PAPER OF SEIZURE

ARRANGED BY :
PANJI PUTRA BAGUS KARYA MUKTI (J210160042)
AZIZAH KAREE (J210164012)
HARRIS HAYIMA (J210164010)
NUR HANNAN BAIKADEM (J210164011)

SCHOOL OF NURSING
FACULTY OF HEALTH SCIENCE
UNIVERSITAS MUHAMMADIYAH SURAKARTA
2019
 CHAPTER I

PREDECESSOR

Seizures are symptoms that arise from direct or indirect effectsfrom central nervous
system disease (CNS). Medicines used for therapyvarious vascular diseases that can affect
the seizure threshold andcause seizures, besides that the disease can also underlie the
incidenceseizures in stressed patients. Seizures are defined as temporary changes
incircumstances or other signs or symptoms that can be caused by dysfunctionbrain. brain
dysfunction can be accompanied by motor, sensory and interferenceautonomous depends on
the area of the brain involved in either the organ itself or even spread to other organs.

Seizures can be caused by various conditions, namely, epilepsy, seizuresfever,

hypoglycemia, hypoxia, hypotension, brain tumor, meningitis,electrolyte imbalance, and
drug overdose. Although the cause of seizuresdiverse but in the initial phase there is no need
to label it in the groupwhich, because airway management and cessation of seizures are the
first priorityin patients with active seizures.

One form of seizure that is often found in children is seizuresfever. Febrile seizures
are seizures accompanied by fever (temperature suhu 100.4 ° F or 38 ° C),without nervous
system infections, which occur in infants and children 6 to 60 months.Febrile seizures occur
in 2% to 5% of all children, thusbecome the most common form. In 1976, Nelson and
Ellenberg,use data from the National Collaborative Perinatal Project and setthat febrile
seizures are classified as simplex or complex. SeizuresSimplex fever is defined as a seizure
that occurs after a fever, which islasts less than 15 minutes and does not repeat within 24
hours.Complex febrile seizures are defined as focal seizures, lasting more than15 minutes,
and or repeat within 24 hours. Children who experience seizures.
 CHAPTER II

DISCUSSION

2.1 Definition

Seizures are a temporary change in behaviorsuddenly which is the result of

abnormal electrical activity in the brain.If the disruption of electrical activity is limited
to certain areas of the brain, it cancause partial seizures, but if there is a disturbance in
electrical activityoccurring in all areas of the brain can cause general seizures.

This change occurs because of a shift in the normal valuebalance excitation and
inhibition in the central nervous system, because toomany factors can affect the normal
value of central nervous system flexibilitythen there are many causes that can cause
seizures.

Seizures can be accompanied by metabolic disorders such as

uremia,hypoglycemia, hyperglycemia, and liver failure, toxic such as overdose and
syndromewithdrawal, and infections such as meningitis and encephalitis, seizures that
occurpatients with this condition do not always lead to a diagnosis of epilepsy,
thoughthe drug used to manage the seizure is the deep antiepileptic drugshort-term, the
drug generally does not need to be continued after the patient has recoveredfrom
seizures.
2.2 Epidemiology

The lifetime risk of generalized seizures is 3-4% withpeak incidence at the onset
of seizures (spasm of neonates or tumors and strokes)life. We know epilepsy is one of
the oldest diseases in the world andranks second from neurological diseases after brain
circulation disorders.This disease affects approximately 50 million people worldwide.
Epilepsyresponsible for 1% of global disease burden, of which 80% is burdenit is in a
developing country. In developing countries in some areas 80-90% of cases do not
receive treatment at all.

Overall the incidence of epilepsy in developed countries ranges from 40-70case

per 100,000 people per year. In developing countries, incidents range from 100-190
cases per 100,000 people per year. The prevalence of epilepsy varies between5-10 cases
per 1,000 people.

In Indonesia there is no definite data regarding epilepsy sufferers, however there

are an estimated 1-2 million epilepsy sufferers. The prevalence of epilepsy in Indonesia
is5-10 cases per 1,000 people and incidents of 50 cases per 100,000 people per year.

According to the Center for Disease and Prevention (CDC) in 2010 in the
US,epilepsy affects 2.5 million people. Doctor from the doctor, self reporting,
andresearch from a mixture of several of these sources, concluded that events
andprevalence of seizures and epilepsy, the first epilepsy seizures occur in 300,000
peopleevery year, 120,000 people are> 18 years old, and between 75,000 and
100.00among them are 5-year-olds who experience seizuresfever. Men have a little
more risk than women.

2.3 Etiology

Seizures are most often seen in critically ill patients. In a study 55patients with
recent onset seizures in intensive care care unitsthe results of more than one third of
seizures are caused by metabolic disordersAcute such as hyponatremia, and eight
patients obtained due to seizuresby the use of antiarrhythmic drugs or antibiotics.

Other causes underlying the onset of seizures are :

 Idiopathic or arises from unknown causes

  Cryptogenic or arises from a suspected causeunknown or unclear
 Symptoms or arising from a known brainabnormalities
 Cerebral trauma with loss of consciousness. In general, there is no riskif the loss
of consciousness is less than 30 minutes.
 Space Occupaying lesions
a. Brain tumor
b. Venous artery malformation (AVM)
c. Subdural hematoma
d. Neurofibromatosis
 Cerebral infection
a. Bacteria or viral meningitis.
b. Encephalitis
c. Brain abscess
 Atypical febrile seizures
 Genetic factors, such as abnormal chromosomes
 Cerebral vascular disorders, such as: hemorrhagic and thrombosis
 Hypoxic acidosis
 Family history

2.4 Pathogenesis

The basis of epilepsy attacks is a disruption of brain neurons and transmission at

the synapse. There are two types of neurotransmitters, namely excitation
neurotransmitterswhich facilitates depolarization of electric charges and
neurotransmitter inhibition (inhibititowards channeling the electrical activity of nerves
in the synapse) which gives risehyperpolarization so that neuron cells are more stable
and do not easily release electricity.Among excitation neurotransmitters, it can be called
glutamate, aspartate,norepinephrine and acetylcholine while the famous inhibitory
neurotransmitter isgamma amino butyric acid (GABA) and glycine. If the results of the
influence of both typesrelease electrical charge and impulse transmission occurs. In a
state of rest,membrane neurons have certain electrical potential and are in a
statepolarization. Potential action will trigger the depolarization of neuronal membranes
andthe whole cell will release an electric charge.
 By various factors, including pathological conditions, can change
functionmembrane neurons so that the membrane is easily traversed by Ca and Na ions
from the roomextra to intra-cellular. Ca Influx will trigger a burst of membrane
depolarizationand releasing excessive, irregular and controlled electrical charges.
Release i electric charge with a large number of neurons synchronously is the basis of
aseizure attack. A characteristic feature of epilepsy is that it takes a whilestopping
attacks due to the influence of the inhibition process. Allegedly this inhibition isthe
influence of neurons around the epileptic site. Other than that, systemspre and post
synaptic inhibition which ensures that neurons do not continue to release. Other
circumstances that can cause an attackstopping epilepsy is the fatigue of neurons due to
the depletion of important substancesfor brain function.

2.5 Classification of Seizures

Seizures have been classified in several etiological classificationseither

idiopathic (primary) or (secondary) symptoms. First seizure classificationproposed by
Gastaut in 1970 and then refined repeatedlyby the International League Against
Epilepsy (ILAE) in 1981, withclassification as follows:

1. Partial (focal) seizures

1.1. Simple partial seizures (without impaired consciousness)

1.1.1. With motor symptoms

1.1.2. With sensory symptoms

1.1.3. With autonomic symptoms

1.1.4. With psychic symptoms

1.2. Complex partial seizures (with impaired consciousness)

1.2.1. Initially simple partial, then followed by impaired consciousness

1.2.1.1. Simple partial seizures, followed by impaired consciousness

1.2.1.2. With automatism

1.2.2. With impaired consciousness since the beginning of the seizure

 1.2.2.1. With consciousness disorder only

1.2.2.2. With automatism

1.3. Partial seizures that become common (tonic-clonic, tonic or clonic)

1.3.1. Simple partial seizures develop into general seizures

1.3.2. Complex partial seizures develop into general seizures

1.3.3. Simple partial seizures develop into complex partials, anddevelop into
general seizures

2. General seizures (convulsions or non-convulsions)

2.1. lena / absent

2.2. myoclonic

2.3. clonic

2.4. tonic

2.5. tonic-clonic

2.6. atonic / astatic

3. Epileptic seizures that are not classified

1. Simplistic partial seizures

Attack where the patient will remain conscious. The patient will experience
symptoms.

in the form of:

 "deja vu": the feeling of having done something the sameprevious.

 Feelings of pleasure or fear that arise suddenly and cannotexplained
 Feelings like numbness, electric shock or needlingcertain parts. - Movements
that cannot be controlled in partscertain body
 Hallucinations
2. Complex partial seizures

Attacks that affect the wider and usually part of the brainlast longer. Patients
may only be aware of some and possibilitiesbig won't remember the time of the
attack. Symptoms include:

 Movements such as shedding or chewing

 Make the same movements over and over or playhis clothes
 Make movements that don't clearly mean, or walk aroundin a state like being
confused
 Repeatedly kicking or punching movements
 Speaking is not clear like mumbling.

3. Clonic tonic seizures (grand mal epilepsy)

It is the most frequent type of seizure, where there are two stages: tonic or
rigid stage followed by clonic or kelonjotan stage. In this type of attackpatients can
only experience the tonic or clonic stage. This type of attackusually preceded by an
aura. Aura is a feeling experienced beforeattacks can include: feeling stomach ache,
numbness, fireflies, earsbuzzing.

At the tonic stage the patient can: lose consciousness, losebalance and fall
because the muscles are tightened, screaming for no reasonclear, bite the inner cheek
or tongue.

During the clonic phase: there is a recurring and not muscular

contractioncontrolled, bedwetting or defecation that cannot be controlled, the
patientlooking very pale, the patient may feel weak, tired or want to sleepafter this
kind of attack.

4. Seizure absences / Petit Mall

This seizure is for typical or petit mal seizures and seizuresatypical.

Absentipical symptoms are marked by cessation of motor motor activitychildren
suddenly, lose consciousness temporarily briefly, which is accompaniedwith a blank
look. Often there are repeated blinks of the eye during seizure episodesoccurs.
Seizure episodes occur less than 30 seconds. These seizures are rarely seen
 onchildren less than 5 years old. Atypical abscess seizures are characterized by
movementsuch as repeated strokes that can be found on the face and extremities
andaccompanied by changes in consciousness.

5. Mioclonic seizures

Seizures that are characterized by head movements like sudden fallsand is

accompanied by flexi arms. This type of braid can occur hundreds of times per day.

2.6 Supporting Check

Physical examination must screen the cause of the seizureby using age and
disease history as a handle. In patientsolder people should be auscultated in the neck
area fordetect vascular disease. cardiovascular examination should bedone at the first
time the seizure appeared because of many eventswhich is similar to seizures but
causes cardiovascular conditions such as syncopecardiovascular. Skin examination
also to detect whether there is a syndromeneurocutaneous like "café au lait spots"
and "iris hamartoma" onneurofibromatosis, "Ash leaf spots", "shahgreen patches",
"subungual fibromas","Adenoma sebaceum" at tuberosclerosis, "port - wine stain"
(capilarryhemangioma) in sturge-weber syndrome. Also need to be seen if there are
tracesa bite that can occur during a seizure or whetherthere are abrasions caused by
patients falling due to seizures, thenis there gingival hyperplasia that can be seen due
to drug administrationphenytoin and is there a "dupytrens contractures" that can be
seen because of itlong-term phenobarbital administration.

Neurological examination includes mental status, "gait", coordination,

nervescranial, motor and sensory functions, and tendon reflexes. The presence of
neurological deficitssuch as hemiparese, dystonia, dysphasia, visual field disorders,
papiledemamay show the presence of lateralisation or structural lesions in the area of
the brainlimited. The presence of nystagmus, diplopia or ataxia may be due to toxic
effectsfrom anti-epileptic drugs such as carbamasepin, phenytoin, lamotrigine.
Pupillary dilationmay occur during a seizure attack. "Dysmorphism" and
interferencelearning may have chromosomal abnormalities and progressive features
such as dementia,the more severe myoclonus can be estimated abnormalities
neurodegenerative. Unilateral automatism can indicate a focal abnormality inthe
ipsilateral temporal lobe while the presence of dystonia can describe
abnormalitiescontralateral focus is temporally pierced.

1. LABORATORY EXAMINATION

Hyponatremia, hypoglycemia, hypomagnesia, uremia and hepatic

encephalopath can trigger seizures. Joint electrolyte examination togetherwith
glucose, calcium, magnesium, "Blood Urea Nitrogen", creatinine and testliver
function may provide very useful instructions. Examinationthe toxicology of
serum and urine should also be done if a "drug" is suspected abuse

2. ELECTROENSEFALOGRAPHIC EXAMINATION

The most frequent investigation is

examinationelectroencephalography (EEG). Routine EEG checks should be
recordedat the moment conscious in a state of rest, at bedtime, with photic
stimulationand hyperventilation. This EEG examiner is a laboratory
examinationimportant to help diagnose epilepsy for the following
reasons.This examination is the main diagnostic tool for evaluating patients
withclear or dubious seizure attacks. EEG examination results willhelp in
making a diagnosis, clarify the type of seizure attackcorrect and recognize
epilepsy syndrome.

3. RADIOLOGICAL EXAMINATION

Ct scan (Computed Tomography Scan) of the head and MRI

(Magnetic Resonance)Imaging) the head is to see whether or not there are
structural abnormalitiesboxed.This head CT scan is done if there is a
contraindication on MRI howeverMRI head examination is the brain imaging
procedure of choice forepilepsy with high sensitivity and more specific than
CT scan. Bybecause it can detect small lesions in the brain, hippocampal
sclerosis, cortical disgenesis,cavernous tumors and hemangiomas, as well as
highly refractory epilepsysurgical therapy. This head MRI examination
 usually includes: T1 andT2 weighted "with a minimum of two slices, namely
axial slices, coronal slices and slicessaggital.

4. EXAMINATION OF NEUROPSICOLOGY

This examination may be performed on epilepsy patients

withconsideration of surgical therapy. This examination is especiallypay
attention to whether there is a decrease in cognitive function, eitherwith
consideration if it turns out the diagnosis is a suspected seizure attacknot
epilepsy.

2.7 Therapy

Anti-epileptic drug (AED) therapy, the main treatment for the most part
patients, have four goals: to eliminate seizures or reduc their frequency to the
maximum possible level, to avoid effectsside effects related to long-term treatment,
and to helppatients in maintaining or restoring their psychosocial activities, andin
maintaining the stability of their daily lives. Decision to startObata anti epilepsy
therapy must be based on analysis of information about possibilitiesseizure
recurrence, continuing consequences of seizures for patients, and effectsbeneficial
and detrimental to the pharmacology that will be given.
 CHAPTER III

CONCLUSION

Seizures are a temporary change in behavior suddenly which is the result of

abnormal electrical activity in the brain.the disruption of electrical activity is limited to
certain areas of the brain, it cancause partial seizures, but if there is a disturbance in
electrical activityoccurring in all areas of the brain can cause general seizures.

Seizures can be caused by various conditions, namely, epilepsy, seizuresfever,

hypoglycemia, hypoxia, hypotension, brain tumor, meningitis,electrolyte imbalance, and
drug overdose. Although the cause of seizuresdiverse but in the initial phase there is no need
to label it in the groupwhich, because airway management and cessation of seizures are the
first priorityin patients with active seizures.

Anti-epileptic drug (AED) therapy, the main treatment for the most partpatients, have
four goals: to eliminate seizures or reducetheir frequency to the maximum possible level, to
avoid effectsside effects related to long-term treatment, and to helppatients in maintaining or
restoring their psychosocial activities, andin maintaining the stability of their daily lives.
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