Seizure Disorders

Seizures defined…..
• Abnormal sudden, explosive,
disorderly discharge of
electrical impulses from the
cerebral neurons characterized
by episodes of abnormal motor,
sensory, autonomic or psychic
activity (or combination)
• Part or all of the brain may be
involved
 2 main types:
❖ Partial - begin in one part of the brain
❖ Generalized - involve electrical discharges
in the whole brain.
 GENERALIZED SEIZURES:
1. GRAND MAL
- May be preceded by AURA; tonic and clonic phase involve
both hemispheres of the brain
- TONIC PHASE: limbs contract or stiffen; pupils dilate and
eyes roll up to one side; glottis closes; may be incontinent;
occurs at the same time as loss of consciousness, lasts 20-
40 seconds
- CLONIC PHASE: Repetitive movement (elbows, legs and
head will flex then relax., increased mucus production
- characteristic EPILEPTIC CRY.
- Tongue is often chewed, incontinent of urine & feces.
- Patient relaxes & lies in deep coma, breathing noisily
- Seizure ends with post-ictal period of confusion and
drowsiness
- Many pts. report headache, sore muscles, fatigue &
depression
2. PETIT MAL ( Little Seizure)
- Not preceded by an aura
- Little or no tonic-clonic seizures
- There is sudden cessation of ongoing physical
activities by blank facial expression, automatism
like lip-chewing, lip smacking

3. MYOCLONIC SEIZURES
- Associated with brain damage
- Generalized jerking or stiffening of extremities
(arms and shoulders)
- “jumps”- sudden muscle jerks
Petit Mal seizure
4. AKINETIC SEIZURES (Drop Attack, Astatic, Atonic)
- Related to organic brain damage
- Sudden brief loss of postural tone, and temporary
loss of consciousness

5. FEBRILE SEIZURE
- Seizures occurs only when fever is rising
- Common among 6 mos. to 5 years
 PARTIAL/ FOCAL SEIZURES
1. SIMPLE PARTIAL SEIZURES
- produces sensory symptoms accompanied by motor
symptoms that are localized or confined to a specific area
only a finger or hand may shake, or the mouth may jerk
uncontrollably
- person may talk unintelligibly, dizzy, experience of
unusual or unpleasant sights, sounds, odors or tastes
- No loss of consciousness
2. COMPLEX PARTIAL SEIZURE/PSYCHOMOTOR
SEIZURES
- may follow trauma, hypoxia, drug use
- characterized by periods of altered behavior that the
client is not aware of
- Aura present; dreamlike state
- The client loses consciousness for a few seconds the
person either remains motionless or moves
automatically but inappropriately for time & place
- may experience excessive emotions of fear, anger,
elation, or irritability.
3. Abdominal seizure
• These seizures are accompanied by autonomic
symptoms or signs, such as abdominal
discomfort or nausea which may rise into the
throat (epigastric rising), stomach pain, the
rumbling sounds of gas moving in the
intestines (borborygmi), belching, flatulence,
and vomiting. Also referred to as abdominal
epilepsy.
 SPECIFIC CAUSES:
• IDIOPATHIC
• ACQUIRED
– Cerebrovascular disease
– Hypoxemia of any cause
– Fever
– Head injury
– Hypertension
– CNS infections
– Metabolic & toxic conditions
– Brain tumor
– Drug & alcohol withdrawal
– Allergies
 NURSING MANAGEMENT
• Before & during a seizure
✓ Observe & record the sequence of signs.
• The circumstances before the seizure.
• Occurrence of an AURA
• The first thing the patient does in the seizure
• Type of movements in the body involved
• Pupil size & if the eyes are open
• AUTOMATISMS
• Incontinence of urine or stool
• Duration of each phase of seizure
• Duration of unconsciousness
• Obvious paralysis or weakness
• Inability to speak after the seizure
• Cognitive status
 “It could be a song, a talk with
someone from years ago, or other
things that I have no reason to
remember.”
“ It's like a big black hole appears beside
me and if I look into the black hole and try
to see what's in there I'll fall in…”
 “…the aura i get is usually a foul smell
like skunk when there is no actual skunk
around”
“It is weird to explain one. Only way is
that I feel weird and that something bad
is going to happen.”
 Nursing Care during Seizure
• Prevent injury & support not only physically but also
psychologically
❖ Provide privacy & protect the patient.
❖ Place patient on the floor if possible.
❖ Protect the head with a pad.
❖ Loosen constrictive clothing
❖ Push aside any furniture
❖ If the patient is in bed, raise side rails.
❖ If an aura precedes the seizure, insert oral airway equipment
.
❖ Don’t attempt to open jaws clenched during spasm or insert
anything.
❖ Don’t restrain the patient during seizure.
❖ If possible, place the pt. on one side with head flexed
forward.
 After the seizure
❖Keep the patient on one side. Make sure the airway
is patent.
❖There is usually a period of confusion after a grand
mal seizure.
❖A short apneic period may occur during or
immediately after generalized seizure.
❖Pt. should be reoriented to the environment.
❖If the pt. becomes agitated after a seizure, use
persuasion & gentle restraint
 The Epilepsies
• A group of syndromes char. by
unprovoked, recurring seizures.
• If seizures repeatedly continue after
the underlying problem is treated, the
condition is called epilepsy.
• It can be primary or secondary.
 Cause
• Inherited
• Idiopathic
• Birth trauma
• Asphyxia neonatorum
• Head injuries
• Some infectious diseases
• Toxicity
• Circulatory problems, fever, metabolic & nutritional
disorders, drug or alcohol intoxication
• Brain tumors, abscesses, congenital malformations
 Pathophysiology
NEURONS carry messages from the body
↓
Impulses occur in bursts whenever a nerve cell has a
task to perform
↓
Permanent changes occur in brain tissue
↓
Brain becomes too excitable or jumpy
↓
Brain sends out abnormal, recurring,
uncontrolled signals
↓
Repeated & unpredictable seizures
 Clinical Manifestations
• Simple staring spells
• Violent shaking and loss of alertness.
• The type of seizure depends on the
part of the brain affected and cause of
epilepsy.
• Strange sensation
 Diagnostic tests
• EEG
• Blood chemistry
• Blood sugar
• Kidney function tests (electrolytes)
• Head CT & MRI
• Lumbar puncture
• Tests for infectious diseases
 Medical Management

❖Pharmacologic Therapy
✓Objective: To achieve seizure control with
minimal side effects
✓Medication therapy controls rather than
cures seizures.
✓Major antiseizure medications:
• Carbamazepine, clonazepam, gabapentin,
phenobarbital, phenytoin, valproate
 Nursing Give phenytoin over 30-40 minutes (rate <50mg/minute). In patients who
are elderly, or have pre-existing cardiac disease, give phenytoin over 60
minutes. N.B. Adminstration should commence immediately after the
considerations mixture has been prepared and completed within 1 hour.

to IV Ideally, administer undiluted via a syringe pump through a large gauge

Phenytoin: needle or IV catheter into a large forearm vein.

If dilution is essential, mix with 100–250ml sodium chloride 0.9% to a

final concentration of <10mg/ml, and administer by infusion pump.

Use the solution immediately, ideally with a 0.2–0.5micron in-line filter.

To avoid local venous irritation, inject sterile sodium chloride 0.9%

through the vein or catheter before and after each phenytoin infusion.

Do not administer as a continuous infusion.

Continuous ECG and blood pressure monitoring is essential during

infusion.
 Ataxia

Monitor for Tremors

signs of
phenytoin Slurred speech
toxicity:
Nausea and vomiting

*Serum phenytoin levels should

be maintained at 10 – 20 mg/dl
 Take drug with food as prescribed. Swallow ER tablets
Take whole, do not cut, crush, or chew them.

Do not Do not discontinue this drug abruptly or change dosage,

discontinue except on the advice of your physician.

Avoid alcohol, sleep-inducing, or OTC drugs; these could

Avoid cause dangerous effects. Avoid grapefruit since it can
increase levels of carbamazepine causing toxicity.

Arrange for frequent checkups, including blood tests, to

Arrange monitor your response to this drug. Keep all appointments
Nursing for checkups.
Considerations
for Use Use contraceptives at all times; if you wish to become
pregnant, you should consult your physician.
Carbamazepine
Wear a medical alert tag at all times so that any emergency
Wear medical personnel will know that you have epilepsy and are
taking antiepileptic medication.

Report bruising, unusual bleeding, abdominal pain,

yellowing of the skin or eyes, pale feces, darkened urine,
Report impotence, CNS disturbances, edema, fever, chills, sore
throat, mouth ulcers, rash, pregnancy.
Monitor for signs
of carbamazepine
toxicity: Loss of appetite,
right-sided
A skin rash
stomach pain,
dark urine

Anemia,
Tachycardia,
neutropenia,
palpitations
thrombocytopenia

Hyponatremia
❖Surgical Management
• Indicated for patients whose epilepsy
results from intracranial tumors,
abscesses, cysts, or vascular
anomalies.
 Status Epilepticus
• Acute prolonged seizure activity
• A series of generalized seizures that occur
without full recovery of consciousness between
attacks.
• A medical emergency
• A tonic-clonic seizure lasting longer than 5
minutes.
• Repeated episodes of cerebral anoxia & edema
may lead to irreversible & fatal brain damage.
 Management
• Stop the seizures as quickly as possible
• Airway & adequate oxygenation
• IV diazepam (Valium), lorazepam (Ativan)
• IV line is established & blood samples are
obtained
• EEG monitoring
• VS & neurologic signs are monitored.
• Cardiac & respiratory depression should be
monitored
end.