Seizure
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Disorders
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Seizure vs.
Epilepsy
Seizure: Sudden discharge of
excessive electrical energy from
nerve cells n the brain.
Epilepsy: A disease diagnosed
primarily from history of seizure
episodes because of increased
basal level excitability of the CNS.
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Generalized
Vs. Partial
Generalized seizure: seizure that
begins in one area of the brain
and rapidly spreads throughout
both hemispheres.
Partial seizures: also called focal
seizures; seizures involving one
area of the brain that do not
spread throughout the entire
organ.
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Predisposing Factors
▪ Abnormal neurons (very sensitive to
stimulation or overrespond)- Primary
seizures
▪ Head injury, drug overdose,
environmental exposure, chemical
imbalances, fever and such-
secondary seizures
Pathophysiology
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(Ebrary.net, n.d.)
Classification of seizure
z Generalized Seizure
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Grand Mal /Tonic-Clonic
▪ -is abrupt onset preceded by an aura ( any
peculiar feeling, sight, sound, taste, smell or
twitching and spasm of small muscle groups).
▪ -person falls to the ground, becomes pale,
pupils dilate, with upward rolling of the eyeballs.
Head is thrown backward or to one side; chest
and abdominal muscles are rigid; limbs are rigid
and contracted (tonic phase)
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Grand Mal /Tonic-Clonic
▪ Generally, 1 to 3 minutes.
▪ This type is what most people think of when they hear the word
"seizure."
▪ Has 5 phases:
▪ Prodromal
▪ Aura
▪ Tonic
▪ Clonic
▪ Post-ictal
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Prodromal
▪ from hours to days
▪ drowsiness, dizziness, lack of
coordination
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Aura
▪ Reflects the portion of the
brain which might be
affected
▪ Smelling unpleasant odors (
temporal lobe)
▪ Flashing of lights ( occipital
lobe)
▪ Numbness of extremities
▪ ( parietal lobe )
▪ Cheshire cat grin ( Frontal
lobe)
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Tonic
▪ All the muscles stiffen
▪ Air being forced past the vocal cords causes a cry or groan
(epileptic cry)
▪ The person loses consciousness and falls to the floor
▪ The tongue or cheek may be bitten, so bloody saliva may
come from the mouth
▪ The person may turn a bit blue in the face.
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Clonic
▪ The arms and usually the legs begin to jerk rapidly
and rhythmically, bending and relaxing at the elbows,
hips, and knees.
▪ After a few minutes, the jerking slows and stops
▪ Bladder or bowel control sometimes is lost as the
body relaxes
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Post ictal
▪ May be unresponsive for 1-4 hours then will
be arousable to pain
▪ Awakens with severe headache and no
memory of the seizure
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Tonic-
Clonic:
What is it
like in real
life?
z Petit Mal/Absence seizure
▪ Short transient losses of consciousness
▪ Eye rolling; drooping or fluttering of
eyelids; drooping of the head; quivering
of limb or trunk muscles.
▪ On completion of the seizure, the child
immediately resume activity without
knowledge of what happened.
▪ It can be precipitated by
hyperventilation or induced by blinking
light.
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Atonic (Drop Attack)
• “A” means without and when you put the
word tonic after it the meaning is: WITHOUT
MUSCLE TONE
• The patient goes limp and falls if standing or
slumps over if sitting…at risk for head injury
(may need helmet)
• Usually not aware during event….post ictus:
immediate…regains consciousness
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Myoclonic
▪ Involves short, sporadic periods of
muscle contractions that last for
several minutes. They are relatively
rare and are often secondary
seizures.
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Jacksonian
▪ –convulsion starts with
one muscle or group of
muscles and then
spreads to other parts
of the body.
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Febrile Seizures
▪ related to very high fevers and
usually involve tonic-clonic
seizures. Febrile seizures most
frequently occur in children; they
are usually self-limited and do not
reappear.
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Status Epilepticus
▪ - When seizures are so frequent that
they may appear to be constant, it is
termed status epilepticus, a medical
emergency which may result in brain
damage because of decreased oxygen
supply to the cerebrum.
Classification
Partial
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Simple partial seizures
▪ Occur in a single area
of the brain and may
involve a single muscle
movement or sensory
alteration.
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Complex partial seizures
▪ involves a series of reactions or emotional changes and
complex sensory changes such as hallucinations, mental
distortion, changes in personality, loss of consciousness,
and loss of social inhibitions.
▪ Motor changes may include involuntary urination,
chewing motions, diarrhea, and so on.
▪ The onset of complex partial seizures usually occurs by
late teens.
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Diagnostic procedure
▪ Electroencephalogram (EEG)
▪ Radiography,
▪ Computed Tomography,
▪ Magnetic Resonance Imaging
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Medical –Surgical Management
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Nursing Diagnosis
▪ Risk for aspiration
▪ Risk for Injury
▪ Impaired memory
▪ Acute confusion
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Injury Prevention During Seizure
▪ Ease patient to the floor when possible
▪ Protect the head with pad to prevent injury
▪ Loosen constrictive clothing
▪ Push aside furniture that may cause injury
▪ If in bed, remove pillows and raise siderails
▪ If aura precedes, insert an oral airway
▪ Do not attempt to open clenched jaw
▪ Do not restrain
▪ Place patient on one side with head flexed forward; suction when possible
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Care during Post Ictus Stage
▪ Note the time the seizure stopped and how the patient is behaving afterwards:
• Are they tired (let them sleep and rest), confused, can’t think or talk, have a headache (ask
where it is located and pain rating), has any injuries (some patienst may bite their tongue or
cheek)
• Maintain airway (suction, administer oxygen)
• If a tonic-clonic seizure, the patient will be very sleepy, won’t remember what happened.
• Assess vital signs and neuro status: pupils, reflexes, is patient confused or oriented
• Clean patient if incontinence was experienced.
• Document and report it to the physician… is this your patient’s first seizure, are they on
anything for seizures (is drug level not therapeutic….may need to draw a drug level if
ordered by MD)
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Important Information
▪ For Grand Mal
▪ -Phenobarb- initial drug of choice, safe to use
• WOF: Respiratory depression and hypotension
• Drug level 15 to 40 mcg/mL
▪ -Dilantin- causes stomatitis and hypertrophy of the
gums (Implication: Meticulous oral hygiene is a
must). Folic acid and vitamin B12 are given to
prevent megaloblastic anemia.
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Important Information
▪ For Petit Mal
▪ -zarontin- blood dyscrasias are less common
▪ -Trimethadione (Tridione)- decrease the
excitability of the motor area of the cerebral
cortex; less hypnotic effect than zarontin but has
toxic effects: blood dyscrasias, insomnia;
fatigue; photophobia; skin rashes.
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Benzodiazepines: absence seizures, tonic
clonic, focal
▪ Diazepam or Lorazepam: status epilepticus (fast
acting)
• Very drowsy, tolerance can develop where it
isn’t as effective, impair liver (monitor liver
studies)
• Reversal agent: Flumazenil (*used with extreme
caution due to its risks)= Can cause seizures
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Medical Management
▪ Antiepileptic drugs (AED)
▪ Phenytoin(Dilantin), phenobarbital,
carbamazepine(Tegretol), valproate sodium
(Depakote)
▪ Side effects: fatigue, dizziness, weight gain,
slurring of speech, uncoordinated movements and
allergic reaction
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Other Treatments
• Surgery: to remove an area of the brain that is causing the
seizure….example: focal seizures that arise from temporal lobe (temporal
lobectomy)
• Meds not working: placement of a vagus nerve stimulator: an electrical
device that sends electrical signals to the vagus nerve
• Ketogenic diet (used in pediatric patient who have epilepsy): high fat, low
carb, diet….used when seizures not controlled by medication
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