C H A P T E R 2 3
Antiseizure agents
353
E
pilepsy
, the most prevalent of the neurological dis
orders, is not a single disease but a collection of different
syndromes characterised by the same feature: sudden
discharge of excessive electrical energy from nerve
cells located within the brain, which leads to a
seizure
.
In some cases, this release stimulates motor nerves,
resulting in convulsions, with tonic–clonic muscle con
tractions that have the potential to cause injury, tics or
spasms. Other discharges may stimulate autonomic
or sensory nerves and cause very different effects, such
as a barely perceptible, temporary lapse in consciousness
or a sympathetic reaction. Because epilepsy involves a
loss of control, it can be very frightening to people when
they are first diagnosed (Box 23.1).
The treatment of epilepsy varies widely, depend
ing on the exact problem and its manifestations. The
drugs that are used to manage epilepsy are called
antiepileptics
, or antiseizure agents, and are sometimes
referred to as anticonvulsants; however, because not all
types of epilepsy involve
convulsions
, this term is not
generally applicable. The drug of choice for any given
situation depends on the type of epilepsy, person’s age
(Box 23.2), specific characteristics such as cultural vari
ations (Box 23.3) and tolerance for associated adverse
effects. Drugs can be used to treat more than one type of
seizure. Table 23.1 lists drugs and the types of seizures
that they can be used to treat.
NATURE OF SEIZURES
The form that a particular seizure takes depends on
the location of the cells that initiate the electrical dis
charge and the neural pathways that are stimulated by
the initial volley of electrical impulses. For the most
part, epilepsy seems to be caused by abnormal neurons
that are very sensitive to stimulation or over-respond for
some reason. These neurons do not appear to be different
from other neurons in any other way. Seizures caused by
these abnormal cells are called primary seizures because
no underlying cause can be identified. In some cases,
however, outside factors—head injury, drug overdose,
environmental exposure and so on—may precipitate
seizures. Such seizures are often referred to as secondary
seizures.
Classification of seizures
Accurate diagnosis of seizure type is very important for
determining the correct medication to prevent future
seizures while causing the fewest problems and adverse
effects. Seizures were formerly categorised as grand mal
(tonic–clonic seizures) or petit mal (absence seizures),
but the International Classification of Seizures currently
refers to seizures in a more systematic approach (based
on the description of symptoms and characteristics),
Teaching and counselling people with epilepsy
Epilepsy, with its stigma, is frightening to people who
know little about the disease.This condition has long
been associated with some sort of brain dysfunction
or possession by the devil or evil spirits. In some eras,
exorcism was the first choice of treatment for a person
with a seizure disorder. A person who receives a diagnosis
of epilepsy must deal with this stigma as well as the
significance of the diagnosis. What does having epilepsy
mean? Individuals who are newly diagnosed with epilepsy
must consider restrictions on their independence as well
as the prospect of chronic therapy for control of this
problem.
In our society, the ability to be readily mobile—to drive
to appointments, work or religious obligations—is very
important to many people. In most cases, the driving
privileges of affected individuals are revoked, at least
temporarily.The conditions for recovering the licence vary
with the diagnosis and the laws of each Australian state or
territory and in New Zealand.
The person who is newly diagnosed with epilepsy
has to cope not only with the stigma of epilepsy, but
also with the loss of a driver’s licence.The nurse may
be in the best position to help the person adjust to both
of these problems through education and referrals to
community resources.Thorough teaching should include
the following:
• Explanations of old stigmas.
• Ways in which people may react to the diagnosis.
• Ways in which people can educate family, friends and
employers about the realities of the condition and its
treatment.
• Actions to take if a seizure happens so that no injuries
occur and no panic develops.
• Information about the availability of public
transportation.
• The importance of encouraging people with epilepsy
to carry or wear a MedicAlert identification, to alert any
emergency caregivers to their condition and to what
drugs they are taking if they are not able to speak for
themselves.
• Contact information regarding other community support
services.
Many communities have epilepsy support groups that
can supply information on valuable resources as well as
updated facts about the laws in each area. While people
are first adjusting to epilepsy and its implications, it may
help to put them in contact with such organisations.The
local chapter of Epilepsy Australia may be able to offer
support groups, lists of resources and support. Individuals
with epilepsy should have several options for getting
around without feeling that they are being a burden or
an imposition.
Individual and family teaching
BOX 23.1
