Seizures

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seizure

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episodes of abnormal motor or sensory, autonomic or psychic activity that results from excessive discharge of the cerebral neurons

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two main types of seizures

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partial or generalized

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partial

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begins with an electrical discharge in one limited area of the brain. Small part or one side of the body affected

r/t head injury, brain infection, stroke or tumor (opposite side of body is affected)

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simple partial

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consciousness remains intact

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generalized

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begins with a widespread electrical discharge, involves both sides of the brain at once, whole body affected. hereditary factors are important

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specific causes of seizures

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cerebrovascular disease

hypoxemia

fever (childhood)

head injury

hypertension

central nervous system infections

metabolic and toxic conditions

brain tumor

drug and alcohol withdrawal

allergies

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facts about simple partial

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different from person to person, depends on the part of the brain when they begin (finger or hand shakes)

one thing in common is that the person remains alert and can remember what happens

usually last for less than 2 minutes

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motor seizures

sensory seizures

autonomic seizures

psychic seizures

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body movement

visual and hearing

change in bp and heart rhythm

feel it coming on deja vu

anyone can have this type of seizure

head injury, brain infection, stroke or brain tumor most likely

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complex partial seizures

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last 30 sec to 2 minutes

may be tired or confused for about 15 minutes afterwards and may not be fully functional for hours

usually start in a small area of the temporal or frontal lobe

quickly involve other area of the brain that affect alertness and awareness

start with a simple partial seizure (also called an aura and often includes an odd feeling in the stomach)

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complex partial seizure reactions

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may lose awareness and stare blankly

have automatisms: mouth movement, picking at the air or clothing, perform other purposeless actions

may repeat words or phrases, laugh, scream, or cry

may turn into secondarily generalized seizures.

if medication is not erective some can be eliminated by epilepsy surgery, sometimes resemble daydreaming or absence seizures

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Secondarily generalized seizure

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start in one limited area of the brain (partial seizure) and spreads throughout the brain, becoming generalized

occur in more than 30% of people with partial epilepsy

convulsive phase usually lasts no more than a few minutes

preceding partial seizure is usually not very long

can be controlled with medication

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primary generalized seizure

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absence seizure (complex absence seizure)

brief episodes of staring

include a change in muscle activity(most common are eye blinks)

usually more than 10 seconds long

usually begin between ages 4 and 14

no warning sign before and completely alert immediately afterward

70% of cases stop by age of 18

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atypical absence seizure

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primary generalized

stare bout often somewhat responsive

eye blinking or slight herking movement of the lips

usually continued to adulthood

daydreaming and inattentiveness can mimic these seizures

diagnosis can be difficult if the behavior during seizures is similar to a child's usual behavior

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mycolonic seizure

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very brief jerks lasting, lasting 2 to 3 seconds

abnormal movement on both side of the body at the same time

primary generized

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atonic seizure

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muscles suddenly lose strength-drop and fall to the floor

eyelids may droop, head nod, may drop items, also known as drop attacks, drop seizures, or akinetic

usually remain conscious, begin in childhood and last to adulthood-primary generalized

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clonic

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consist of rhythmic jerking movements of the arms and legs. Length of time varies

rare

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tonic clonic seizure (grand mal)

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usually last 2 to 3 minutes

more than 5 minutes call for medical help

lasting more than 30 minutes indicates convulsion

lose consciousness and fall

may bite tongue or cheek

may turn blue in the face

after the tonic phase comes the clonic

arms and legs jerk rapidly and rhythmically

bladder and/ or bowel control may be lost as the body relaxes

may be drowsy, confused, agitated or depressed, children and adults may be affected

can be controlled by medications

seizure free for a year or two while taking medication will remain seizure free

no epilepsy wave on eeg can stay free of any seizure medication

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aura

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experiences alteration in smell, taste, visual perception, hearing and emotional state

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ictus

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actual seizure activity

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postictal state

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drowsiness and confusion are common during this phase. The brain is recovering from the insult it has experienced. patient often sleeps for a period of time.

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seizure diagnosis

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determine if the pt. did or did have an actual seizure

past medical history

careful history of clinical presentation and events related to alleged seizure

general physical and neurological examination

ct. scan

eeg

single pet

mri

video eeg

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seizure medication

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keppra (levetiracetam)

Dilantin(phenytoin)

tegretol (carbamazepine)

lamictal (lamotrigine)

Depakote (valproate)

neurotin (gabapentin)
cerebyx (fosphenytoin)

luminal (phenobarbital) rarely used

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medical management of seizure

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pharmacologic therapy used to control seizures with minimal side effects

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side effects of anti-seizure medications

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cns disturbances, visual disturbances, lightheadedness, balance problems, confusions, headache

gi-mild g.i dysfunction

acute toxicity occurs when the med is initially prescribed-skin rash, easy bleeding/bruising, jaundice

chronic toxicity occurs late in the course of therapy

Dilantin causes gingival hyperplasia

other drugs may affect hematopoietic, GU and hepatic systems

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atypical absence seizure (primary generalized)

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stare but often somewhat responsive

eye blinking or slight jerking movement of the lips

usually continue to adult hood

day dreaming and inattentiveness can mimic these seizures,

diagnosis can be difficult if the behavior during seizures is similar to a child's behavior

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myoclonic seizure (primary generalized)

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very brief jerks, lasting 2-3 seconds

abnormal movements on both sides of the body at the same time

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atonic seizure

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muscles suddenly lose strength

eyelids may droop, head nod , may drop items, and often fall to the ground. Also known as drop attacks, drop seizures or akinetic

begin in childhood and last till adult hood

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tonic seizure (primary generalized)

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usually last less than 20 seconds

occur most often during sleep

tone is greatly increased and the body, arms, or legs make sudden stiffening movements

consciousness is usually preserved

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plan of care for a patient experiencing a seizure

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observe and document. of pt. signs and symptoms before, during, and after seizure

nursing actions during seizure for patient safety and protection

after seizure care to prevent complications

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what to observe and doc

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circumstances before the seizure, aura or not, where did the seizure begin and how did it proceed. type of body movement and areas of body involved, unconsciousness, if present and duration, incontinence urine or stool, obvious paralysis or weakness after the seizure, inability to speak after the seizure, whether the patient sleeps post seizure, cognitive status, injuries

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nursing care during procedure

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provide privacy, ease to floor if possible, protect the head with a pad, loosen constrictive clothing, move any furniture close enough to cause injury, oral airway if present an aura

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do not (during seize)

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attempt to pry open the jaws or insert anything during a seizure, attempt to restrain the pt. during the seizure,

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if possible (during seize)

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turn to side with head flexed forward, use suction if available to clear secretions

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nursing care after a seize

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keep on side ot prevent aspiration, (maintain patent airway) assess for injury, reorient to the environment, if agitated use persuasion and gentle restraint to promote calmness, neurologic assessment, vital signs and maintain seizure precautions

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nursing priorities

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protect from injury, maintain airway/rep. function, promot positive self esteem, provide information about disease process, prognosis and treatment

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status epilepticus

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series of seizures occurring without full recovery between attacks.

Last atleast 30 minutes

medical emergency-vigorous muscular contractions impose a heavy metabolic deman

respiratory arrest leading to brain hypoxia and venous congestion-leads to irreversible and fatal brain damage

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precipitating factors of status epilepticus

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withdrawal of anti-seizure medication

fever

concurrent infection

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status epilipticus goal

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stop seiz as quickly as possible and maintain a seizure free state

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medical man. of status epilpticus

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establish an airway with adequate oxygenation,

intubate if remain unconscious and unresponsive

establish iv. diazepam, lorazepam, fosphenytoin-give halt to seizure

lab drawn

ongoing neuro, cardiac and resp. assessment

vital signs