Nursing Guide to Epilepsy: Nursing Diagnosis, Interventions, & Care Plans

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures caused by abnormal electrical activity in the brain. Seizures can vary widely in type, frequency, and severity, ranging from brief lapses in attention (absence seizures) to full-body convulsions (tonic-clonic seizures).  

Epilepsy affects individuals of all ages, with varying causes that include genetic factors, brain injury, and infections. Management aims to control seizures, improve quality of life, and address any underlying causes. While some individuals can achieve full seizure control with treatment, others may have more treatment-resistant forms of epilepsy. 

Etiology and epidemiology 

Epilepsy has diverse causes, often categorized into genetic, structural, metabolic, and unknown origins. In some individuals, the disorder has a hereditary component, while in others, it arises from brain damage due to trauma, stroke, infection, or developmental abnormalities. Conditions like brain tumors, vascular diseases, and degenerative diseases (e.g., Alzheimer’s) are also known triggers. Epilepsy is more common in early childhood and in older adults, but it can occur at any age. 

Common causes of epilepsy include: 

• Genetic predisposition: Mutations in specific genes can lead to epilepsy.
• Brain injury: Trauma, stroke, or surgery can damage brain tissue, triggering seizures.
• Infections: Conditions like meningitis or encephalitis may result in scarring that leads to seizures.
• Developmental disorders: Conditions like cerebral palsy and neurodevelopmental abnormalities can cause epilepsy. 

Epidemiology: 

Epilepsy affects approximately 50 million people worldwide, making it one of the most common neurological disorders. It occurs more frequently in low- and middle-income countries, likely due to higher rates of brain infections, injuries, and inadequate healthcare. The lifetime risk of developing epilepsy is about 3%. 

Epilepsy ICD-10 code 

The ICD-10 code for epilepsy is G40.9 – Epilepsy, unspecified. 

Epilepsy Diagnosis 

The diagnosis of epilepsy is based on a combination of clinical history, neurological examination, and diagnostic tests. 

1. Patient history: A thorough history of the seizure episodes, including triggers, duration, and postictal symptoms, is essential. Witness descriptions can provide additional details, especially if the patient has impaired awareness during seizures.
2. Electroencephalogram (EEG): This test measures electrical activity in the brain. An abnormal EEG showing focal or generalized epileptiform discharges  can confirm the diagnosis, though a normal EEG does not rule out epilepsy.
3. Neuroimaging: MRI or CT scans are used to detect structural abnormalities, such as brain tumors, lesions, or scars, that could be causing seizures.
4. Blood tests: Lab work may be used to identify metabolic causes or rule out other conditions, such as electrolyte imbalances or infections, that can mimic seizures.
5. Genetic testing: In cases where a genetic cause is suspected, testing for specific mutations may be indicated. 

Management 

Management of epilepsy focuses on seizure control, preventing complications, and addressing the underlying cause when possible. 

1. Antiepileptic drugs (AEDs): Medications are the primary treatment for epilepsy, with over 20 AEDs available to reduce seizure frequency or eliminate them. Common AEDs include levetiracetam, lamotrigine, and valproate. Drug selection depends on seizure type, patient age, comorbidities, and drug side effects.
2. Surgical intervention: For patients with drug-resistant epilepsy, surgery may be an option. This can include  surgery to remove the seizure focus or vagus nerve stimulation (VNS) to reduce seizure frequency.
3. Dietary therapy: The ketogenic diet (high fat, low carbohydrate) has been shown to reduce seizures in some children with refractory epilepsy.
4. Seizure precautions: Patients should be educated on avoiding known triggers (e.g., flashing lights, sleep deprivation, alcohol) and protecting themselves during a seizure (e.g., lying on the ground, placing soft objects around the head).
5. Lifestyle modifications: Adequate sleep, stress reduction, and adherence to medication are crucial in preventing seizure recurrence. 

Epilepsy nursing care plan 

Nursing considerations 

Nurses play a critical role in managing patients with epilepsy by providing support during seizures, monitoring medication adherence, and educating patients and families about seizure management. 

Assessment 

• Seizure activity: Document the type, frequency, duration, and postictal state of and seizure activity. Note any precipitating factors (e.g., flashing lights, stress, or fatigue). 
• Neurological status: Regularly assess for changes in cognitive function, motor skills, and speech. Postictal confusion and fatigue should be noted. 
• Medication adherence: Assess for missed doses of antiepileptic medications, which are a common cause of breakthrough seizures. 
• Safety risks: Evaluate the patient’s environment for seizure triggers and ensure appropriate safety measures are in place to prevent injury. 

Nursing diagnosis/risk for 

• Risk for injury related to seizure activity and loss of consciousness during a seizure. 
• Ineffective self-health management related to complex medication regimens and lifestyle changes. 
• Anxiety related to unpredictability of seizures and social stigma. 
• Knowledge deficit related to the disease process, medications, and lifestyle modifications. 

Interventions 

• Seizure precautions: Ensure the patient’s environment is safe by padding bedrails, removing sharp objects, and advising the patient to avoid potentially hazardous activities (e.g., swimming alone, operating machinery). 
• Medication management: Administer antiepileptic drugs as prescribed and monitor for side effects such as dizziness, fatigue, or rash. Educate the patient on the importance of adherence to prevent breakthrough seizures. 
• Post-seizure care: After a seizure, place the patient in the recovery position (on their side) to maintain an open airway and prevent aspiration. Provide reassurance as the patient regains consciousness, as postictal confusion is common. 
• Patient education: Teach patients and caregivers how to manage seizures, including when to seek emergency help (e.g., if a seizure lasts more than 5 minutes or if there are repeated seizures without recovery in between). 

Expected outcomes 

• The patient will remain free from injury during seizure episodes. 
• The patient will demonstrate adherence to prescribed medication regimens. 
• The patient will have fewer seizure episodes and maintain a higher quality of life. 
• The patient will express an understanding of seizure triggers and strategies to avoid them. 

Individual/caregiver education 

• Medication adherence: Emphasize the importance of taking antiepileptic medications as prescribed and explain the risks of abrupt discontinuation (e.g., seizure recurrence or status epilepticus). 
• Seizure response: Teach caregivers how to respond during a seizure, including protecting the patient from injury, timing the seizure, and when to call for emergency help. 
• Safety measures: Advise on implementing safety precautions at home, such as using protective headgear for patients prone to falls, avoiding baths in favor of showers, and ensuring supervision during activities like swimming. 
• Seizure diary: Encourage patients to keep a seizure diary to track episodes, potential triggers, and medication side effects, which can help tailor treatment plans. 

References 

1. Mayo Clinic: Epilepsy Overview 
2. Epilepsy Foundation: Managing Epilepsy 
3. American Academy of Neurology: Epilepsy Treatment Guidelines 
4. ICD-10 Data: G40.9 Epilepsy, unspecified Seizure - StatPearls - NCBI Bookshelf 

Resources 

• Epilepsy Foundation: Provides resources on managing epilepsy, support groups, and educational materials for patients and caregivers. 
• National Institute of Neurological Disorders and Stroke (NINDS): Offers information on current research and treatment options for epilepsy. 
• American Academy of Neurology: Shares guidelines and resources for the treatment and management of epilepsy. 
• Seizure Tracker: A free app that helps patients and caregivers track seizure activity, medications, and potential triggers.