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DRUGS FOR SEIZURE DISORDER

LEARNING OBJECTIVES :

 Describe the pathologic effect of seizure


 Discuss the classification system of epilepsy
 Cite the desired therapeutic outcomes for
seizure disorder
 Identify the mechanisms of action thought to
control seizure activity when anticonvulsants
are administered
 Discuss non-drug treatment for seizure
Seizure
 Are symptoms of an abnormality in the nerve
cells of the brain

 Are brief periods of abnormal electrical activity


in the nerve centers

 May result from fever, head injury, brain tumor,


meningitis, hypoglycemia, a drug overdose or
withdrawal, or poisoning
Epilepsy
 If seizures are chronic and recurrent; a sudden
discharge of excessive electrical energy from
nerve cells in the brain.

 Causes :
 Idiopathic
 Head injury, brain tumor, meningitis
 stroke
2 Broad Categories :
1. Generalized seizures
 Convulsive
 nonconvulsive

2. Partial seizures
 Simple
 complex
Generalized Convulsive Seizures :
 Grand mal/Tonic-clonic
 Tonic phase – intense muscular contraction, fall, lose
consciousness and lie rigid

 Clonic phase – bilateral, symmetrical jerks beginning


slightly and becoming violent, bites tongue and
incontinent of urine or feces

 Postictal phase – resting, recovery of flaccid paralysis


and sleep within 60 sec lasting 2-3 hours
 Patient has no recollection of attack on awakening
 Atonic or akinetic seizures – sudden loss of
muscle tone; drop attack

 Myoclonic seizure – lightning-like repetetive


contractions of the voluntary muscles of the
face, trunk and extremities; occurs most often at
night; no loss of consciousness
Generalized Nonconvulsive Seizures
 Petit mal – absence epilepsy (altered
consciousness for 5-20 seconds); occurs in
children and disappears in puberty; staring in
space and exhibit few rhythmic movements of
the eyes, head, lip smacking, mumbling,
chewing or swallowing ,movements
 Partial(localized) Seizures
 Partial simple motor sizure(Jacksonian)
-convulsion of voluntary muscles

 Partial seizure with complex symptoms


(psychomotor seizure) – confused, dream-like
state; aimless wandering
ANTICONVULSANT THERAPY
 Used to reduce frequency of seizure
 Determine underlying cause – specifically
treated before anticonvulsant therapy

GOALS :
 Improve quality of life
 Reduce frequency of seizure activity
 Minimize adverse effects
ACTIONS
 Anticonvulsants increase the seizure threshold
and regulate neuronal firing by inhibiting
excitatory or enhancing inhibitory processes

 Act on sodium-calcium channels to stabilize the


neuronal membranes and may decrease the
release of excitatory neurotransmitters
e.g. Phenytoin, carbamazepine, lamotrigine,
zonisamide, valproic acid
 Enhance the inhibitory effect of GABA, an
inhibitory neurotransmitter that counterbalance
the effect of excitatory neurotransmitters

e.g. Barbiturates, benzodiazepines, tiagabine,


gabapentin, pregabalin – initial treatment of a
newly dignosed seizure disorder
Anticonvulsant Therapy Considerations

 Children – may cause a change in personality and


possible indifference to school and family
activities (discuss with health care provider,
teachers, family or caregivers)

 Liquid dosages must be measured accurately (use


oral syringe) and shake well before use.

 Medicines should be taken at the same time daily


to maintain blood level. Monitor response to
therapy
NURSING PROCESS :
Assessment :
 History of seizure activity

 Seizure description

 Postictal behavior
Nursing Diagnoses :
 Risk for injury
 Disturbed body imag
 Impaired Gas Exchange
 Disturbed Sensory Perception (visual or tactile)
 Readiness for enhanced self health management
Planning :
 Seizure activity – seizure precaution; equipment
and supplies be available at bedside; periodic
laboratory studies

 Psychosocial assessment – discuss seizure


concerns with client, SO and family.

 Emergency equipment
Implementation :
 Management of seizure activity
 Do not leave patient

 Protect from further injury – padding around


head; do not restrain; loosen tight clothing; if
standing, lower patient to horizontal position

 Once on relaxation state, turn head to side

 Remain calm and quiet and give reassurance


 Suction as needed and provide ventilatory
support if breathing does not return
spontaneously

 Provide a place for the patient to rest

 Initiate nursing intervention appropriate to the


underlying cause of seizures

 If seizure lasts for more than 4 minutes (status


epilepticus) suumon assistance
 Psychological Implications
 Lifestyle – provide appropriate limitation for
client safety (RA 1973 – PWD do not experience
discrimination in employment)

 Expressing feelings – self-concept issues relating


to the disease

 Acceptance by peers (school-age children)


 Signs of denial (increased seizure activity in a
previously well-controlled patient) – adherence
to drug regimen

 Adherence – determine reasons for


nonadherence
PATIENT EDUCATION :
 Exercise and activity – avoid activities that
trigger seizure and excessive exercise

 Nutrition - avoid excessive stimulants (caffeine-


containing products), alcoholic beverages and
vitamin supplements (some anticonvulsants
interfere with vitamin and mineral absorption
 Safety – be alert for signs of confusion and
impaired coordination

 Stress – reduce tension and stress

 Oral hygiene – prevents gingival hyperplasia


(gum overgrowth) with hydantoins use

 Consult OB if pregnant with anticonvulsant use


and patient should carry an ID card
DRUG THERAPY FOR SEIZURE DISORDERS
 Benzodiazepines
Action : inhibit neurotransmission by enhancing
the effects of GABA in postsynaptic clefts
between nerve cells
1. Diazepam – rectal gel forms used to prevent
breakthrough seizures
2. Lorazepam
3. Clonazepam – oral tx. of absence, akinetic and
myoclonic seizure
4. Clorazepate – used with other antiepileptic to
control partial seizure
 Dosage and Administration :
Intravenous (IV)
 DO NOT mix diazepam and lorazepam in the
same syringe with other meds
 DO NOT add to other IV solutions due to
precipitate formation
 Administer at slow rate (diazepam at 5 mg/min;
lorazepam at 2 mg/ min)
 If possible give under ECG monitoring and
observe for bradycardia
 ALWAYS check for I.V. Incompatibility before
administering either medication

 Use SAS (saline-administer-saline flush) technique

 Administer phenytoin slowly at a rate of 25-50 mg/min


preferably through a large vein or as IV piggyback
(irritating to small veins); avoid I.M. Admin. (absorption
is slow and painful
 Phenytoin toxicity signs – nystagmus, sedation, lethargy

 Observe for respiratory depression and hypotension


NONPHARMACOLOGIC TREATMENT

(refractory seizures)
 Surgical intervention
 implantable vagus nerve stimulator (children 12
y/o and older)
 Ketogenic diet (restrict carbohydrates and
protein) – fat is the primary fuel to produce
acidosis and ketosis

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