AANN Core Curriculum, 7th Edition, Ch. 14 Epilepsy: Digital Version-Chapter 14

Chapter 14
Pdf Summary
Epilepsy is a spectrum of neurological disorders marked by an enduring tendency to have recurrent, unprovoked seizures. A seizure is a temporary event caused by abnormal, excessive synchronized electrical activity in the brain; a single seizure, especially one triggered by an acute reversible illness or metabolic disturbance, does not necessarily mean epilepsy. Diagnosis and management use the seizure type, epilepsy type, and, when identifiable, epilepsy syndrome.<br /><br />About 1.2% of the U.S. population has active epilepsy, and roughly 1 in 26 people develop it during their lifetime. It affects people of all ages, with incidence higher in young children and older adults. Causes include genetic, structural, infectious, metabolic, and immune factors, though the cause is unknown in many cases. Seizures arise from disrupted neural networks and an imbalance between excitatory activity, especially glutamate, and inhibitory activity, including GABA.<br /><br />The ILAE classification distinguishes focal, generalized, unknown-onset, and unclassified seizures, with motor and nonmotor features. Evaluation relies on a detailed event and medical history, examination, EEG, and brain imaging. Seizure first aid prioritizes preventing injury, positioning the person on their side when appropriate, timing the seizure, and never restraining them or placing anything in their mouth. Emergency care is needed for seizures lasting over five minutes, repeated seizures without recovery, breathing problems, injury, or a first seizure.<br /><br />Treatment aims for seizure freedom with one antiseizure medication and minimal adverse effects. Options include medication, surgery for drug-resistant epilepsy, neuromodulation, and dietary therapies. Status epilepticus is a time-critical emergency. Care should account for age, comorbidities, medication interactions, pregnancy-related risks, and the possibility of seizure mimics such as syncope or psychogenic nonepileptic seizures.<br /><br />Nurses support safety, medication adherence, education, and individualized self-management, while addressing stigma, psychological and social comorbidities, and risks such as SUDEP. Patient-centered goals should reflect what matters to each person, including quality of life and maintaining normal daily activities.
Keywords
epilepsy
seizures
neurological disorders
antiepileptic medication
EEG
brain imaging
status epilepticus
neuromodulation
SUDEP
seizure first aid