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Recommended Practice

Evidence in Action

26

Epilepsy and Seizures


Ava Bentley

Who is this for?


The purpose of this information sheet is to
summarize research and present the best
available evidence on the management of
epilepsy and seizures in adults and older
adults. Statistics indicate that 1 in 100
people over the age of 60 has epilepsy as
well as approximately 1 in 20 people living
in aged care facilities.
Epilepsy is a neurological condition that
causes recurrent epileptic seizures. The
seizures are a result of abnormal and
excessive brain activity and can occur
without any immediately identifiable cause.
Epilepsy can have a significant impact on
physical and mental health.

What We Know
Causes

The most common cause in the elderly is


stroke. This is followed by degenerative
diseases such as multiple sclerosis
and trauma. One in three new epilepsy
cases diagnosed in the elderly have no
underlying cause.
Difficulty In Diagnosis

It is important that an accurate diagnosis


is made by a specialist urgently and at
least within 2 weeks. Epilepsy is often
misdiagnosed/underdiagnosed in older
people for the following reasons:
1. The signs of epilepsy and seizures can
be different in older people than in
younger people.
2. Confusion following a seizure can
hinder diagnosis.
3. Communication difficulties, language
disturbance, and dementias can cause
difficulty getting a medical history.
4. Accurate diagnosis is harder in the
presence of high blood pressure, heart
disease, a history of mini strokes, and/
or other conditions.
Signs and Symptoms in Older Adults

Full-blown epileptic seizures are not


generally seen in older adults. Instead
they have slighter movements and fewer
unusual sensations. In certain cases the

only sign of a seizure could be dizziness, a


blank stare, or prolonged confusion.
Aims of epilepsy treatment
To achieve:
an unchanged or improved quality of life
optimum seizure control
close monitoring of the condition
sufficient social support

Challenges

Depression with epilepsy can


decrease quality of life and
socioeconomic well-being
Risk of fractures double in older people
with epilepsy
Problems with anti-epileptic medication,
multiple medications, and interactions
with other medications can occur

Epilepsy can compound difficulties


when other medical conditions are
present
Loss of independence or self-esteem
Recommendations

People with epilepsy should have good


access to:
prompt medical investigation
written and visual information about
the condition
counseling services
information about voluntary
organizations
epilepsy specialist nurses
referral to a specialist including a
surgeon if needed
Particular attention should be paid to
people with:
failing vision
deafness
difficulty in swallowing and eating
problems with memory, organizing
themselves, and thinking
difficulties with dexterity
Reference
JBI, Evidence Summary: Epilepsy: Diagnosis and
Management, 2008.

Evidence Reliability
The evidence related to the topic of each
consumer publication produced by the Joanna Briggs Institute is assessed for reliability and quality. We do not rate a procedure
or treatment, but the evidence (or research)
that is available to support it. Evidence can
play a critical role in any investigation and it
is important for detectives to recognize evidence that will provide reliable information
to aid in the investigation.
This is also the case when assessing health
information, as some types of evidence are
more reliable than others. For Joanna Briggs
Institute evidence-based information for consumers, you can be assured that the best
available evidence is utilized. If you would
like more information about research and levels of evidence, please contact the Joanna
Briggs Institute or visit the research page of
our consumer web site.
Disclaimer
The procedures described in this pamphlet
must only be used by people who have appropriate expertise in the field to which the procedure relates. The applicability of any information
must be established before relying on it. While
care has been taken to ensure that this pamphlet summarizes available research and expert
consensus, any loss, damage, cost, expense
or liability suffered or incurred as a result of
reliance on these procedures (whether arising
in contract, negligence or otherwise) is, to the
extent permitted by law, excluded.
What is Evidence-Based
Health Information?
Just as a detective searches for evidence to
solve a crime, so too do health professionals

look for evidence to guide their practice. The


detective must have evidence to support their
case. In a similar fashion, the healthcare professional must have evidence to support their
proposed course of treatment. They search
for information that will help them to provide
the most effective or beneficial form of care to
their patients. Due to the wealth of information
available to them, the process of discovering
which information is the best can be difficult
and time consuming. It would take an enormous amount of time for your doctor to sift
through the large amounts of research and
information available to them on a particular
topic. This is where the Joanna Briggs Institute comes into play. We conduct the detective work, providing them (and you) with the
best available evidence.
What does this mean
for consumers?
As consumers of healthcare it is important
to know that your treatment is being based
on the best available evidence. It is also
important that you are provided with all of
the information in order to have greater independence in relation to your own healthcare
decisions and to be involved in the decisionmaking process.
Further Information
The Joanna Briggs Institute Consumer Information Program provides up-to-date literature
reviews to ensure your information is based
on the best available evidence. The Institute
also produces systematic reviews and Best
Practice Information sheets aimed at clinicians and health professionals. This means
you are provided with the same high standard
of publications based on the same information as those working directly in the field.

Evidence in Action

27

Recommended Practice

Evidence in Action

28

Wash
YourHands

Standard
Precautions

TakeCare
withSharps

Clinical
Competency

BackCare

Epilepsy/Seizure Management
3. Clear the surrounding area.
4. Obtain assistance from other staff member.
5. If older person is in bed use padding, raise bed sides and
raise or lower bed as required.
6. Turn older person on their side and flex head slightly forward.
7. Support the older person on their side with pillows.
8. Do not restrain.
9. Do not place anything in the older persons mouth.
10. Ensure privacy.
11. Ensure oxygen and suction equipment is available.
12. Ensure Medical Officer is notified of the older persons
condition, and arrange for transfer to acute hospital if
seizures continue.

Equipment

Older persons medical record

Oxygen and suction equipment available

Protective / safety devices

Medication administration devices as required

Recommended Practice
1. Assess and note reliable history of seizure activity, witnessed
event, observers account. Check for any relevant medical
orders in relation to the seizure management of the older
person, if it has happened previously. (i.e. medication)
2. When seizure begins, position the older person safely.

13. Observe and record the following:


Initial symptoms
Pallor
Cyanosis
Abnormal movements
Tongue biting
Urinary incontinence
Impaired conscious level
14. Observe and record post ictal signs and symptoms:
Confusion
Headache
Drowsiness
Todds paresis
Time scale
15. Provide reassurance and explanation to the older person and
their family.
16. Document in case notes the episode and management.

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