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Epilepsy
101
Recognition and Care of Seizures and
Emergencies
Patricia Osborne Shafer RN, MN
American Epilepsy Society
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Objectives
Recognize generalized and partial seizures.
Demonstrate basic first aid for seizure
types.
Identify
when a seizure may become an
emergency situation.
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Types of Seizures
Generalized Partial (also called
Involves the whole localization related, focal)
brain from the onset Begins in one side of
brain
Types: Can spread to other
Absence side
Myoclonic
Types:
Clonic
Tonic Simplepartial
Tonic-clonic Complex partial
Atonic (drop attack) Secondary generalized
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Revised Terminology and Concepts for
Classification of Seizures/Epilepsies
Generalized and focal seizures redefined
Generalized: “occurring in and rapidly
engaging bilaterally distributed networks”
Focal (partial): occurring “within networks
limited to one hemisphere and either discretely
localized or more widely distributed”
Types of generalized seizures simplified, while
focal seizures described in relation to
manifestations
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Parts of a Seizure
Prodrome – changes in behavior, mood or
feelings that may occur hours or days before a
seizure
Aura - Symptoms correspond to the area of brain
affected by the abnormal electrical activity. Most
commonly seen with complex partial seizures.
Ictus- What is seen/felt during abnormal electrical
activity
Postictal- What is seen/felt until the brain recovers
to baseline
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Simple Partial Seizures
Sometimescalled ‘auras’, is the first
symptom of a seizure
No change in consciousness/awareness
What is seen/felt correlates with abnormal
electrical activity in a part of the brain
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Examples of Simple Partial
Seizures Motor
Sensory Unilateral jerking of face,
Smells arm, and/or leg
Sensations may spread from one
Visual changes part of body to others
Auditory symptoms May be unable to speak
Autonomic Can involve any part of
Dilated pupils the body
Queasy Stomach
Psychic
Skin flushing
Dejà-vu, jamais vu, out of
Pallor
body experience
Feelings of fear, anxiety,
happiness, depression
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Nursing Care During
Seizure Simple Partial
Promote safety Reassure
Guide patient to a
safe place Time the seizure
Stay within arm’s
Document event
reach
Stay calm
Observe the patient
Speak calmly
Assess awareness
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Complex Partial Seizures
May start as simple Motor signs include:
partial seizure or start One or both sides of body
suddenly
May be stiffening, jerking,
Awareness is impaired, twitching, or absence of
though may be difficult movement
to assess
May involve any part of
May or may not hear, the body including jaw,
understand, see, respond swallowing muscles,
or recall events during shoulders
seizure Can spread from one
body area to others
Duration: seconds to
minutes
Post-ictal
fatigue, confusion,
Automatisms: unusual and sleepiness, headache
repetitive behaviors
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Nursing Care During
Complex Partial Seizure
Promote safety
Guide patient away from potential dangers.
Do not restrain patient
Patient may become combative if restrained
If safe, let patient wander in an enclosed area
Assist patient to lie down if there is a loss of tone
Stay calm
Observe behavior and time the seizure
Observe post ictal state (patient may be confused or
tired)
Reorient and reassure
Stay with the patient until he/she returns to baseline
Document
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Secondarily Generalized
Seizures
Starts
in focal brain area then spreads from
one side to include the other side
That is, the seizure may start as a simple partial
seizure or as a complex partial seizure
May spread slowly or rapidly to a generalized
seizure, usually causing patient to fall
Electrographically, seizure involves both sides of
brain
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Secondarily Generalized
Seizures
Eyes may roll back, may fall to ground or lean over
Body becomes rigid (tonic) and then jerks (clonic)
May involve incontinence of bladder and/or bowel
May have forced head turn or eye deviation to side
May involve one side of body more than the other
Lasts 5 minutes or less
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Seizures
Involve both hemispheres at the onset
Typesof primary generalized seizures:
Absence
Myoclonic
Tonic
Atonic
Clonic
Tonic-clonic
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Absence Seizures
(previously called petit mal)
Sudden onset of behavioral arrest
May involve eyelid fluttering
Duration: 5-30 seconds
Usually occurs many times/day, difficult to identify
clinically because of brief duration
Returnsto baseline almost immediately
Possible amnesia
Hyperventilation and/or flashing lights may
precipitate seizures
Classic EEG pattern
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Nursing Care: Absence
Seizure
Promote safety Observe postictal
behavior
Stay within reach
Usually returns to
Falling unlikely baseline immediately
Reorient
Stay calm
Ifphoto-sensitive, avoid
Observe behavior exposure to flashing
and time the lights or patterns
seizure
Document seizure
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Tonic-Clonic Seizures
(previously called grand mal or major motor)
Often begins with an ictal cry (loud groan)
Body may be tonic – posturing or stiffening
of all muscles
Person may appear as if not breathing as
chest muscles are rigid
Clonic
movements – rhythmic jerking of
head and extremities
May have forced eye deviation upward
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Tonic-Clonic Seizures
Duration: Generally lasts from seconds to 1-2
minutes
Excessive salivation(collection of drooling
May involve tongue biting
May involve bladder and/or bowel incontinence
May turn dusky or cyanotic
Postictally, may have
Confusion
Muscle aches, pain, headache
Sedation or fatigue for minutes to hours
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Nursing Care: Generalized
Tonic-Clonic Seizure
Stay calm
Promotesafety
Cushion fall if possible
Support head
Loosen restrictive clothing
Place NOTHING between teeth
NO food or drink until able to swallow
Do not forcefully reposition or restrain the movements
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Tonic-Clonic Seizure
Promote Safety
Place patient in side-lying position as soon as possible
Due to size or location of teenagers and adults, may
need to wait until seizure is subsiding before turning
to side
Side-lying position promotes drainage of saliva from
mouth
May need to reposition head to keep airway clear
In hospital, suctioning may help maintain airway,
especially if seizure is long
Observebehavior and time the seizure
Assess for injury after the seizure is over
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Post Ictal Nursing Care:
Tonic Clonic Seizure
Observe behavior Assess for injury
May be sleepy, Monitor duration of
confused, combative,
difficulty talking, and postictal state
unable to remember Confusion may last
If sleepy, continue in minutes
side-lying position to Sleepiness may last
protect the airway minutes to hours
Gently restrain, if NPO until able to swallow
needed, to avoid injury
Document
Reassure/reorient
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Tonic Seizures
Sustained bilateral stiffening or posturing
Usually brief but can last minutes
May cause fall if standing or sitting
Sudden, very unpredictable
Significantrisk of injury due to loss of protective
reflexes, ie. cough, righting reflex
May have change in breathing patterns or
look like not breathing or may appear pale
or cyanotic
Can occur in clusters, sometimes along
with other seizure types
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Atonic Seizures
Atonic-also called “drop attacks”
Sudden loss of tone
Drop of head with or without slight bending of knees
Drop of head, trunk or entire body
May fall backwards or forward if sitting or standing
Impaired awareness may be present but not discernible
Usually very brief, variable intensity (mild to forceful)
Significantrisk of injury
High risk for head lacerations, fractures, and other
injuries
Often require helmets and safety gear
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Myoclonic Seizures
Verybrief, fast muscle contractions of the head,
arms, legs, face, trunk and/or body
Single jerk or clusters
Unilateral or bilateral, can be specific muscle
groups
May cause loss of balance or fall
May drop objects
Often
occur when drifting to sleep or shortly after
awakening
Impaired awareness may not be discernible
Clusters may precede a generalized tonic-clonic
seizure
Some myoclonus may not be epilepsy-related
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Nursing Care: Tonic, Atonic
and Myoclonic Seizures
Stay calm
Promote safety
Be sure safety gear is worn, if ordered
Cushion fall if possible – support head
Clear area of harmful objects or surfaces
Loosen restrictive clothing
Place NOTHING between teeth
There is no danger of the person swallowing
their tongue
NO food or drink until able to swallow
Turnto side-lying position if not able to protect
airway
Do not forcefully reposition
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Nursing Care: Tonic, Atonic
and Myoclonic Seizures
Observe behavior and time the
seizure/seizure cluster
Post ictal care:
Observe behavior
Reassure and re-orient
Assess for injury
NO food or drink until able to swallow
Assess return to baseline state
Document
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Febrile Seizures
Frequency Prolonged
13% > 10 minutes
2% - 5% of children
in United States
5% > 30 minutes
Mostoften in
children aged: 3
mos-5 years A prolonged 1st febrile
seizure, implies the
Associated with fever
≥ 101 next seizure will likely
be prolonged
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Febrile Seizures
Simple febrile seizure
Generally lasts a few minutes and does not require
treatment
Occurs within 24 hours of fever onset
Usually generalized tonic clonic seizure
No localizing deficits afterwards
No prior history of non-febrile seizures
No current intracranial infection
No other neurological/developmental abnormalities
No family history of non-febrile seizure
Complex febrile seizure
Last > 15 minutes
Have focal features or
Recur within 24 hours
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Summary of General First Aid
Stay calm/speak quietly Keep onlookers away
Time the seizure Staywith person until
Promote safety seizure ends
Help person to floor or
safe place, Reorient and reassure
Prevent or cushion fall if
patient
possible
Assess frequently until back
Support head
to baseline
Remove harmful objects
Make comfortable May need to sleep/rest
Maintain open airway Nothing to eat or drink
Place nothing in mouth until able to swallow
between teeth
Assess for injury
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Videos
Video introducing partial seizures and what they
look like from epilepsy.com
Understanding Partial Seizures
Video introducing generalized seizures and what
they look like from www.epilepsy.com
Understanding Generalized Seizures
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Epilepsy
101 For
Nurses
For Nurses Caring for
People with Epilepsy
American Epilepsy Society
