Chapter 59: Chronic Neurologic Problems
The primary classifications of headaches include tension-type, migraine, and cluster headaches.
o Tension-type headache, the most common type of headache, is characterized by its
bilateral location and pressing/tightening quality. Tension-type headaches are usually of
mild or moderate intensity and not aggravated by physical activity.
o Migraine headache is a recurring headache characterized by unilateral or bilateral
throbbing pain, a triggering event or factor, strong family history, and manifestations
associated with neurologic and autonomic nervous system dysfunction.
o Cluster headaches are a rare form of headache with a sharp stabbing pain. Cluster
headaches involve repeated headaches that can occur for weeks to months at a time,
followed by periods of remission.
Therapies used in the treatment of headaches include drugs, meditation, yoga, biofeedback,
cognitive-behavioral therapy, and relaxation training.
Drug therapies include:
o Tension-type: nonopioid analgesic is used alone or in combination with a sedative,
muscle relaxant, tranquilizer, or codeine.
o Migraine: analgesic, triptans, and preventive treatment (i.e., topiramate).
o Cluster: drug therapy is not as useful as it is for the other types of headaches;
prophylactic drugs may be prescribed.
Headaches may be related to an inability to cope with daily stresses. The most effective therapy
may be to help patients examine their lifestyle, recognize stressful situations, and learn to cope
with them more appropriately.
In addition to using analgesics and analgesic combination drugs for the symptomatic relief of
headache, the patient should be encouraged to use relaxation techniques because they are
effective in relieving tension-type and migraine headaches.
SEIZURE DISORDERS AND EPILEPSY
Seizure is a paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts
normal function. Seizures are often symptoms of an underlying illness.
Epilepsy is a condition in which a person has spontaneously recurring seizures caused by a
chronic underlying condition. Seizures are divided into two major classes: generalized and partial.
Generalized seizures involve both sides of the brain and are characterized by bilateral
synchronous epileptic discharges in the brain from the onset of the seizure. Because the entire
brain is affected at the onset of the seizures, there is no warning or aura.
o Tonic-clonic seizure is characterized by loss of consciousness and falling to the ground if
the patient is upright, followed by stiffening of the body (tonic phase) for 10 to 20
seconds and subsequent jerking of the extremities (clonic phase) for another 30 to 40
o Absence (petit mal) seizure usually occurs only in children and rarely continues beyond
o Atypical absence seizure, which is characterized by a staring spell accompanied by other
signs and symptoms, includes brief warnings, peculiar behavior during the seizure, or
confusion after the seizure.
Partial seizures, also referred to as partial focal seizures, are caused by focal irritations. They
manifest with unilateral manifestations that arise from localized brain involvement.
o Simple partial seizures with elementary symptoms do not involve loss of consciousness
and rarely last longer than 1 minute.
o Complex partial seizures can involve a variety of behavioral, emotional, affective, and
cognitive functions. These seizures usually last longer than 1 minute and are frequently
followed by a period of postictal confusion.
Status epilepticus is a state of continuous seizure activity or a condition in which seizures recur in
rapid succession without return to consciousness between seizures. It is the most serious
complication of epilepsy and is a neurologic emergency.
Most seizures do not require professional emergency medical care because they are self-limiting
and rarely cause bodily injury. However, if status epilepticus occurs, if significant bodily harm occurs,
or if the event is a first-time seizure, medical care should be sought immediately.
Seizure disorders are treated primarily with antiseizure drugs. Therapy is aimed at preventing
seizures because cure is not possible.
A significant number of patients whose epilepsy cannot be controlled with drug therapy are
candidates for surgical intervention to remove the epileptic focus or prevent spread of epileptic
activity in the brain. When a seizure occurs, the nurse should carefully observe and record details of the event because
the diagnosis and subsequent treatment often rest solely on the seizure description.
During the seizure it is important to maintain a patent airway. This may involve supporting and
protecting the head, turning the patient to the side, loosening constrictive clothing, or easing the
patient to the floor, if seated.
Because many seizure disorders cannot be cured, drugs must be taken regularly and continuously,
often for a lifetime. The nurse should ensure that the patient knows this, as well as the specifics of
the drug regimen and what to do if a dose is missed.
Multiple sclerosis (MS) is a chronic, progressive, degenerative disorder of the CNS characterized
by disseminated demyelination of nerve fibers of the brain and spinal cord.
The cause of MS is unknown, although research findings suggest that MS is related to infectious
(viral), immunologic, and genetic factors and is perpetuated as a result of intrinsic factors (e.g.,
MS is characterized by chronic inflammation, demyelination, and gliosis (scarring) in the CNS.
The onset of the disease is often insidious and gradual, with vague symptoms occurring
intermittently over months or years. Thus the disease may not be diagnosed until long after the
onset of the first symptom.
The disease is characterized by chronic, progressive deterioration in some persons and by
remissions and exacerbations in others.
Common signs and symptoms of MS include motor, sensory, cerebellar, and emotional
Because there is no definitive diagnostic test for MS, diagnosis is based primarily on history,
clinical manifestations, and the presence of multiple lesions over time as measured by MRI.
Because there is currently no cure for MS, collaborative care is aimed at treating the disease
process and providing symptomatic relief. Drug therapy used includes immunosuppressants, immunomodulators, and adrenocorticotropic
Spasticity is primarily treated with antispasmodic drugs. However, surgery, dorsal-column
electrical stimulation, or intrathecal baclofen delivered by pump may be required.
Exercise improves the daily functioning for patients with MS not experiencing an exacerbation.
Various nutritional measures have been used in the management of MS, including megavitamin
therapy and diets consisting of low-fat and gluten-free food and raw vegetables.
During an acute exacerbation the patient may be immobile and confine