Epilepsy: Comprehensive Psychiatric and Neurological Nursing Care
Epilepsy is a brain disorder characterized by an enduring predisposition to recurrent unprovoked seizures. A seizure is a transient episode caused by abnormal excessive or synchronous neuronal activity. One provoked seizure from hypoglycaemia, fever, poisoning or withdrawal does not automatically establish epilepsy.
Emergency: a convulsive seizure lasting 5 minutes or repeated seizures without recovery is status epilepticus—call for help, support ABC, check glucose, give protocol-directed first-line benzodiazepine and arrange urgent escalation.
Classification
| Type | Features | Examples |
|---|---|---|
| Focal onset | Begins in one hemisphere; awareness may be preserved or impaired | Motor, sensory, autonomic or cognitive symptoms; automatisms |
| Generalized onset | Networks on both sides involved from onset | Tonic-clonic, absence, myoclonic, tonic, atonic |
| Unknown onset | Onset not witnessed or unclear | Classified further when evidence becomes available |
Causes and precipitants
- Structural: perinatal brain injury, stroke, trauma, tumour and malformation.
- Infectious: cerebral malaria, neurocysticercosis, meningitis, encephalitis and HIV-related CNS disease.
- Genetic/metabolic/immune: epilepsy syndromes, inherited metabolic disorders and autoimmune encephalitis.
- Triggers in established epilepsy: missed medicines, sleep deprivation, fever, alcohol/substance use, flashing light in susceptible people and interacting medicines.
Assessment
- Obtain eyewitness description or video: warning/aura, onset, eye/head deviation, stiffening, jerking, responsiveness, colour, injury, incontinence and recovery.
- Ask previous events, birth/development, infection/trauma, family history, medicines/adherence, pregnancy potential, substances and psychosocial impact.
- Examine vitals, glucose, injury, neurological signs, cognition and mental health; assess depression, suicide risk, psychosis and stigma.
Investigations
Bedside glucose and targeted blood tests identify provoked seizures. Electroencephalography supports seizure classification but a normal EEG does not exclude epilepsy. Brain imaging assesses structural causes; urgent imaging is indicated for focal deficit, trauma, persistent altered consciousness or suspected acute lesion. Consider ECG for convulsive syncope and lumbar puncture when CNS infection is suspected and safe.
Seizure first aid
- Stay calm, time the seizure, remove hazards and cushion the head.
- Loosen tight clothing; turn to the side as soon as safely possible and observe breathing.
- Do not restrain, put anything in the mouth, force fluids/medicine or perform unnecessary crowding.
- Call emergency help for first seizure, duration ≥5 minutes, repeated seizures, pregnancy, injury, breathing difficulty, water-related event or failure to recover.
Hospital and long-term management
- Stabilize ABC, glucose, oxygenation and injury; treat the provoking cause. Follow the facility status-epilepticus protocol with respiratory monitoring.
- Select antiseizure medicine according to seizure type, age, comorbidity, interactions, pregnancy potential, affordability and monitoring. Start low, titrate and avoid abrupt withdrawal.
- Review adherence and seizure diary before declaring treatment failure. Refer persistent seizures despite two appropriate tolerated regimens for specialist evaluation.
- Address education, occupation, driving, bathing, cooking, heights, contraception/pregnancy planning and mental health.
Antiseizure medicine nursing pharmacology
| Medicine | Uses | Major cautions/interactions | Monitoring/teaching |
|---|---|---|---|
| Carbamazepine | Focal seizures; some generalized tonic-clonic seizures | Multiple enzyme-inducing interactions; may worsen absence/myoclonic seizures; rash, hyponatraemia, blood dyscrasia | Report rash/fever; monitor FBC, sodium and liver function as indicated. |
| Valproate | Broad-spectrum seizure control | Major fetal and neurodevelopmental harm; liver disease; weight gain, tremor, thrombocytopenia, pancreatitis | Avoid in women/girls able to become pregnant unless strict specialist conditions; monitor LFT/FBC and pregnancy prevention. |
| Phenobarbital | Selected generalized/focal seizures where used | Sedation, cognitive/behavioural effects, respiratory depression and dependence; additive CNS depression | Falls/respiratory monitoring; never stop abruptly. |
| Levetiracetam | Broad-spectrum option | Somnolence, irritability, aggression or mood change; renal dose adjustment | Monitor mental health and renal function. |
Nursing care plan
| No. | Intervention | Rationale/evaluation |
|---|---|---|
| 1 | Maintain seizure precautions and accurately document onset, semiology, duration and recovery. | Prevents injury and supports diagnosis/treatment evaluation. |
| 2 | After seizure: recovery position, airway/SpOâ‚‚/glucose assessment, neurological observations and reassurance. | Detects hypoxia, metabolic cause, injury and status. |
| 3 | Administer medicines on time; check interactions and adverse effects. | Missed doses and toxicity are preventable causes of harm. |
| 4 | Screen mood, suicide risk, cognition and social exclusion; refer appropriately. | Psychiatric comorbidity strongly affects quality of life and adherence. |
Complications and prevention
Status epilepticus, aspiration, injuries, burns, drowning, medicine toxicity and sudden unexpected death in epilepsy may occur. Improve control through adherence, adequate sleep, avoidance of hazardous alcohol/substances, infection and head-injury prevention, antenatal/perinatal care, individualized rescue plans and regular review.
Revision questions
- Classify seizures and give examples.
- Describe seizure first aid and prohibited actions.
- Explain four medicine-specific nursing responsibilities.
References
- WHO. mhGAP Guideline, 2023.
- Uganda Ministry of Health. Uganda Clinical Guidelines, 2023.