E.

Febrile seizure
SEIZURE DISORDERS - Seizures occurs only when fever is rising

Seizures 2. Partial seizures

- Abnormal sudden, explosive, disorderly
discharge of cerebral neurons, involving A. Psychomotor seizures
motor, sensory and autonomic - may follow trauma, hypoxia, drug use
responses characterized by episodes of - purposeful but inappropriate, repetitive
abnormal motor, sensory, autonomic or motor acts
psychic activity (or combination) - Aura present; dreamlike state
- Part or all of the brain may be involved
- Often used interchangeably with B. Simple partial seizures
“CONVULSION“ - produces sensory symptoms
- Convulsions are when a person's body accompanied by motor symptoms that
shakes rapidly and uncontrollably. are localized or confined to a specific
area
Types of Seizures - only a finger or hand may shake, or the
1. Generalized Seizures: mouth may jerk uncontrollably
A. Grand mal - person may talk unintelligibly, dizzy,
- May be preceded by aura; tonic and experience of unusual or unpleasant
clonic phase sights, sounds, odors or tastes
- involve both hemispheres of the brain - No loss of consciousness
- Tonic Phase: limbs contract or stiffen;
pupils dilate and eyes roll up to one C. Complex partial seizure
side; glottis closes; may be incontinent; - characterized by periods of altered
occurs at the same time as loss of behavior that the client is not aware of
consciousness, lasts 20-40 seconds - The client loses consciousness for a few
- Clonic Phase: Repetitive movement, seconds
increased mucus production - the person either remains motionless or
- characteristic epileptic cry. moves automatically but
- Tongue is often chewed, incontinent of inappropriately for time & place
urine & feces. - may experience excessive emotions of
- Patient relaxes & lies in deep coma, fear, anger, elation, or irritability.
breathing noisily - the person does not remember the
- Seizure ends with post-ictal period of episode when it is over
confusion and drowsiness
- Many pts. report headache, sore Specific Causes
muscles, fatigue & depression 1. IDIOPATHIC
2. ACQUIRED
B. Petit mal  Cerebrovascular disease
- Not preceded by an aura
 Hypoxemia of any cause
- Little or no tonic-clonic seizures
 Fever
- There is sudden cessation of ongoing
 Head injury
physical activities
- Characterized by blank facial  Hypertension
expression, automatism like  CNS infections
lip=chewing, cheek smacking  Metabolic & toxic conditions
 Brain tumor
C. Myoclonic seizures  Drug & alcohol withdrawal
- Associated with brain damage  Allergies
- Generalized jerking or stiffening of
extremities Nursing Management
Before & during a seizure
D. Akinetic seizures  Observe & record the sequence of signs.
- Related to organic brain damage  The circumstances before the seizure.
- Sudden brief loss of postural tone, and  Occurrence of an AURA
temporary loss of consciousness  The first thing the patient does in the
seizure
  Type of movements in the body Brain sends out abnormal, recurring,
involved uncontrolled signals
 Pupil size & if the eyes are open ↓
 AUTOMATISMS Repeated & unpredictable seizures
 Incontinence of urine or stool
 Duration of each phase of seizure Clinical Manifestations
 Duration of unconsciousness  Simple staring spells
 Obvious paralysis or weakness  Violent shaking and loss of alertness.
 Inability to speak after the seizure  The type of seizure depends on the part
 Cognitive status of the brain affected and cause of
epilepsy.
Nursing Care during Seizure  Strange sensation
 Prevent injury & support not only physically
but also psychologically Diagnostic tests
 Provide privacy & protect the patient.  EEG
 Place patient on the floor if possible.  Blood chemistry
 Protect the head with a pad.  Blood sugar
 Loosen constrictive clothing  CBC
 Push aside any furniture  Kidney function tests
 If the patient is in bed, raise side rails.
 Head CT & MRI
 If an aura precedes the seizure, insert oral.
 Lumbar puncture
 Don’t attempt to open jaws due to spasm
 Tests for infectious diseases
or to insert anything.
 Don’t restrain the patient during seizure.
Medical Management
 If possible, place the pt. on one side with
Pharmacologic Therapy
head flexed forward.
 Objective: To achieve seizure control with
minimal side effects
After the seizure
 Medication therapy controls rather than
 Keep the patient on one side. Make sure
cures seizures.
the airway is patent.
 Major antiseizure medications:
 There is usually a period of confusion after
- Carbamazepine, clonazepam,
a grand mal seizure.
gabapentin, phenobarbital, phenytoin,
 A short apneic period may occur during or
valproate
immediately after generalized seizure.
 Pt. should be reoriented to the
Surgical Management
environment.
- Indicated for patients whose epilepsy
 If the pt. becomes agitated after a seizure,
results from intracranial tumors, abscesses,
use persuasion & gentle restraint
cysts, or vascular anomalies.

EPILEPSY STATUS EPILEPTICUS

- A group of syndromes characterized by - Acute prolonged seizure activity
unprovoked, recurring seizures - A series of generalized seizures that occur
- If seizures repeatedly continue after the without full recovery of consciousness
underlying problem is treated, the between attacks.
condition is called epilepsy. - A medical emergency
- It can be primary or secondary. - A tonic-clonic seizure lasting longer than 5
minutes.
Pathophysiology - Repeated episodes of cerebral anoxia &
NEURONS carry messages from the body edema may lead to irreversible & fatal brain
↓ damage.
Impulses occur in bursts whenever a nerve cell Management
has a task to perform  Stop the seizures as quickly as possible
↓  Airway & adequate oxygenation
Permanent changes occur in brain tissue  IV diazepam (Valium), lorazepam (Ativan)
↓  IV line is established & blood samples are
Brain becomes too excitable or jumpy obtained
↓  EEG monitoring
 VS & neurologic signs are monitored.
 Cardiac & respiratory depression should be
monitored