOCELE OR MYELOMENINGOCELE • MENINGOCELE • SPINA BIFIDA OCCULTA

  50. MENINGOMYELOCELE (MMC) • Most common • Involves the spinal cord • Have soft rounded protrusion • Sac containing meninges, portions of spinal cord and nerve roots and CSF • Sac protrudes through defective vertebra • MASS DOES NOT TRANSILLUMINATE

More Related