Epilepsy management issues and techniques.

Twenty-five people with epilepsy were interviewed to identify their perception of self-management. The interviews revealed that there were three domains of self-management: (a) treatment management, (b) seizure management, and (c) life management. Management issues arose in daily life, at work, and in relationships and were related to the seizure event, seizure consequences, and medication. Participants described how they managed situations created by their disorder. Self-management techniques included management of employment and social situations, seizures, seizure consequences, and medication. The study revealed that epilepsy affects all areas of life and provides a unique look at the concept of self-management.

Epilepsy.

Diagnosis and management of the epilepsies are routinely performed by primary care physicians. In the United States, only 17% of patients with new-onset epilepsy are examined by neurologic specialists, and even fewer patients employ neurologists for their ongoing care. With the changes dictated by the evolving health care system in the United States, the responsibilities for the treatment of patients with epilepsies by primary care physicians will continue to increase. At the same time, there has been an explosion of new information about the diagnosis, evaluation, natural history, and neurobiologic aspects of epilepsy. New medical and surgical treatments are being introduced with a quickening pace. Finally, the concept that certain epilepsies may be progressive and that early identification and aggressive treatment represent one's best chance for establishing control for these patients has gained widespread confirmation from both clinical and animal model studies. The past standard of care is quickly ending. No longer should a patient or a physician accept only partial seizure control. This monograph attempts to lay the basis for improved understanding of epilepsy so that our patients will be seizure free without side effects and will be able to fully participate in our society.

Multiple subpial transection for Landau-Kleffner syndrome.

Landau-Kleffner syndrome (LKS) is an acquired epileptic aphasia caused by a lesion in the speech centers of the cerebral cortex during a critical period of childhood development. Characteristics of LKS include language deterioration, seizure disorders, and severe electroencephalogram abnormalities. Multiple subpial transection (MST) is a surgical procedure that eliminates seizure activity in the cerebral cortex while preserving the child's normal cortical functions of speech, movement, primary sensation, and memory. This article presents a summary of clinical studies on LKS and discusses the diagnosis of LKS, traditional medical treatments, patient selection for MST procedures, and perioperative care of children undergoing MST procedures.

Landau-Kleffner syndrome. Treatment with subpial intracortical transection.

Landau-Kleffner syndrome (LKS) is an acquired epileptic aphasia occurring in childhood and associated with a generally poor prognosis for recovery of speech. It is thought to be the result of an epileptogenic lesion arising in speech cortex during a critical period of development. Utilizing a new surgical technique designed to eliminate the capacity of cortical tissue to generate seizures while preserving the normal cortical physiological function, we have treated 14 children with aphasia, seizures and a severely abnormal EEG by multiple subpial transection of the epileptogenic cortex. Seven of the 14 patients (50%) have recovered age-appropriate speech, are in regular classes in school and no longer require speech therapy. Four of the 14 (29%) have shown marked improvement, are speaking and understanding verbal instruction but are still receiving speech therapy. Thus, 11 of the 14 (79%), none of whom had used language to communicate for at least 2 years, are now speaking--a rate of sustained improvement considered unusual in this disorder. This study documents the value of a treatment modality not previously used in LKS. Success depends on selection of cases having severe epileptogenic abnormality that can be demonstrated to be unilateral in origin despite a bilateral electrographic manifestation.

Expansion of the seizure monitoring program. A collaborative approach.

This article discusses an interdisciplinary total quality management (TQM) project that planned for the expansion of the seizure monitoring program on a neuroscience unit. The processes of education, bed management, and patient care were evaluated by a TQM group of staff nurses, unit leader, attending physicians, clinical nurse specialist, and technicians. Each participant identified actual and potential problems and their effects on the participant's area of care.

A correlational study of disabilities, stressors and coping methods in victims of multiple sclerosis.

Twenty multiple sclerosis (MS) patients admitted to the hospital for treatment of exacerbation of their disease were asked to identify stressors and the coping mechanisms they employed to deal with stressors. They completed the MS Stressor Scale (a twenty item Likert-type scale) and the Jalowiec Coping Scale (sixty-item Likert-type scale). Disability level was measured using the Barthel Index. Results showed an overall mean stress score of 1.49 on a scale of 1 to 3. The most stressful items identified were feeling tired, inability to walk and uncertainty about the future. The most prevalent coping theme used was self-reliance and the most prevalent individual coping responses were a sense of humor and trying to learn more. A positive correlation was found between uncertainty about the future and fatalistic coping, and a negative correlation between depression and optimistic coping. No relationship was found between degree of disability and stressors.

Potential for altered nutritional status in the stroke patient.

Metabolic events combined with neurological deficits place some stroke patients at risk for malnutrition. Nutritional support in the poststroke patient is an important part of recovery. Basic knowledge of nutritional assessment and interventions for altered nutritional status can help the nurse plan appropriate care.