Neurological Seizures

Seizure Disorders

Seizures:Electrical Activity

Abrupt, uncontrolled electrical discharges of cerebral neurons that interrupts normal brain function

May be a symptom of an underlying illness or may be spontaneous

Epilepsy

Group of syndromes characterized by spontaneous reoccurring seizures

When seizures continue to occur for unknown reasons or because of an underlying problem that cannot be corrected, the condition is known as epilepsy.

Classification of Seizures

Generalized Seizures

Partial Seizures

Generalized Seizure

► Affects entire brain► No warning► Loss of

consciousness

Types of Generalized Seizures

Tonic –clonic (grand mal) Loss of consciousness

Fall to ground Tonic- muscles stiffness &

Clonic-extremity jerking Excessive salivation Cheek biting Incontinence may occur

Tonic – muscle stiffness Clonic-muscle contraction

and relaxation (jerking)

Absence seizures – disconnects from the world for a few seconds (staring, glaring)

Myoclonic seizures – involves jerking only for a few seconds

Partial Seizures (Simple or Complex)

Local onsetMay or may not

loose consciousness

Begin in a specific area of brain

May generalize and turn into tonic-clonic seizures

Causes of Seizure Disorder

Idiopathic (unknown)Birth injuryCNS defects or infectionHead traumaBrain tumorsCVA- cerebral vascular diseaseChronic disease Metabolic disorders

PRECIPITATING FACTORS

FatigueDecreased physical

healthAlcohol ingestionEmotional stressFlashing lightsMenstrual cycleHypoglycemia

Sleep deprivationStimulantsWithdrawal Substance abuseHigh FeverElectrolyte

imbalanceHypoxia

Diagnostic Studies

MOST USEFUL diagnostic tool is an accurate and comprehensive description of the seizures and health history

Electroencephalogram (EEG) Not completely reliable

CT/CAT, MRI, PET scansLabs (e.g. electrolytes/drug screen) to

R/O other medical causes

Electroencephalography: EEG

Clinical Manifestations

Determined by the site of the electrical disturbance

May involve Changes in

consciousness Motor Sensory/senses Emotional Combinations

Signs & Symptoms

May have a variety of presentations

Prodrome epileptic cry

Sensory changes Deja vue Aura- Smells, sights,

numbness, tingling, emotional changes

May have motor symptoms

Complications of Seizure

Greatest risk with loss of consciousness

Trauma from fallHead injuryDrowningAuto accident

Phases of Seizure

Pre-ictal-before the seizure May have warning

Ictal-during seizurePostictal-after the seizure

Usually lethargic, sleepy, memory loss

During a Seizure…

During a Seizure…

During a Seizure…

During a Seizure…

During a Seizure…

During a Seizure…

Seizure Management

Monitor seizure activity and time eventMaintain patent airway

Support head or neck Turn patient on side to prevent aspiration

Prevent or minimize injury Do not restrain; stay with client Ease patient to floor Protect head Loosen restrictive clothing Do not place anything in mouth

video

Nursing Interventions: post seizure

Assess VS, LOC (GCS), pupilsMay require O2 or suctioningPatient will usually sleepReorient pt when arousesAllow to restDextrose if hypoglycemicAdminister prescribed meds

Seizure Precautions

Hospital at bedside: Oxygen Suction Oral Airway IV access Bed in low position Side rails up

• Padded side rails controversial

No padded tongue blades

Drug Therapy: Antiepileptic Drugs

Stabilize nerve cell membranesPrevent the spread of epileptic

discharges80% of patients controlled with

medication

Common Medications Phenytoin (Dilantin) Carbamazepine

(Tegretol)Valproic acid (Depakene)Barbiturates -

PhenobarbitalSuccinimides -ZarontinBenzodiazepines –

Valium, AtivanClonazepam –Klonopin

Newer Antiseizure DrugsNeurontinLamictalFelbatolTopamaxCerebyx

EducationMedication Therapeutic drug levels

Drug-drug and food-drug interactions

Stress compliance with medications

Do not stop abruptly

What to do if you miss a dose

Client and Family Education

Care of client during a seizure

When to call 911 Seizure precautions Keep seizure diary Rest; Manage stress Take medications as

prescribed

Status Epilepticus

State of continuous seizure activity Neurological emergency Uses up all brain energy stores May cause permanent brain damage Tonic-clonic Status Epilepticus can

lead to a respiratory or cardiac arrest and death

Emergency Care

Status Epilepticus Establish airway Administer oxygen IV antiseizure drugs

• Lorazepam (Ativan) or Diazepam (Valium): a short-acting benzodiazepine

• Phenytoin (Dilantin) long-acting

Stat labs

Surgical Management

Remove the epileptic focus Prevent spread of epileptic activityInvolves resection of brain tissue/ lobe

Brain Mapping

Video with EEG

Alternative Therapies: Do NOT REPLACE DRUGS

BiofeedbackKetogenic Diet-high fat low carb

Body burns fat instead of glucose for energy

Vagal nerve stimulation Implantation of a device to stimulate the

vagal nerve To abort the seizure

Psychosocial

Social stigmaUnable to driveFear of embarrassmentEffects of medications

Complications of Status Epilepticus

AspirationCerebral hypoxiaMusculoskeletal traumaDeath

Referrals and resources

Refer to community resourcesResources: Epilepsy Foundation Of

America, National Epilepsy League