Introduction 

The current report is based on exploring a case study where the focused patient is a six years old boy, named Henry, who was diagnosed with epilepsy. This case report is based on several structural components which include the exploration of the pathophysiology of the diagnosed condition for the focused patient along with a clinical manifestation to evaluate the clinical signs and symptoms.

Moreover, this report also contains suitable pharmacological approaches along with effective communication needs for the patient. Summarizing the content of this report, it could be mentioned that this report helps in exploring the underlying mechanism behind the development of epilepsy in Henry while evaluating the signs and symptoms.

Moreover, exploring the subtype of the epilepsy condition for Henry along with the needed pharmacological approaches to manage this issue was also a major part of this report content. Finally, the effective communication approaches that need to be implemented to support Henry and his family members during this challenging situation have also been discussed here. These all followed the epilepsy nursing arrangements in Australia as suggested by Rapport et al. (2021). 

Pathophysiology 

The following part highlights the pathophysiology of the epileptic condition experienced by Henry. These include the exploration of the underlying mechanisms, the exploration of the disruption of normal pathways and the exploration of the contribution of any predisposition in disease development. 

The underlying mechanism of disease development 

Regarding the underlying mechanism of developing epilepsy, it could be said that the change from the normal network within the brain into a hyperexcitable network causes the development of this disease. This situation often occurs due to a disturbance in the extracellular ion homeostasis which alters the energy metabolism and changes the receptor functions within the brain which disrupts the transmitter uptake (Boleti et al., 2024). This results in a release of excessive excitatory glutamate and causes recurrent seizures (Lystad et al., 2022). Therefore, these aspects highlighted the underlying mechanism of the disease conditions that were experienced by Henry while being admitted to the emergency department with the sudden onset of seizures.  

Disruption of normal pathways 

During the development of epilepsy, disruption of the circuitry connection between the cerebral cortex and the thalamus could be noticed and this disruption results in unnatural brain wave patterns due to hyperpolarization of the relay neurons. This thalamocortical circuit is responsible for the excitation of the cortex during the normal sleep cycle with the help of thalamic relay neurons, thalamic reticular neurons and cortical pyramidal neurons. Therefore, the disruption of this circuit is often associated with several factors like the alteration of the GABA receptor function and the T-type calcium ion channels which causes abnormal paroxysmal episodes of clarithromycin cortical activation which is known as the absence of epileptic seizures (Sumadewi et al., 2023). Therefore, this justifies the development of seizures in Henry for at least three minutes which highlighted the diagnosis of epilepsy. 

Predisposition contribution to disease development 

The development of epilepsy is highly heritable where there are around 19 genome-wide significant loci that are responsible for the development of genetic generalized epilepsy. Around 29 genes underlie these loci which highlights the contribution of genetic predisposition in the development of this disease (Landoulsi et al., 2022). Therefore, in the case of Henry, the Development of the disease could be a part of the history of epilepsy in his family as his father suffered from febrile seizures as a child.  

Clinical Manifestations 

The following part highlights the clinical manifestations related to the disease symptoms that were noticed in Henry. This includes the exploration of the subtypes of epilepsy along with connecting it to the conditions of Henry. 

Epilepsy subtypes 

The classification of epilepsy related to the onset of the seizures includes focal onset seizures, generalized onset seizures and finally unknown onset seizures. Among these, focal onset seizures are again subdivided into focal aware seizures and focal impaired awareness. Apart from that, the generalized onset seizures are divided into motor and non-motor types. The motor type is again subdivided into myoclonic, atonic, tonic, clonic, tonic-clonic and absence. Moreover, there are some other types of seizures which could not be diagnosed and therefore these are categorized as unknown onset seizures (Epilepsy Action Australia, 2024). In the case of Henry, he was suffering from primary general tonic-clonic seizures. 

Connecting with the case study 

While connecting the conditions of Henry with the symptoms of epilepsy, it could be mentioned that Henry experienced a sudden onset of seizures for approximately 3 minutes which was followed by drowsiness and confusion. His mother reported a development of generalized tonic-clonic seizures. The diagnosis was reported after doing the MRI and EEG which helps understand the development of epilepsy (Supriya et al., 2021). The symptoms which were experienced by Henry justified the development of generalized tonic-clonic seizures as this type of seizure starts with a sudden loss of consciousness where the body of the individual becomes stiff with the jerking of muscles. Moreover, after the episode of seizures, the person could experience confusion, drowsiness, agitation and headache (Healthdirect Australia, 2024). The identification of such aspects demonstrated the connection of Henry with the development of epilepsy characterized by generalized tonic-clonic seizures. 

Pharmacology 

The following part provides the idea related to the suitable pharmacological interventions for treating epilepsy.  

Pharmacological Interventions

The drug Levetiracetam is usually used for managing myoclonic seizures, primary generalized tonic-clonic seizures, prophylaxis of traumatic brain injury and seizures in palliative care (Kondasinghe et al., 2021). The contradictions of this drug include hypersensitivity. The dose of this drug Is 20 mg/kg body weight for children aged above 5. The side effects of this drug include increased diastolic blood pressure, gastrointestinal complexes and pharyngitis (Kumar et al., 2023). The nursing considerations of this disease include the effective monitoring of the dose administration as there are chances of side effects which could disrupt the quality of life (de Castro et al., 2023).

Another drug carbamazepine usually helps in managing epilepsy, bipolar disorders and trigeminal neuralgia (Beran, 2020). The contradictions of this drug include hypersensitivity and bone marrow depression. The doses of this drug are 400-800 mg/day for children aged between 6-12. The side effects of this drug include drowsiness, dizziness, nausea, vomiting and ataxia (Maan et al., 2023). The nursing considerations of this disease include the effective monitoring of the dose administration as paediatric patients are more susceptible to carbamazepine toxicity (Khalili et al., 2023).

Finally, the drug named lamotrigine usually helps in managing primary generalized tonic-clonic seizures, partial seizures and Lenox Gastaut syndrome. The contradictions of this drug include hypersensitivity. The doses of this drug are usually increased over the days of each week or every other week (Betchel et al., 2023). The side effects of this drug include nausea, vomiting, abdominal pain, weight changes, constipation, oedema, Xerostomia or sudden death (Nightscales et al., 2023). The nursing considerations of this disease include the effective monitoring of the rash development related to the hypersensitivity susceptibility (Edinoff et al., 2021). 

Pharmacological Interventions Related to the Case Study

In managing the treatment of Henry, the Levetiracetam drug could be utilized in a single bolus dose for treating his symptoms as suggested by Kodankandath et al. (2020). However, treatment should be monitored by the nursing individuals regarding the administration of the doses as there are some adverse side effects of these medicines.

Communication 

The following part outlines the importance of effective communication with the patient and the patient party along with the impact of diagnosis on the development of clinical interactions. 

Effective communication with the children and the parents 

In the process of communicating with children and their parents within a clinical setting, there is a need to maintain an empathetic approach. In this context, the work by Lind et al. (2024) highlighted the need to demonstrate effective listening and observing skills along with adapting with the child during the communication process. Moreover, developing a safe and welcoming environment for the children is also necessary.

Apart from that, involving the child along with the parent and using visual tools could help in the process of developing empathetic communication. In the case of Henry and his parents, using such approaches might be proven beneficial where the use of different visual aids could help in improving the health literacy Henry related to his disease conditions (Mbanda et al., 2021). This could also help in the process of supporting the family members of Henry to cope with this situation. 

Impact of diagnosis on the development of interaction 

In the case of the current report, the focused patient Henry was diagnosed with epilepsy. This diagnosis might have created several impacts regarding the development of interaction approaches for Henry. This has been advocated by Beghi (2019) who mentioned that patients diagnosed with epilepsy often experience social vulnerability, communication challenges and interpersonal difficulties.

Moreover, the negative public stigma towards epilepsy patients also causes a social maladjustment which reduces the chances of developing social interactions (Coleman et al., 2022). Therefore, these aspects might have been challenging for both Henry and his family members. The diagnosis of epilepsy of Henry could create a challenge for him to interact with his peers in school or maybe other people within his circle due to the susceptibility to sudden onset of seizures as well as the stigma in the people around him (Hohmann et al., 2022). Moreover, his family members could also face challenges like social exclusion. 

Conclusion 

In this nursing assignment conclusion, it could be stated that this report effectively explores the epilepsy conditions of Henry while focusing on the different aspects of disease description. By summarizing the findings of this report, it could be stated that epilepsy is one of the crucial paediatric concerns with abnormal brain activities which needs to be resolved by using pharmacological management. Moreover, the development of empathetic communication is also necessary for supporting the patient and the family members of the patient. 
 

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References

Al Khalili, Y., Sekhon, S., & Jain, S. (2023). Carbamazepine toxicity. In StatPearls [Internet]. StatPearls Publishing. PMID: 29939629
Beghi, E. (2019). Social functions and socioeconomic vulnerability in epilepsy. Epilepsy & Behavior, 100, 106363. https://doi.org/10.1016/j.yebeh.2019.05.051 
Beran, R. G. (2020). Carbamazepine–An oldie but a goodie–A clinician’s perspective. Seizure, 83, 243-245. https://doi.org/10.1016/j.seizure.2020.10.024  
Betchel, N. T., Fariba, K. A., & Saadabadi, A. (2023). Lamotrigine. In StatPearls [Internet]. StatPearls Publishing. PMID: 29262021
Boleti, A. P. D. A., Cardoso, P. H. D. O., Frihling, B. E. F., de Moraes, L. F. R. N., Nunes, E. A. C., Mukoyama, L. T. H., ... & Migliolo, L. (2024). Pathophysiology to Risk Factor and Therapeutics to Treatment Strategies on Epilepsy. Brain Sciences, 14(1), 71. https://doi.org/10.3390/brainsci14010071
Coleman, H., zPeterson, C. L., & Walker, C. (2022). Understanding the experiences of stigma in relation to social support among an Australian community cohort of people living with epilepsy. Australian Journal of Social Issues, 57(4), 920-937. https://doi.org/10.1002/ajs4.226  
de Castro, A. C., Nascimento, F. A., Beltran-Corbellini, Á., Toledano, R., Garcia-Morales, I., Gil-Nagel, A., & Aledo-Serrano, Á. (2023). Levetiracetam, from broad-spectrum use to precision prescription: A narrative review and expert opinion. Seizure: European Journal of Epilepsy, 107, 121-131. https://doi.org/10.1016/j.seizure.2023.03.017
Edinoff, A. N., Nguyen, L. H., Fitz-Gerald, M. J., Crane, E., Lewis, K., St Pierre, S., ... & Urits, I. (2021). Lamotrigine and Stevens-Johnson syndrome prevention. Psychopharmacology Bulletin, 51(2), 96. PMID: 34092825
Epilepsy Action Australia. (2024). Seizure Types and Classification. Retrieved September 7, 2024, from https://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy/seizure-types-and-classification/#1691367283362-a069fcba-8d7f 
Healthdirect Australia. (2024). Epilepsy. Symptoms, Causes, Diagnosis and Treatments | Healthdirect. Retrieved September 7, 2024, from https://www.healthdirect.gov.au/epilepsy 
Hohmann, L., Berger, J., Kastell, S. U., & Holtkamp, M. (2022). Perceived epilepsy-related stigma is linked to the socioeconomic status of the residents. Frontiers in Public Health, 10, 952585. https://doi.org/10.3389%2Ffpubh.2022.952585
Kodankandath, T. V., Theodore, D., & Samanta, D. (2020). Generalized tonic-clonic seizure. PMID: 32119383
Kondasinghe, J. S., Look, M. L., Moffat, P., & Bradley, K. (2022). Subcutaneous levetiracetam and sodium valproate use in palliative care patients. Journal of Pain & Palliative Care Pharmacotherapy, 36(4), 228-232. https://doi.org/10.1080/15360288.2022.2107145 
Kumar, A., Maini, K., & Kadian, R. (2023). Levetiracetam. In StatPearls [Internet]. StatPearls Publishing. PMID: 29763065
Landoulsi, Z., May, P., Krause, R., Berkovic, S. F., Cavalleri, G. L., & Koeleman, B. P. (2022). Genome-wide meta-analysis of over 29,000 people with epilepsy reveals 26 loci and subtype-specific genetic architecture. https://doi.org/10.1101/2022.06.08.22276120
Lind, B. M., Wigert, H., Jenholt Nolbris, M., & Patriksson, K. (2024). Child healthcare nurses’ experience of communication with 4‐year‐old children during their visit to the child healthcare centre. Public Health Nursing. http://dx.doi.org/10.1111/phn.13351
Lystad, R. P., McMaugh, A., Herkes, G., Badgery-Parker, T., Cameron, C. M., & Mitchell, R. J. (2022). The impact of childhood epilepsy on academic performance: A population-based matched cohort study. Seizure, 99, 91-98. https://doi.org/10.1016/j.seizure.2022.05.014
Maan, J. S., Duong, T. V. H., & Saadabadi, A. (2023). Carbamazepine. PMID: 29494062
Mbanda, N., Dada, S., Bastable, K., & Ingalill, G. B. (2021). A scoping review of the use of visual aids in health education materials for persons with low literacy levels. Patient Education and Counseling, 104(5), 998-1017. https://doi.org/10.1016/j.pec.2020.11.034
Nightscales, R., Barnard, S., Laze, J., Chen, Z., Tao, G., Auvrez, C., ... & O'Brien, T. J. (2023). Risk of sudden unexpected death in epilepsy (SUDEP) with lamotrigine and other sodium channel‐modulating antiseizure medications. Epilepsia Open, 8(2), 334-345. https://doi.org/10.1002/epi4.12693 
Rapport, F., Hutchinson, K., Herkes, G. K., Bleasel, A., Nikpour, A., Ryder, T., ... & Braithwaite, J. (2021). Determining the role and responsibilities of the Australian epilepsy nurse in the management of epilepsy: a study protocol. BMJ open, 11(1), e043553. https://doi.org/10.1136%2Fbmjopen-2020-043553 
Sumadewi, K. T., Harkitasari, S., & Tjandra, D. C. (2023). Biomolecular mechanisms of epileptic seizures and epilepsy: a review. Acta Epileptologica, 5(1), 28. https://doi.org/10.1186/s42494-023-00137-0
Supriya, S., Siuly, S., Wang, H., & Zhang, Y. (2021). Epilepsy detection from EEG using complex network techniques: A review. IEEE Reviews in Biomedical Engineering, 16, 292-306. https://doi.org/10.1109/RBME.2021.3055956