SEIZURE MANAGEMENT

SEIZURE

SEIZURES

• Seizures are symptoms of a brain problem.

• They happen because of sudden, abnormal electrical activity in the brain.

• When people think of seizures, they often think of convulsions in which a person's body shakes rapidly and uncontrollably.

• Not all seizures cause convulsions.

• There are many types of seizures and some have mild symptoms.

• Seizures fall into two main groups. Focal seizures, also called partial seizures, happen in just one part of the brain.

• Generalized seizures are a result of abnormal activity on both sides of the brain.

ANATOMY

The brain is well protected by:

• The scalp

• The Skull

• The Dura

ANATOMY

THE DURA

• A tough 3-layer sheath that surrounds the brain and spinal cord

• Layers include – the dura mater (strongest layer)– arachnoid mater (middle layer) – and pia mater (closest to the brain)

ANATOMY

THE CEREBRUM

• Made up of two cerebral hemispheres that are connected in the middle

• It is the largest part of the brain

• Each area of the cerebrum performs an important function, such as language or movement

• Higher thought (cognition) comes from the frontal cortex (front portion of the cerebrum)

• Outside of the cerebrum are blood vessels

• There are fluid-filled cavities and channels inside the brain

ANATOMY

THE CEREBELLUM

• Located in the lower, back part of the skull

• Controls movement and coordination

THE BRAINSTEM AND PITUITARY GLAND

• Responsible for involuntary functions such as breathing, body temperature, and blood pressure regulation

• Pituitary gland is the "master gland" that controls other endocrine glands in the body, such as the thyroid and adrenal glands

• Pineal gland

ANATOMY

THE CRANIAL NERVES• Twelve large nerves exit the

bottom of the brain to supply function to the senses such as hearing, vision, and taste

THE CEREBRAL BLOOD VESSELS• A complicated system that

supplies oxygenated blood and nutrients to the brain

ANATOMY

ANTERIOR CEREBRAL CIRCULATION• The front of the brain is supplied

by the paired carotid arteries in the neck.

POSTERIOR CEREBRAL CIRCULATION• The back portion of the brain is

supplied by the paired vertebral arteries in the spine.

PATHOPHYSIOLOGY

• A seizure occurs when a portion of the brain becomes overly excited or when nerves in the brain begin to fire together in an abnormal fashion.

• Seizure activity can arise in areas of the brain that are malformed from birth defects or genetic disorders or disrupted from infection, injuries, tumors, strokes, or inadequate oxygenation.

• The pathophysiology of seizures results from an abrupt imbalance between the forces that excite and inhibit the nerve cells such that the excitatory forces take precedence.

• This electrical signal then spreads to the surrounding normal brain cells, which begin to fire in concert with the abnormal cells.

• With prolonged or recurrent seizures over a short period, the risk of future seizures increases as nerve cell death, scar tissue formation, and sprouting of new axons occur.

PATHOPHYSIOLOGY

• Nerve cells between discharges normally have a negative charge internally due to the active pumping of positively charged sodium ions out of the cell.

• Discharge or firing of the nerve cell involves a sudden fluctuation of the negative charge to a positive charge as ions channels into the cell open and positive ions, such as sodium, potassium, and calcium, flow into the cell. Both excitatory and inhibitory control mechanisms act to allow appropriate firing and prevent inappropriate excitation of the cell.

• The pathophysiology of seizures can occur due to increased excitation of the nerve cell, decreased inhibition of the nerve cell, or a combination of both influences.

CAUSES

COMMOM CAUSES• Alcohol abuse• Alcohol withdrawal• Cancer• Concussion• Drug abuse• Head injury• Insulin reaction

• Low blood oxygen• Low blood pressure• Encephalitis• Low blood sugar• Petit-mal seizure• Stroke • Vasovagal syncope • Epilepsy

PROBLEMS

• Depression• Injuries that occur during the seizure:

– Fractures– Tongue laceration– Dental injury– Shoulder dislocation

• Learning disabilities• Medication side effects• Status epilepticus:

– Seizure that lasts longer than 30 minutes– Multiple episodes of seizure without complete recovery between

episodes

TYPES

I. PARTIAL SEIZURE• SIMPLE PARTIAL SEIZURE : affect only a small region of the brain, often the

temporal lobes and/or hippocampi. People who have simple partial seizures retain consciousness.

• COMPLEX PARTIAL SEIZURE : may involve the unconscious repetition of simple actions, gestures or verbal utterances, or simply a blank stare and apparent unawareness of the occurrence of the seizure, followed by no memory of the seizure.

TYPES

II. GENERALIZED SEIZURES• ABSENCE SEIZURES :

– Involve an interruption to consciousness where the person experiencing the seizure seems to become vacant and unresponsive for a short period of time (usually up to 30 seconds). Slight muscle twitching may occur.

• MYOCLONIC SEIZURES : – Involve an extremely brief (< 0.1 second) muscle contraction and can result in jerky

movements of muscles or muscle groups.• CLONIC SEIZURES :

– Are myoclonus that are regularly repeating at a rate typically of 2-3 per second. in some cases, the length varies.

• TONIC–CLONIC SEIZURES : – Involve an initial contraction of the muscles (tonic phase) which may involve tongue biting,

urinary incontinence and the absence of breathing. This is followed by rhythmic muscle contractions (clonic phase). This type of seizure is usually what is referred to when the term 'epileptic fit' is used colloquially.

• ATONIC SEIZURES : – Involve the loss of muscle tone, causing the person to fall to the ground. These are sometimes

called 'drop attacks' but should be distinguished from similar looking attacks that may occur in cataplexy.

TYPES

III. MIXED SEIZURES• Mixed seizure is defined as the existence of both generalized and partial seizures in the same

patient.

IV. CONTINUOUS SEIZURES• STATUS EPILEPTICUS : – Refers to continuous seizure activity with no recovery between successive seizures. When the seizures

are convulsive, it is a life-threatening condition and emergency medical assistance should be called immediately if this is suspected. A tonic-clonic seizure lasting longer than 5 minutes (or two minutes longer than a given person's usual seizures) is usually considered grounds for calling the emergency services.

• EPILEPSIA PARTIALIS CONTINUA : – Is a rare type of focal motor seizure (hands and face) which recurs every few seconds or minutes for

extended periods (days or years). It is usually due to strokes in adults and focal cortical inflammatory processes in children (Rasmussen's encephalitis), possibly caused by chronic viral infections or autoimmune processes.

SIGNS & SYMPTOMS

I. ABSENCE SEIZURE

• staring

• the consumer suddenly stops what they is doing

• a few seconds of unresponsiveness (usually less than 10 seconds, but it can be up to 20 seconds) that can be confused with daydreaming

• no response when you touch the consumer

• the consumer is alert immediately after the seizure

• the consumer may have many seizures per day

• Less common features include:– repetitive blinking

– eyes rolling up

– head bobbing

– automatisms such as licking, swallowing, and hand movements

– autonomic symptoms such as dilated pupils, flushing, pallor, rapid heartbeat, or salivation

SIGNS & SYMPTOMS

II. MYOCLONIC SEIZURE

• one or many brief jerks, which may involve the whole body or a single arm or leg

• in juvenile myoclonic epilepsy, these jerks often occur upon waking

• the consumer remains conscious

III. ATONIC SEIZURE

• sudden loss of muscle tone

• the consumer goes limp and falls straight to the ground

• the consumer remains conscious or has a brief loss of consciousness

• eyelids droop, head nods

• jerking

• the seizure usually lasts less than 15 seconds, although some may last several minutes

• the consumer quickly becomes conscious and alert again after the seizure

SIGNS & SYMPTOMS

IV. TONIC-CLONIC SEIZURE• the consumer cries out or groans loudly • the consumer loses consciousness and falls down • in the tonic phase, the consumer is rigid, their teeth clench, their lips may turn blue

because blood is being sent to protect their internal organs, and saliva or foam may drip from their mouth; they may appear to stop breathing because their muscles, including their breathing muscles, are stiff

• heart rate and blood pressure rise • sweating • tremor • in the clonic phase, the consumer resumes shallow breathing; their arms and legs jerk

quickly and rhythmically; their pupils contract and dilate • at the end of the clonic phase, the consumer relaxes and may lose control of their bowel

or bladder • following the seizure, the consumer regains consciousness slowly and may appear

drowsy, confused, anxious, or depressed

SIGNS & SYMPTOMS

SIGNS & SYMPTOMS

V. MOTOR SEIZURE

• brief muscle contractions (twitching, jerking, or stiffening), often beginning in the face, finger, or toe on one side of the body

• twitching or jerking spreads to other parts of the body on the same side near the initial site

• other motor seizures may involve movement of the eye and head

• the seizure begins the same way each time

• the consumer remains conscious

VI. SENSORY SEIZURES

• seeing something that is not there, such as shapes or flashing lights, or seeing something as larger or smaller than usual

• hearing or smelling something that is not there

• feeling of pins and needles or numbness in part of the body

• the consumer remains conscious

SIGNS & SYMPTOMS

VII. AUTONOMIC SEIZURES

• changes in heart rate

• changes in breathing

• sweating

• goose bumps

• flushing or pallor

• the consumer remains conscious

• strange or unpleasant sensation in the stomach, chest, or head

• changes in heart rate

• changes in breathing

• sweating

• goose bumps

• flushing or pallor

• the consumer remains conscious

SIGNS & SYMPTOMS

VIII. PSYCHIC SEIZURES• problems with memory • garbled speech • problems with memory • garbled speech • sudden emotions for no apparent reason, such as fear, depression, rage,

or happiness • feeling as though they are outside their own body • feelings of déjà vu, or knowledge of the future

SIGNS & SYMPTOMS

COMPLEX PARTIAL SEIZURE

• warning sign such as a feeling of fear or nausea

• loss of awareness

• confusion after the seizure

• loss of memory about events just before or after the seizure

• loss of awareness

• blank stare

• walking or running

• screaming, yelling, or thrashing, either from sleep or while awake

• automatisms such as mouth movements, picking at air or clothing, repeating words or phrases

• confusion after the seizure

• loss of memory about events just before or after the seizure

MANAGEMENT

RECOGNIZING A SEIZURE • How a seizure affects a person, and what it may look like

depends on the part of the brain that is involved in the seizure. A seizure is caused by an electrical disturbance in the brain. Seizures can vary in how they look depending on the consumer.

MANAGEMENT

RESPONDING TO SEIZURES • If a person you are supporting is experiencing a seizure, respond the way

that you have been trained in your individual orientation to that person and your First Aid training.

• ALWAYS FOLLOW THE INDIVIDUAL PERSON’S SEIZURE PROTOCOL. • Each person served by DDD has an Individual Support Plan that includes a

listing of ”risks” that may affect the person. A person with seizures should have a risk assessment that outlines specific steps to follow when this person has a seizure.

MANAGEMENT

SOME GENERAL GUIDELINES FOR RESPONDING TO SEIZURES INCLUDE: • For convulsive type seizures:

– (convulsive means the person has uncontrollable movement of the muscles) – Stay calm and time the seizure. – If the person is having a convulsive type seizure, loosen any tight clothing and

remove eyeglasses if they wear them. – Clear the area of any potential hazards that could cause an injury to the consumer

such as hard, sharp, or hot objects, but do not interfere with their movements – if you can do so safely, turn the person’s body to the side to permit the draining of

fluids. – Something soft should be placed under the head. – Stay with the person. Continue to monitor the person after the seizure. – If the person is tired, assist him/her to a quiet comfortable place and allow time to

rest.

• For non convulsive type seizures ‐– (seizures that may involve the person’s senses or behavior, but that do not involve

convulsions.) – Time the seizure. – Be available if they need assistance.

MANAGEMENT

WHAT NOT TO DO DURING A SEIZURE: • Do NOT attempt to stop the seizure! • Do NOT restrain the person or try to hold them down in

any way! • Do NOT force anything between their teeth or put

anything in their mouth! • Do NOT give the person anything to eat or drink until

s/he has fully recovered consciousness!

MANAGEMENT

WHEN TO CALL 911: • FOLLOW THE PERSON’S SEIZURE PROTOCOL

– If the person does not have a known seizure disorder call 911 – If the seizure or recovery is different than what is typical for that person, call 911 – If a seizure lasts longer than 5 minutes call 911! (unless you have been instructed

otherwise in the individual orientation to the person) – If a person is having repeated seizures call 911 – If the person’s well being is in question, call 911 – If a person has trouble breathing after the seizure (lips or nail beds turning blue), call

911 – If a person is injured or seems to be in pain, call 911 – If you think the person’s health, well being, or life are in danger, call 911 ‐

MANAGEMENT

REPEATED SEIZURES • Can be life threatening! ‐• CALL 911! • Almost all seizures end naturally with no intervention within a few

minutes. The person may be tired and confused following a seizure and need to sleep. If however a person does not completely recover from one seizure before beginning another one, it’s possible that they are experiencing status epilepticus, a life threatening seizure. If in question, ‐call 911!

SUPPORTING A PERSON AFTER A SEIZURE • Provide any needed first aid for minor injuries or call 911 if necessary • Be calm, friendly and reassuring • Help the person to an area where they can rest comfortably • The person will is likely to be very tired. Allow them to rest. They may

sleep very deeply for a period of time following a seizure. • The person may seem confused or disoriented following a seizure.

MANAGEMENT

AFTER A SEIZURE • Once the seizure is over, and the person is safe and comfortable, you will

need to document some information about the seizure. When completing your documentation of the seizure:

• Note the time the seizure started and ended • Note the characteristics of the seizure

– Did the person lose consciousness? – Were they incontinent? – Did they experience convulsions? – What body parts were involved? – Was there a change in the coloring of the skin, or a blue tint to the lips or nail beds? ‐– What was the consumer’s condition following the seizure, i.e. were they confused, did

they have a headache, were they aware of their environment?

• When it is safe to do so, write a seizure report and/or incident report following your agency’s policy.

• After a seizure, a person is often very tired. Assist them as necessary to a place where they can rest.