Impact of periictal nurse interventions on postictal generalized EEG suppression in generalized convulsive seizures.

OBJECTIVES: The objective of this study was to determine the impact of periictal nurse interventions on postictal generalized EEG suppression (PGES) in generalized convulsive seizures (GCS). METHODS: We retrospectively reviewed the video-EEG recordings of patients during long-term video-EEG monitoring. We compared the duration of seizures, seizure phases (tonic, clonic, and tonic-clonic phases), and the occurrence and duration of postictal generalized EEG suppression (PGES) in patients with and without periictal interventions (e.g., oxygen administration, suctioning, and repositioning). Statistical analyses were performed to determine the association between the seizure-related variables and the periictal interventions. RESULTS: A total of 109 patients with 150 GCS were included in the study. Periictal interventions were provided in 122 GCS, of which, ictal administration of oxygen was provided in 29 GCS. The duration of PGES was significantly shortened in GCS with interventions when compared with those without interventions (p=0.003). However, the ictal administration of oxygen, assessed as an independent variable, did not influence the occurrence or duration of PGES. CONCLUSION: Periictal interventions significantly shortened the duration of PGES, and may, as a consequence, reduce the risk of SUDEP. However, ictal administration of oxygen did not influence the occurrence or duration of PGES.

[How parents of adults persons with epilepsy do their best]. / Wie eltern erwachsener menschen mit epilepsie das beste aus ihrer situation machen--eine qualitative studie.

Epilepsy is a common and chronic disease which affects persons at every age. Even though medication can prevent seizures, epilepsy has implications for daily living. Sorrows, increased depression rates and restrictions in everyday life were documented among family caregivers of adult persons with epilpesy. To date, no study investigated how parents adapt to the epilepsy of adult children over time. The aim of this study was to explore experiences of parents of adult patients with epilepsy. Applying an interpretative phenomenological approach, narrative interviews with parents were reviewed to investigate parents' experiences. All parents described how they did their best to live with their situation. However, parents' experiences were distinctive and can be described as: "Being on the way together", "walking on a thightrope" and "struggling and caring all along". Using paradigm cases to describe what the epilepsy of their adult children ment to parents allowed to consider the context of these parents' experiences and enhanced understanding. As parents continue to support their adult children with epilepsy they should be included in specialist counselling and involved in care planning of their adult children.

Impact of periictal interventions on respiratory dysfunction, postictal EEG suppression, and postictal immobility.

PURPOSE: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality. Seizure-related respiratory dysfunction (RD), the duration of postictal generalized electroencephalography (EEG) suppression (PGES), and duration of postictal immobility (PI) may be important in the pathophysiology of SUDEP. Periictal interventions may reduce the risk of SUDEP. METHODS: We assessed the impact of periictal nursing interventions on RD, PGES, and PI duration in patients with localization-related epilepsy and secondarily generalized convulsions (GCs) recorded during video-EEG telemetry in the epilepsy monitoring unit. Video-EEG data were retrospectively reviewed. Interventions including administration of supplemental oxygen, oropharyngeal suction, and patient repositioning were evaluated. Interventions were performed based on nursing clinical judgment at the bedside and were not randomized. The two-sided Wilcoxon rank-sum test was used to compare GCs with and those without intervention. Robust simple linear regression was used to assess the association between timing of intervention and duration of hypoxemia (SaO(2) < 90%), PGES, and PI using data from only the first GC for each patient. KEY FINDINGS: Data from 39 patients with 105 GCs were analyzed. PGES >2 s occurred following 31 GCs in 16 patients. There were 21 GCs with no intervention (NOINT) and 84 GC with interventions (INT). In the INT group, the duration of hypoxemia was shorter (p = 0.0014) when intervention occurred before hypoxemia onset (mean duration 53.1 s) than when intervention was delayed (mean duration 132.42 s). Linear regression indicated that in GCs with nursing interventions, earlier intervention was associated with shorter duration of hypoxemia (p < 0.0001) and shorter duration of PGES (p = 0.0012). Seizure duration (p < 0.0001) and convulsion duration (p = 0.0457) were shorter with earlier intervention. PI duration was longer for GCs with PGES than GCs without PGES (p < 0.0001). The mean delay to first active nonrespiratory movement following GCs with PGES was 251.96 s and for GC without PGES was 66.06 s. The duration of PI was positively associated with lower SaO(2) nadir (p = 0.003) and longer duration of oxygen desaturation (p = 0.0026). There was no association between PI duration and seizure duration (p = 0.773), between PI duration and PGES duration (p = 0.758), or between PI duration and the timing of first intervention relative to seizure onset (p = 0.823). PGES did not occur in the NOINT group. The mean duration of desaturation was longer (110.9 vs. 49.9 s) (p < 0.0001), mean SaO(2) nadir was lower (72.8% vs. 79.7%) (p = 0.0086), and mean end-tidal CO(2) was higher (58.6 vs. 50.3 mmHg) (p = 0.0359) in the INT group compared with the NOINT group. The duration of the seizure or of the convulsive component was not significantly different between the INT and NOINT groups. SIGNIFICANCE: Early periictal nursing intervention was associated with reduced duration of RD and reduced duration of PGES. These findings suggest the possibility that such interventions may be effective in reducing the risk of SUDEP in the outpatient setting. Validation of these preliminary data with a prospective study is needed before definitive conclusions can be reached regarding the efficacy of periictal interventions in reducing the risk of SUDEP.

Febrile seizures, genetic (generalized) epilepsy with febrile seizures plus, and Dravet's syndrome.

PURPOSE: This article discusses febrile seizures, generalized epilepsy with febrile seizures plus, and Dravet's syndrome. CONCLUSIONS: It can be difficult for patients and their families to comprehend what it means to have a seizure disorder with a genetic cause. Nurses caring for patients with seizure disorders require knowledge of the condition, its causes, treatment, and prognosis to better care for and inform their patients. PRACTICE IMPLICATIONS: It is important for all specialists working with pediatric populations to understand possible causes of seizure disorders linked to febrile episodes, its diagnosis, and treatment, and their responsibility to provide pertinent education to patients and their families.

Epilepsy: its presentation and nursing management.

Nearly 25,000 people in the UK develop epilepsy each year, making it one of the most common serious neurological conditions. The form a seizure takes depends on where it starts in the brain and how far it spreads. Nurses need to recognise the different types of epileptic seizure and the appropriate nursing management of each. National guidance on how epilepsy services can be improved will be published by the government and will include a national service framework for long-term conditions, including epilepsy.

Impact of epilepsy on quality of life.

Epilepsy is a chronic condition with a profound effect on the quality of life. Health, family life, social, community and civic activities, economics and personal development are the major variables associated with quality of life for the person with epilepsy. In this article, a model describing the relationship between these variables and quality of life is presented. This model organizes a comprehensive nursing approach to the patient with epilepsy. A case study analysis approach is used to help further illustrate interactions among the variables. Nursing interventions based upon analysis of the model are suggested.