By Elizabeth (Noddy) Dempsey
Candidate ANP Epilepsy
Epilepsy, a very common neurological condition – 50 million people worldwide are diagnosed. In Ireland 1 in every 131 people over the age of five are effected totalling 37,000 people (Linehan et al. 2010). An epileptic seizure is a transient occurrence of signs and symptoms due to abnormal neuronal or electrical activity which can effect level of awareness. Partial seizures occur in a specific part of the brain and may not effect level of awareness, whereas generalised seizures effect the whole brain and can cause loss of consciousness, with neurological, psychological and cognitive concerns for some people.
The Epilepsy service in the Mater Hospital has developed with the guidance of Professor Tim Lynch in order to provide service for both in patients and outpatients. We currently have two dedicated Epilepsy clinics monthly. These clinics are for both newly diagnosed patients with seizures and also return patients with diagnosis of epilepsy where updates of their seizure management and lifestyle are addressed. Medication treatments with possible side effects are discussed, seizure triggers, safety and driving are central to all clinic discussions. Concerns for people diagnosed with Epilepsy include frustration and many psychological concerns which impact on daily life in addition to the medical diagnosis.
Dr Ronan Kilbride Consultant Neurologist/Neurophysiologist commenced the Complex Epilepsy Clinics in February 2014. These Epilepsy clinics for Mater Hospital patients are located in the DNI. These complex clinics are for existing epilepsy patients with more difficult to control or possible refractory seizures. Assessment for medication management, additional diagnostic work up, possible epilepsy monitoring and also consideration for surgery are all evaluated at the Complex clinic.
Epilepsy at the Mater Hospital is also part of the National Epilepsy Clinical Care Programme (NECCP) which is linked with Beaumont Hospital. Beaumont is the National Epilepsy Centre for Leinster North East region. This NECCP link with Dr Kibride and the Complex Epilepsy clinic is key for access to the Epilepsy monitoring services and also Epilepsy surgery for Mater Hospital patients. We also have established links with maternity services in particular with the Rotunda and Holles Street Hospitals.
Epilepsy in the Mater Hospital like other Neurology conditions, has a team approach in that we have many disciplines and specialist areas that work together for diagnostics to ensure best plan of care for each patient. Administration services at both the DNI and Neurology department are a very significant part of the Epilepsy service.
From a Nursing perspective our presence as Epilepsy Nurses is across the full trajectory of care with Epilepsy patients. In the Mater Hospital we are involved both with inpatients and at the OPD clinics. The Epilepsy phone support service currently runs from Monday to Wednesday for our patients where daily issues and concerns are managed, thereby minimising presentations either to the Accident & Emergency Department and also reducing urgent OPD review. Epilepsy Nursing has also developed in the Mater Hospital through the NECCP with the Candidate Advanced Nurse Practitioner (cANP) role established where autonomy in Nursing practice continues to evolve with research and leadership being core competencies also. This new National model of Epilepsy Nursing promotes better access for people with epilepsy and thus minimises unnecessary costs with reduced hospital admissions. The already established weekly Epilepsy Nurse Led clinics, Epilepsy phone support and soon to be expected sanctioning of Nurse prescribing, helps to facilitate continuity of Mater Hospital Epilepsy patient care.
Epilepsy Ireland, (previously known as Brainwave), service with information booklets are displayed in the DNI. Epilepsy Ireland is a great resource for patients and staff with comprehensive website, quarterly newsletter and many other user friendly resources. Epilepsy Ireland also adopt T.E.A.M. approach to seizure management;
T. take care to protect the person
E. Ensure you stay with the person
A. Allow the seizure to run its course
M. Move the person onto their side when the seizure is over
Seizures and Epilepsy in 80% of cases can be well managed; the expectation for all our patients is no seizures, nor side effects from medications with good quality of life.
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