Seizure Disorders

Seizure disorders, including epilepsy, are complex

neurological conditions that affect millions of people
worldwide. These disorders are characterized by sudden,
uncontrolled electrical disturbances in the brain, leading
to a wide range of symptoms and manifestations.
Defining Seizures and Epilepsy
Seizure Epilepsy

A seizure is a sudden, uncontrolled electrical disturbance Epilepsy is a chronic neurological disorder characterized
in the brain. This neurological event can cause various by recurrent, unprovoked seizures. To be diagnosed with
changes in behavior, movements, feelings, and epilepsy, an individual must have experienced at least two
consciousness. Seizures can be brief, lasting only a few unprovoked seizures occurring more than 24 hours apart,
seconds, or prolonged, continuing for several minutes. or one unprovoked seizure with a high risk of recurrence.
The manifestation of a seizure depends on which part of Epilepsy affects people of all ages and can significantly
the brain is affected and how widely the disturbance impact daily life, requiring ongoing medical management
spreads. and lifestyle adjustments.
Classification of Seizures: Focal Seizures
Focal Seizures Simple Focal Seizures Complex Focal Seizures
Focal seizures, also known as Simple focal seizures occur Complex focal seizures involve
partial seizures, originate in one without loss of consciousness. impaired awareness or
specific area of the brain. These Symptoms may include consciousness. The individual
seizures can manifest in various involuntary muscle movements, may appear confused, perform
ways depending on the location sensory disturbances, or repetitive movements, or be
of the abnormal electrical emotional changes. The person unresponsive to their
activity. Focal seizures are further remains aware and can often environment. These seizures can
categorized into two main types: describe their experience during last from 30 seconds to several
simple focal seizures and the seizure. minutes.
complex focal seizures.
 Classification of Seizures: Generalized
Seizures

Tonic-Clonic Absence (Petit Atonic Seizures Myoclonic and

(Grand Mal) Mal) Seizures Clonic Seizures
Also known as "drop
Seizures
Characterized by brief attacks," these seizures Myoclonic seizures
These seizures involve a loss of lapses in awareness, cause a sudden loss of involve sudden, brief
consciousness, muscle stiffening often lasting only a few muscle tone, leading to muscle jerks, while
(tonic phase), and jerking seconds. The person falls. They are typically clonic seizures are
movements (clonic phase). They may appear to be brief but can result in characterized by
are the most recognizable type of staring into space and injury. repetitive, rhythmic
generalized seizure and can last be unresponsive during jerking movements.
several minutes. this time. Both can affect various
parts of the body.
Unknown Onset Seizures

1 Definition 2 Diagnostic Challenges 3 Importance of

Classification
Unknown onset seizures are Identifying the onset of these
those that do not have a clear seizures can be challenging While initially classified as
point of origin in the brain. due to various factors, such as unknown onset, further
This classification is used lack of observable symptoms evaluation and monitoring
when there is insufficient at the beginning of the seizure, may eventually reveal the true
information to determine absence of witnesses, or nature of these seizures.
whether the seizure is focal or limited diagnostic information Proper classification is crucial
generalized at its onset. available at the time of for determining appropriate
evaluation. treatment strategies and
understanding the underlying
causes.
Epidemiology of Seizure Disorders
Global Prevalence Approximately 50 million people worldwide have epilepsy

Incidence 2.4 million new cases diagnosed annually

Age Distribution Affects all age groups, with higher incidence in young
children and older adults

Geographical Variation Higher prevalence in low and middle-income countries

Gender Distribution Slightly higher incidence in males

Risk Factors for Seizure Disorders

Genetic Predisposition Neurological Conditions

Certain genetic mutations can increase the risk of Brain tumors, stroke, and neurodegenerative diseases can
developing epilepsy. Family history of seizure disorders lead to seizures by disrupting normal brain function and
may indicate a higher susceptibility. structure.

Head Trauma Infections

Traumatic brain injuries, from mild concussions to severe Certain infections affecting the brain, such as meningitis,
trauma, can increase the risk of developing seizures, both encephalitis, and neurocysticercosis, can lead to seizures
immediately and years after the injury. and increase the risk of developing epilepsy.
Pathophysiology of Seizures

Neuronal Hyperexcitability 1
Seizures begin with abnormal electrical activity
in neurons, caused by imbalances in excitatory
and inhibitory neurotransmitters or ion channel 2 Synchronization
dysfunction. As the abnormal activity spreads, it recruits
neighboring neurons, leading to synchronized
firing of large groups of neurons.
Propagation 3
The synchronized activity can spread to other
brain regions, potentially evolving into a
generalized seizure if it crosses both 4 Termination
hemispheres. Seizures typically self-terminate due to
neuronal exhaustion or activation of inhibitory
mechanisms, though some may require
intervention.
Seizure Triggers
Lifestyle Factors Environmental Factors Physiological Factors

• Sleep deprivation • Flashing lights • Hormonal changes (e.g.,

• Stress and anxiety (photosensitive epilepsy) menstruation)

• Alcohol consumption • Loud noises or specific sounds • Fever or illness

• Dehydration • Certain smells or tastes • Medications or drug interactions

• Metabolic imbalances
Clinical
Manifestations
and Diagnostic
Procedures for
Seizure Disorders
Generalized Seizures: Clinical Presentation
1 2 3 4

Initial Phase Tonic Phase Clonic Phase Postictal State

The onset of a This phase is Following rigidity, After the seizure
generalized seizure is characterized by rhythmic jerking subsides, the patient
often sudden and muscle rigidity movements occur. enters a period of
dramatic. The patient throughout the body. These convulsions can confusion,
may experience an The patient's arms and be violent and may last disorientation, and
abrupt loss of legs may extend, and for several minutes. often fatigue. This
consciousness, falling they may arch their During this phase, the postictal state can last
to the ground if back. Breathing may patient may from minutes to hours.
standing. become labored or experience
temporarily cease. incontinence or bite
their tongue.
Focal Seizures: A Closer Look
Altered Sensations Localized Twitching Automatisms and Aura

Patients may report unusual Focal motor seizures can cause Complex focal seizures may involve
sensory experiences such as strange rhythmic jerking or twitching in a automatisms - repetitive,
tastes, smells, or visual distortions. specific body part, such as a finger, purposeless movements like lip-
These altered sensations can be hand, or facial muscles. This smacking or hand-wringing. Auras,
highly specific and consistent for movement may spread to adjacent which are essentially focal seizures
each individual. areas over time. that don't progress, can serve as a
warning sign for an impending
larger seizure.
Complications of Seizures: Status Epilepticus
Definition and Urgency Physiological Impact
Status epilepticus is a life-threatening condition Prolonged seizure activity can lead to hypoxia,
characterized by seizures lasting more than 5 minutes metabolic acidosis, hyperthermia, and cerebral edema.
or recurring seizures without full recovery between These physiological changes can result in permanent
episodes. It requires immediate medical intervention brain damage if not promptly addressed.
to prevent neurological damage and other systemic
complications.

Treatment Approach Long-term Consequences

Management of status epilepticus involves rapid Survivors of status epilepticus may face cognitive
administration of antiepileptic drugs, often in impairments, increased risk of recurrent seizures, and
escalating doses or combinations. In refractory cases, higher mortality rates. Close follow-up and tailored
medically induced coma may be necessary to suppress rehabilitation are crucial for these patients.
seizure activity.
Physical Injuries and Psychosocial Impact
Traumatic Aspiration Risk Dental Trauma Psychosocial
Injuries Consequences
During seizures, Tongue biting and
Seizures can lead to patients are at risk of dental injuries are The unpredictable
falls resulting in head aspirating saliva, food, common during tonic- nature of seizures can
trauma, lacerations, or or stomach contents, clonic seizures. lead to anxiety,
fractures. Patients may potentially leading to Patients may depression, and social
also suffer from aspiration pneumonia. experience chipped isolation. Patients may
shoulder dislocations This risk is particularly teeth, jaw fractures, or face challenges in
or vertebral high in convulsive soft tissue lacerations employment, driving
compression fractures seizures where in the oral cavity. restrictions, and
due to severe muscle protective reflexes are maintaining
contractions during impaired. relationships,
generalized seizures. significantly impacting
their quality of life.
Comprehensive Neurological Assessment
Patient History Physical Examination Cognitive Evaluation
A detailed medical history is A thorough neurological exam Assessment of memory,
crucial, including seizure assesses mental status, cranial language, and executive
descriptions, frequency, duration, nerve function, motor strength, functions can reveal cognitive
and potential triggers. Family sensory perception, reflexes, and impairments associated with
history of neurological disorders coordination. This helps identify seizures or underlying
and current medications are also focal neurological deficits that neurological conditions.
important factors to consider. may indicate the seizure's origin.
Electroencephalography (EEG) in Seizure
Diagnosis

Brain Activity Mapping Seizure Classification

EEG records electrical activity across different brain Different seizure types produce distinct EEG patterns,
regions, providing a real-time map of neural function. This aiding in accurate classification.
helps identify abnormal patterns associated with epilepsy
and other seizure disorders.

Localization of Seizure Foci Long-term Monitoring

EEG helps pinpoint the origin of seizure activity in the brain, Prolonged EEG recordings, often combined with video
which is crucial for surgical planning in drug-resistant monitoring, allow for the capture of infrequent seizures
epilepsy cases. This localization guides targeted and help differentiate epileptic from non-epileptic events,
interventions to control seizures effectively. improving diagnostic accuracy.
Advanced Imaging Studies in Seizure
Diagnosis
Imaging Modality Primary Use Advantages Limitations

MRI Structural abnormalities High soft tissue contrast Time-consuming,

contraindicated with
certain implants

CT Acute settings, Rapid acquisition, good Lower soft tissue

calcifications for bone imaging resolution than MRI

PET (positron emission Metabolic activity Identifies epileptogenic Expensive, limited

tomography) zones availability

SPECT (Single-photon Ictal blood flow Can capture seizure Requires injection
emission computed events during seizure
tomography)
Laboratory Tests for Seizure Evaluation

Basic Metabolic Complete Blood Toxicology Genetic Testing

Panel Count Screening
For patients with
A comprehensive CBC helps identify Toxicology tests are suspected genetic
metabolic panel underlying infections or crucial in cases of new- epilepsy syndromes,
assesses electrolyte hematological disorders onset seizures or targeted genetic panels
imbalances, particularly that may contribute to breakthrough seizures in or whole-exome
sodium, calcium, and seizure activity. patients with well- sequencing may be
glucose levels, which Abnormalities in white controlled epilepsy. performed. These tests
can trigger seizures if blood cell count may They can detect can identify specific
abnormal. Renal and indicate systemic substances like alcohol, genetic mutations
liver function tests are inflammation or recreational drugs, or associated with various
also included to guide infection requiring certain medications that epilepsy types,
medication choices and further investigation. may lower seizure informing prognosis and
dosing. threshold. treatment strategies.
Critical Care
Management for
Seizures
Effective critical care management of seizures requires swift action
and comprehensive care.
ABC Assessment
1 Airway
Ensure a clear airway. Remove any obstructions like vomit, foreign objects, or secretions. Position the
patient in a way that helps maintain an open airway, such as a head tilt-chin lift, jaw thrust maneuver, or to
the sides. Consider using an oropharyngeal or nasopharyngeal airway if necessary.

2 Breathing
Support breathing. Monitor oxygen saturation levels using a pulse oximeter and provide supplemental
oxygen if the patient's saturation falls below the target range. Assess the patient's respiratory rate, depth,
and effort. If necessary, consider using mechanical ventilation to support breathing.

3 Circulation
Monitor circulatory status. Check the patient's pulse rate and rhythm, blood pressure, and capillary refill
time regularly. Assess the patient's skin color, temperature, and moisture. Consider administering fluids or
medications to maintain adequate blood pressure and perfusion.
Safety Precautions

1 Remove Harmful 2 Provide Padding 3 Proper Positioning

Objects
Use soft materials to protect Position the patient to prevent
Clear the area around the the patient from injury during aspiration and maintain
patient of any potentially seizure activity. airway patency.
dangerous items.
Seizure Documentation
Onset Time Duration
Record the exact time the Note how long the seizure
seizure began for accurate lasts, crucial for
duration tracking. determining status
epilepticus.

Movement Types Triggers/Aura

Describe the specific Document any reported
movements observed triggers or aura experienced
during the seizure episode. by the patient.
Antiepileptic Drugs (AEDs)
Drug Mechanism of Action Route Common Side Effects

Lorazepam Gamma-aminobutyric IV, IM Drowsiness, sedation,

acid (GABA) enhancer respiratory depression

Diazepam GABA enhancer IV, rectal Drowsiness, sedation,

respiratory depression

Levetiracetam Synaptic vesicle IV, oral Dizziness, somnolence,

glycoprotein 2A (SV2A) ataxia
modulator

Phenytoin Na+ channel blocker IV, oral Nystagmus, ataxia,

diplopia, gingival
hyperplasia
Emergent Medications
Initial Benzodiazepine
Administer IV benzodiazepines like lorazepam or diazepam for immediate seizure control in status epilepticus.

AED Loading
Following initial control, administer a loading dose of a longer-acting antiepileptic drug (AED) such as
levetiracetam or phenytoin. The goal is to achieve therapeutic blood levels of the chosen AED as soon as
possible.

Maintenance Therapy
After the loading dose, establish a maintenance dosing regimen based on the patient's response to
treatment and regular monitoring of drug levels. Maintenance therapy aims to prevent future seizures and
maintain the patient's seizure-free status.
Continuous EEG Monitoring
Indications Setup Interpretation

Used for refractory seizures or Involves placing electrodes on the Continuous analysis by
suspected non-convulsive status scalp. Requires specialized neurophysiologists. Aids in guiding
epilepticus. Helps detect subclinical equipment and trained personnel. treatment and assessing response.
seizures.
Hemodynamic
Monitoring

Heart Rate Respiratory Rate

Monitor for tachycardia or Assess for changes in breathing
bradycardia associated with pattern or respiratory
seizures or medications. depression.

Temperature Blood Pressure

Watch for hyperthermia, which Monitor for hypertension or
can exacerbate seizures or hypotension related to seizure
indicate complications. activity.
Management of Complications

1 Hypoxia 2 Hyperthermia 3 Metabolic Acidosis

Provide supplemental oxygen. Use cooling blankets or ice Correct with intravenous
Consider intubation for packs. Administer antipyretics bicarbonate. Address
persistent low saturation. as needed. underlying causes like
hypoperfusion.
Postictal Care

1 Immediate Assessment
Check for confusion, weakness, or neurological
deficits as seizure subsides.

2 Ongoing Monitoring
Continue close observation for recurrence of seizures
or worsening symptoms.

3 Gradual Reorientation
Provide reassurance and orientation as patient
regains consciousness.
Patient Positioning
Recovery Position Head Elevation
Place patient on left side to Slightly elevate head of bed
maintain clear airway and to reduce intracranial
prevent aspiration. pressure when appropriate.

Comfort Measures
Use pillows to support limbs and maintain comfort during recovery.
Patient and Family Education
Seizure Triggers Medication Adherence Safety Measures

Educate on common triggers like Stress importance of taking AEDs as Teach strategies to prevent injury
sleep deprivation, stress, and prescribed. Discuss potential side during seizures. Discuss driving
medication non-adherence. effects. restrictions.
Long-term Management Strategies

1 Regular Follow-ups 2 Lifestyle Modifications 3 Support Groups

Schedule periodic neurology Encourage healthy sleep Connect patients with epilepsy
appointments to assess patterns, stress reduction support groups for ongoing
treatment efficacy and adjust techniques, and balanced education and emotional
as needed. nutrition. support.
Nursing Care for
Seizure Patients
Effective nursing care for seizure patients requires a comprehensive
approach.
Neurological Assessment

1 Initial Evaluation
Perform a baseline neurological assessment upon
admission. Check level of consciousness, pupil
reactivity, and motor function.

2 Ongoing Monitoring
Conduct regular neurological checks. Look for
changes in mental status or new focal deficits.

3 Post-Ictal Assessment
Assess patient immediately after a seizure. Document
duration, type, and recovery time.
Seizure Activity Monitoring
Visual Observation EEG Monitoring
Watch for twitching, staring spells, or rhythmic Assist with continuous EEG monitoring if ordered.
movements. Note the time and duration of any events. Ensure proper electrode placement and signal quality.

Video Recording Documentation

Use video monitoring when available. This helps Keep detailed seizure logs. Include time, duration,
correlate clinical events with EEG findings. type, and post-ictal state for each event.
Identifying Seizure
Triggers
1 Medication 2 Sleep Patterns
Compliance
Assess sleep quality and
Check if the patient has duration. Sleep
been taking anti- deprivation is a common
epileptic drugs as seizure trigger.
prescribed. Missing
doses can trigger
seizures.

3 Stress Levels 4 Environmental

Factors
Evaluate patient's stress.
High stress can lower Look for triggers like
seizure threshold. flashing lights or loud
noises. Modify
environment if
necessary.
Common Nursing
Diagnoses
Diagnosis Related Factors

Risk for Injury Sudden loss of

consciousness, falls

Risk for Aspiration Impaired swallowing reflex

during seizures

Impaired Physical Mobility Post-ictal confusion, muscle

weakness

Anxiety Fear of seizures, social stigma

Planning and Goal
Setting
Prevent Injury Maintain Airway
Aim to maintain a safe Ensure airway patency
environment. Implement during and after seizures.
fall prevention strategies. Position patient
appropriately.

Reduce Seizure Improve Quality of

Frequency Life
Work towards decreasing Set goals to enhance
seizure occurrences through patient's daily functioning
medication compliance and and reduce anxiety.
trigger management.
Seizure Precautions

Bed Safety Protective Gear

Use padded side rails. Keep bed Consider helmet for patients
in low position when occupied. with frequent falls. Use as
needed.

Call System Padding

Ensure call bell is within reach. Place pillows around patient.
Teach patient how to use it. Pad hard surfaces in room.
Safe Medication Administration
Proper Dosing Timing Monitoring

Double-check all anti-epileptic drug Administer medications at Watch for side effects. Check drug
doses. Use weight-based dosing consistent times. Maintain levels as ordered.
when appropriate. therapeutic blood levels.
Patient Education on
Seizure Management

1 Recognizing Signs
Teach patients and families to identify auras and early
seizure symptoms.

2 First Aid
Demonstrate proper seizure first aid techniques.
Emphasize safety and timing.

3 Medication Management
Explain importance of medication adherence. Discuss
potential side effects.

4 Lifestyle Changes
Advise on sleep hygiene, stress reduction, and
avoiding triggers.
Emotional Support and
Counseling
Active Listening Coping Strategies
Provide opportunities for Teach relaxation
patients to express fears techniques. Help patients
and concerns. Listen develop positive coping
empathetically. mechanisms.

Support Groups Family Involvement

Connect patients with Include family in
epilepsy support groups. discussions. Address their
Encourage peer interaction. concerns and questions.
Evaluating Intervention
Effectiveness
Monitor Seizure Assess Medication
Frequency Efficacy
Track changes in seizure Evaluate if medications are
occurrence. Compare to controlling seizures. Note
baseline. any side effects.

Review Safety Gather Patient

Measures Feedback
Check if implemented safety Ask patients about their
precautions are preventing perception of care. Identify
injuries. areas for improvement.
Rehabilitation and
Recovery
Speech Therapy Physical Therapy
Address any language or Help regain strength and
communication difficulties mobility, especially after
resulting from seizures. prolonged ICU stay.

Occupational Neuropsychological
Therapy Assessment
Assist in relearning daily Evaluate cognitive impacts
activities and improving and guide rehabilitation
cognitive function. strategies.
Promoting Treatment
Adherence

Medication Reminders Seizure Diaries

Suggest using pill organizers or Encourage patients to keep
smartphone apps. Help seizure journals. Teach proper
establish medication routines. documentation techniques.

Regular Check-ins Family Involvement

Schedule follow-up phone calls. Educate family members on
Address concerns and reinforce importance of adherence.
compliance. Encourage their support.