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7/29/2019 Fuentes Seizure

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seizure- are episodes of abnormal motor, sensory, autonomic, or psychicactivity (or a combination of these) that result from sudden excessive

discharge from cerebral neurons.

Partial Seizures- seizures beginning locally

Simple Partial Seizures- seizures with elementary symptoms, generally without impairment of consciousness]

Complex Partial Seizures- with complex symptoms, generally withimpairment of consciousness

Generalized Seizures- convulsive or non convulsive, bilaterally symmetric, without local onset

Epilepsy - a group of syndromes characterized by unprovoked, recurringseizures

Status epilepticus- an acute prolonged seizure activity - is a series of generalized seizures that occurs wthout

full recovery of consciousness between attacks



Category:Idiopathic:•genetic,•developmental defects

Acquired:

•Cerebrovascular disease•Hypoxemia•Fever (childhood)•

Head injury •CNS infections•Metabolic and toxic conditions•Brain tumor•Drug and alcohol withdrawal• Allergies



Risk Factors Given

disturbance in cerebral function

Electrical disturbance in the nerve cells in one section of the brain

Diseased tissue in the Cerebrum discharges electrical impulses abnormally

Neurons emits abnormal, recurring, uncontrolled electrical discharges

Erratic Electrical discharge thatbegins in one part of the brain

Partial seizures (Simple and Complex) Generalized seizure

erratic electrical dischargesinvolving the whole brain



International Classification of Seizures

Seizures are divided first into two categories:•Partial (focal)

1. simple partial seizures (with no alteration of consciousness or memory)

•motor seizures with twitching,•abnormal sensations, abnormal visions,sounds or smells,and

•distortions of perception.•.resulting in flushing,•tingling,•nausea.

2. complex partial seizures (with alteration of

consciousness or memory)•may have an aura (nausea, heat or tingling, or distortionof sensory perceptions)•lip smacking,• walking around aimlessly, or• saying nonsense phrases over and over again.•These purposeless activities are called automatisms.



•Generalized

Absence Seizures•previously called petit mal seizures.•usually have onset in childhood, but they can persistinto adulthood.•present with staring spells lasting several seconds,

sometimes in conjunction with eyelid fluttering orhead nodding.•These seizures can be difficult to distinguish fromcomplex partial seizures that also may result in

staring.• Absence seizures usually are briefer and permitquicker recovery.



Generalized Tonic-Clonic Seizures

•previously called grand mal seizures.•These seizures start with sudden loss of consciousnessand tonic activity (stiffening) followed by clonic activity (rhythmic jerking) of the limbs.•

The patient's eyes will roll up at the beginning of theseizure and the patient will typically emit a cry, notbecause of pain, but because of contraction of therespiratory muscles against a closed throat.• Generalized tonic-clonic seizures usually last one to

three minutes.• After the seizure, the patient is "postictal“ (sluggish,sleepy and confused, variably for hours)



Atonic Seizures

•These are epileptic drop attacks.•

typically occur in children or adults with widespread brain injuries.•People with atonic seizures suddenly become limp and may fall to theground.•helmets are sometimes required to protect against serious injuries.

Myoclonic Seizure

•a brief un-sustained jerk or series of jerks,•less organized than the rhythmic jerks seen during a generalized tonic-clonic seizure.

Tonic Seizures

•involve stiffening of muscles as the primary seizure manifestation.• Arms or legs may extend forward.•Consciousness may or may not be lost.•

the clonic (jerking) phase is absent.



During a seizure:Major responsibility of the nurse is to observe and record the sequence of signs

Before and during a seizure, the patient is assessed and the ff items are documented

the circumstances before the seizure (visual, auditory stimuli, emotiopnalor psychological disturbances, hyperventilation)

the occurrence of an aura (premonitory warning or sensation which may be Visual , Auditory)

the 1st thing the patient does in the seizure– where the movements orstiffness begins, conjugate gaze position,etc.

the type of movements in the part of body involved

size of both pupils whether eyes are are open



•Presence of automatisms (involuntary motor activity, such as lipsmacking or repeated swallowing)

•

Incontinence of urine or stool

•Duration of each phase of seizure

•Unconsciousness, if presence, and its duration

• Any obvious weakness of arms and legs after the seizure

•Inability to peak after the seizure

• Whether or not the patient sleeps afterward

•Cognitive status (is pt. confused or not confused after theseizure?)



Nursing care during a seizure: •Provide privacy and protect the pt. from conscious onlookers

•Ease the pt to the floor if possible, protect the head with a pad to prevent injury

•Loosen constrictive clothing

•Push aside any furniture that may injure the pt. during seizure

•If pt. is in bed, remove pillows and raise siderails

•If an aura precedes a seizure, insert an oral airway to reduce the possibility of biting the tongue or cheek

•Do not attempt to pry open jaws that are clenched in a spasm or to insert

anything

•No attempt should be made to restrain the patient during the seizure

•If possible, place the patient on one side with the head flexed forward

•If suction available, use if necessar to clear secretions



After a seizure:

After a seizure, the nurse’s role is to document the events leading to andoccurring during and after the seizure and to prevent complications

Keep the patient on one side to prevent aspiration

There is usually a confusion after a grand mal seizure

A short apneic period may occur during or immediately after a generalizedseizure

The patient, upon awakening, shoulb be oriented to the environment

If pt. becomes agitated after a seizure, use persuation and gentle restraint toassist him to stay calm.



Medication Dose related side effects Toxic effects

Carbamazepine Skin rash.Dry mouth, nausea, vomiting, fluid retention,unsteadiness, dizziness,

drowsiness, fatigue,headache, low sodium in theblood, blood disorders,dermatitis, and hives.

Severe skin rash, blooddyscrasias, hepatitis

Ethosuximide Nausea, vomiting, diarrhoea,abdominal pain, anorexia,and weight loss.

Hepatotoxicity, bone marrowdepression

Lamotrigine Drowsiness, tremor, nausea,ataxia, dizziness

Severe rash

Phenobarbital sedation, irritability,diplopia, ataxia

skin rash, anemia

Phenytoin visual problems, hirsutism,

gingival hyperplasia

Peripheral neuropathy,

ataxia, drowsiness, blooddyscrasias



Risk for Injury Related to seizure activity injury preventionseizure precautions

Fear related to possibility of seizures:adherence to prescribed medication regimen

emphasize need to medication complianceencourage periodic monitoring of condition to assure adequacy of treatmentregimen Avoid factors that may initiate seizure (emotional disturbances, environmentalstressors, fever, etc)encourage pt. to follow a regular and moderate routine in lifestyle, diet,

exercise, and restavoid photic stimulationavoid alcoholic beverages



Ineffective individual coping

•Counseling of patient and patient’s family •Encourage provision of social and recreational activities within thefamily

Knowledge deficit•Educate them about the condition and the limitation it imposesas well as the symptoms and management•Provide modification on pts efforts and behaviors if necessary •Instruct the pt. to carry a medication card or bracelet



Seizures occur when the electrical system of the brain malfunctions. The brain cells keepfiring instead of discharging electrical

energy in a controlled manner. The resultcan be a surge of energy through the brain,causing unconsciousness and musclecontractions.

Seizures that begin focally can spread to the entire brain, in whichcase a tonic-clonic seizure ensues. It is important, however, todistinguish those that are true grand mal, generalized from thestart, from those that start focally and secondarily generalize.Secondarily generalized seizures arise from a part of the brain thatis focally abnormal. Drugs used to treat primarily and secondarily

generalized tonic-clonic seizures are different. Patients withsecondarily generalized tonic-clonic seizures may be candidates forcurative epilepsy surgery, whereas, primarily generalized tonic-clonic seizures are not surgical candidates, because there is noseizure origin site (focus) to remove.



A group of syndromes characterized by unprovoked, recurring seizures

Types:

•

Primary – idiopathic

•Secondary – known cause-birth trauma -metabolic-asphyxia - alcohol intoxication-head injuries - brain tumor-bacterial, viral, parasitic dses. - abscess-toxicity - congenital malformation-fever



Sensory Stimuli

Brain integration (neurons)

Discharge of electrochemical energy

Action/purposeful activity is carried out(motor output)

Neuronal/electrical system of the brainmalfunctions

Repeated discharges of electrical energy inan uncontrolled manner

the brain cells keep firing even afterbrain integration—motor output is carried

out

Resulting a surge of energy through thebrain,

Parts of the body controlled by the errantbrain cells also performs erratically

Simple to staring episodes, convulsivemoments, muscle contractions, loss of

consciousness, etc.

Depending on the location of the discharging neurons, seizures

may range from a simple stari ng

episode to prolonged convulsive

moments with loss of

consciousness



•There is an increase in seizure frequency during menses; this has beenlinked to the increase sex hormones that alter the excitability of neurons in

the cerebral cortex

•Effectiveness of contraceptives is decreased by antiseizure medz

• Women of childbearing age who have epilepsy require special care before,

during, and after pregnancy

•Risk of fetal congenital anomaly is 2-3x higher in women with epilepsy

•Maternal seizures, antiseizure medz, and genetic predisposition allcontribute to possible malformation

• Women taking antiseizure medz are at risk and needs careful monitoring,including blood studies to detect the level of antiseizure medz throughoutpregnancy

•Bone loss is associated with long term use of anti seizure medz



•Cerebrovascular dse is the leading cause of seizures in the elderly

•

The increase incidence is also associated with stroke, head injury,dementia, infection, alcoholism, and aging

•Because of decreased liver and renal fx, elderly pts. Must bemonitored closely for adverse and toxic effects of antiseizure medzand for osteoporosis.



• society wide efforts are the key to prevention of epilepsy :

--thru highway safety programs and occupational safety precautions

Mgt. of epilepsy is individualized to meet the needs of each pt. and not just to

manage and prevent seizuresPharmacologic therapy:

• objective is to achieve seizure control with minimal Side effects

•

Medication therapy controls rather than cure seizures•Starts with single medication starting dose and rate of increase in dosage depends on

the occurrence of side effects

•Changing to another medication may be necessary if seizure control is not achieved or if

toxicity makes it impossible ti increase the dosage



Side effects of antiseizure medz may be divided into 3 grps. :

1. Idiosyncratic or allergic disorders - skin reactions2. Acute toxicity- may occur when medz is initially prescribed

3. Chronic toxicity- occurs late in the course of therapy

Various manifestations of antiseizure drug toxicity:

• gingival hyperplasia

• severe skin rash

•

Hepatitis• Blood dyscrasias

• Aplastic anemia

• leukopenia



Indication:

•Pts whose epilepsy results from :

-intracranial tumors

-brain abscess

-cysts

-vascular anomalies

•

Pts whose seizures originate in a reasonably well-circumscribed area of thebrain that can be excised without producing significant neurologic deficits.



Neurosurgery and Resection surgery

-aided with microsurgical techniques, EEG with depth electrodes, improved

illumination and hemostasis and introduction of neuroleptic agents & local

anesthetic agents

-Use of special testing devices, electrocortical mapping and pt’s response to

stimulation

Generator implant- when seizures are refractory to medz inadolescent and adults with partial seizures

•Implanted under the clavicle.

•Device is connected to the vagus nerve in the cervical area delivers electrical

signals to the brain to control & reduce seizure activity



The major potential complications forpatients with epilepsy are:

- status epilepticus

- medication side effects ( toxicity)



• An acute prolonged seizure activity (includes continuous clinical or electrical seizures

lasting atleast 30 mins., even without impairment of consciousness)

• A series of generalized seizures that occur without full recovery of consciousness

between attacks

Risk factors:

• Withdrawal of antiseizure medication

•Fever

•Concurrent infection



• A MEDICAL EMERGENCY!Depletion of GABA(a principle inhibitory neurotransmitter)

and the excessive action of glutamate (an proconvulsive neurotransmitter)

state of raised excitability

Vigorous muscular contractions

Creates heavy metabolic demand and interference with respirations

Hypoxia

Cerebral anoxia

Repeated and prolonged cerebral anoxia

Irreversible and fatal brain damage



Goals of treatment are :

• to stop the seizures as quickly as possible

• to ensure adequate cerebral oxygenation (respiratory support, ET)

• to maintain patient in s seizure-free state

•IV diazepam lorazepam or fosphenytoin is administered in an attempt to



•IV diazepam,lorazepam,or fosphenytoin is administered in an attempt tohalt seizures immediately

•Other medz- phenytoin, phenobarbital- are administered later to

maintain a seizure free state

•IV line is established and blood samples are obtained to monitor serumelectrolytes, glucose, and phenytoin levels

•EEG monitoring

• VS and neurologic signs monitoring on a continuing basis

•IV infusion of dextrose if the cause of seizure

•If initial treatment is unsuccessful, general anesthesia with short-actingbarbiturate may be used

•Serum concentration of antiseizure medz are measured



•Ongoing assessment and monitoring of respiratory and cardiacfunction

•Monitoring and documenting the seizure activity and patient’sresponsiveness

•

Turn pt. to a side lying position

•Suction equipments should be readily available

•IV lines must be closely monitored

•Protect patient from injury most esp. during seizure attacks

•Refer accordingly

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