Case Study

(Seizure Disorder)

Prepared By:

Tiongson, Elena Marie R.

Valondo, Jennylyn

Vallejo, Lynette

Varilla, Krisren

(Group 6)

Submitted to:

Ms. Louuie Marrie Carag RN, MSN

Seizure Disorder
Introduction
Also known as convulsions, epileptic seizures, and if recurrent, epilepsy. It is a sudden
alteration in normal brain activity that cause distinct changes in behavior and body function.
They are thought to result from abnormal, recurrent, uncontrolled electric discharges of neurons
in the brain.

Predisposing factors include head or brain trauma, tumors, cranial surgery, metabolic
disorders (hypocalcemia, hypoglycemia or hyperglycemia, hyponatremia, anoxia); central
nervous system infection; circulating disorders; drug toxicity; drug withdrawal states (alcohol,
barbiturates); and congenital neurodegenerative disorders.
There are two basic types of seizures:
Epileptic: These seizures have no apparent cause (or trigger) and occur repeatedly. These
seizures are called a “seizure disorder” or “epilepsy.”
Nonepileptic: These seizures are triggered (provoked) by a disorder or another condition
that irritates the brain. In children, a fever can trigger a nonepileptic seizure.

Signs and Symptoms

Almost all seizures are relatively brief, lasting from a few seconds to a few minutes. Most
seizures last 1 to 2 minutes. When a seizure stops, people may have a headache, sore muscles,
unusual sensations, confusion, and profound fatigue. These after-effects are called the postictal
state. In some people, one side of the body is weak, and the weakness lasts longer than the
seizure (a disorder called Todd's paralysis). Most people who have a seizure disorder look and
behave normally between seizures. Other possible symptoms include numbness or tingling in a
specific body part, brief episodes of unresponsiveness, loss of consciousness, confusion, and loss
of muscle or bladder control.

Pathophysiology
 Before age 2: High fevers or temporary metabolic abnormalities, such as abnormal blood
levels of sugar (glucose), calcium, magnesium, vitamin B6, or sodium, can trigger one or
more seizures. Seizures do not occur once the fever or abnormality resolves. If the
seizures recur without such triggers, the cause is likely to be an injury during birth, a birth
defect, or a hereditary metabolic abnormality or brain disorder.
 2 to 14 years: Often, the cause is unknown.
 After age 25: A head injury, stroke, or tumor may damage the brain, causing a seizure.
Alcohol withdrawal (caused by suddenly stopping drinking) is a common cause of
seizures. However, in about half of people in this age group, the cause is unknown.

Seizures with no identifiable cause are called idiopathic.

Conditions that irritate the brain—such as injuries, certain drugs, sleep deprivation, infections,
fever—or that deprive the brain of oxygen or fuel—such as abnormal heart rhythms, a low level
of oxygen in the blood, or a very low level of sugar in the blood—can trigger a single seizure
whether a person has a seizure disorder or not. A single seizure that results from such a stimulus
is called a provoked seizure (and thus is a nonepileptic seizure). People with a seizure disorder
are more likely to have a seizure when they are under excess physical or emotional stress or
deprived of sleep. Avoiding these conditions can help prevent seizures.

Rarely, seizures are triggered by repetitive sounds, flashing lights, video games, or even touching
certain parts of the body. In such cases, the disorder is called reflex epilepsy.
 Causes of Seizures
Cause Examples

High fever Heatstroke

Infections

Brain infections Abscess

AIDS

Malaria

Meningitis

Rabies

Syphilis

Tetanus

Toxoplasmosis

Viral encephalitis

Metabolic disorders High blood levels of sugar or sodium

Kidney or liver failure

Low blood levels of sugar, calcium,

magnesium, or sodium

Underactive parathyroid gland

Vitamin B6 deficiency (in newborns)

Inadequate oxygen supply to the brain Abnormal heart rhythms

Carbon monoxide poisoning

Near drowning

Near suffocation

Stroke

Vasculitis

Diagnostic Procedure
1. EEG, with or without video monitoring, locates epileptic focus, spread, intensity, and
duration, helps classify seizure type.
2. CT scanning or MRI identifies lesion that may cause of seizure.
3. Single photon emission CT scanning (SPECT) or positron emission tomography (PET)
identifies seizure foci.
4. Neuropsychological studies evaluate for behavioral disturbances.
5. Serum electrolytes, glucose, and toxicity screen determine the cause of first seizure.
6. Lumbar puncture and blood cultures may be necessary if fever is present.

Medical Management
1. Antiepileptic drugs (AEDs) may be used singly or in combination to increase
effectiveness, treat mixed seizure types, and reduce adverse effects.
2. A wide variety of adverse reactions may occur, including hepatic and renal dysfunction,
vision disturbances, drowsiness, ataxia, anemia, leukopenia, thrombocytopenia, psychotic
symptoms, skin rash, stomach upset, and idiosyncratic reactions.

Surgical Management
1. Surgical treatment of brain tumor or hematoma may relieve seizures caused by these.
2. Temporal lobectomy, extratemporal resection, corpus callosotomy, or
hemispherectomy may be necessary in medically intractable seizure disorders.

Nursing Management
1. Monitor the entire seizure event, including prodromal signs, seizure behavior, and
postictal state.
2. Monitor complete blood count, urinalysis, and liver function studies for toxicity caused
by medications.
3. Provide safe environment by padding side rails and removing clutter.
4. Place the bed in low position.
5. Do not restrain the patient during seizure.
6. Do not put anything in the patient’s mouth during seizure.
7. Maintain a patent airway until the patient is fully awake after a seizure.
8. Provide oxygen during the seizure if the patient becomes cyanotic.
9. Place the patient on side during a seizure to prevent aspiration.
10. Protect the patient’s head during the seizure.
11. Teach stress reduction techniques that will fit into the patient’s lifestyle.
12. Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds
to sedation.
13. Encourage the patient to determine existence of triggering factors for seizures, such as
skipped meals, lack of sleep, and emotional stress.
14. Remind the family the importance of following medication regimen and maintaining
regular laboratory testing, medical check ups, and visual examinations.
15. Encourage patient to follow a moderate lifestyle routine, including exercise, mental
activity, and nutritious diet.