2. Seizure disorders are treated primarily with antiseizure drugs. Therapy is aimed at preventing seizures because cure is not possible. Drugs generally act by stabilizing nerve cell membranes and preventing spread of the epileptic discharge.

3. Give special consideration to how antiseizure drugs interact with the normal changes of aging: Phenytoin is metabolized by the liver and can be a problem for older adults due to age related changes in the liver enzymes which decreases the liver’s ability to metabolize drugs. Phenobarbital and Primidone have potential effects on cognitive functions Tegretol- has many significant drug interactions GERONTOLOGIC CONSIDERATION

4. New drugs offer greater treatment for the elderly and less SE such as: Gabapentin, Levetiracetam, Lamotrigine,Oxycarbazepine, Topiramate, and Zonisamide GERONTOLOGIC CONSIDERATION CONT.

5. Patients whose epilepsy cannot be controlled by drug therapy are candidates for surgical intervention to remove the epileptic focus or prevent spread of epileptic activity in the brain. SURGICAL INTERVENTION:

6. Limbic resection, primarily anterior temporal lobe resection; amygdalohippocampectomy; neocortical resection, including extratemporal resection and lesionectomies; hemispherectomies; multilobar resections; and corpus collosum sections. SURGICAL INTERVENTIONS INCLUDE:

7. Before surgery is performed, three requirements must be met: (1)the diagnosis of epilepsy must be confirmed (2) there must have been an adequate trial with drug therapy without satisfactory results (3) the electroclinical syndrome (type of seizure disorder) must be defined. SURGICAL INTERVENTION REQUIREMENTS

8. SURGICAL INTERVENTION CONT.

9. Ketogenic Diet- The ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures. **Patients on this diet should be monitored closely for bleeding if they are using anticoagulants. The name ketogenic means that it produces ketones in the body (keto = ketone, genic = producing). NUTRITIONAL OR DIETARY MODIFICATIONS OR RESTRICTIONS:

10. Ketones are formed when the body uses fat for its source of energy. Usually the body usually uses carbohydrates (such as sugar, bread, pasta) for its fuel, but because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead. Ketones are not dangerous. They can be detected in the urine, blood, and breath. Ketones are one of the more likely mechanisms of action of the diet; with higher ketone levels often leading to improved seizure control. HOW DOES THIS WORKS?

11. General safety measures, such as the wearing of helmets in situations involving risk of head injury. Improved perinatal, labor, and delivery care have reduced fetal trauma and hypoxia and thereby have reduced brain damage leading to seizure disorders. Practice good general health habits (e.g., maintaining a proper diet, getting adequate rest, exercising). HEALTH PROMOTION:

12. Help the patient identify events or situations that precipitate the seizures and provide suggestions for avoiding them or handling them better. Excessive alcohol intake, fatigue, and loss of sleep should be avoided, and the patient should be helped to handle stress constructively. HEALTH PROMOTION CONT.