Seizures

Seizures
 A seizure is the physical findings or
changes in behavior that occur after an
episode of abnormal electrical activity in
the brain.
 The term "seizure" is often used
interchangeably with "convulsion." During
convulsions a person has uncontrollable
shaking that is rapid and rhythmic, with the
muscles contract and relax repeatedly.
 Causes
 Abnormal levels of sodium or glucose in the blood
 Brain infection, including meningitis
 Brain injury that occurs to the baby during labor or
childbirth
 Brain problems that occur before birth (congenital brain
defects)
 Brain tumor (rare)
 Drug abuse
 Electric shock
 Epilepsy
 Fever (particularly in young children)
 Head injury
 Cont…
 Heat illness (heat intolerance)
 High fever
 Poisoning
 Street drugs, cocaine, amphetamines
 Stroke
 Toxemia of pregnancy
 Toxin buildup in the body due to liver or kidney failure
 Very high blood pressure (malignant hypertension)
 Withdrawal from alcohol or certain medicines after using
for a long time
 Types of seizures
 Different types of generalized seizures are:
 absence seizures (formerly known as petit mal)
 tonic-clonic or convulsive seizures (formerly
known as grand mal)
 atonic seizures (also known as drop attacks)
 clonic seizures.
 tonic seizures.
 myoclonic seizures.
 Focal (or partial) seizures

 Focal (or partial) seizures occur when seizure activity is

limited to a part of one brain hemisphere. There is a site,
or a focus, in the brain where the seizure begins. There
are two types of focal seizures:-

1.Focal seizures with retained awareness This type of focal

seizure was previously known as a simple partial seizure.
2.Focal seizures with a loss awareness This type of focal
seizure may also be called a focal dyscognitive seizure
(previously known as complex partial seizures)
 Types of Seizures
A. GENERALISED SEIZURES

i. Generalised tonic-clonic seizures

ii. Absence seizures
iii. Myoclonic seizures
iv. Atonic seizures
v. Infantile seizures
 Types of seizures
B. UNCLASSIFIED SEIZURES

i. Unclassified seizures
ii. Neonatal seizures
iii. Infantile spasms
Unclassified Seizures
 Neonatal Seizure
 Less than 1 month of age.

 Brief episodes of apnea, eye deviation, eye

blinking, or repetitive movements of the
arms and legs.
 Infantile Spasms
 Infants under 12 months.

 Abrupt movements of the head, trunk, or

limbs.
 The classic spasm is a sudden flexion of
the neck and abdomen with extension of
the limbs.
 Seizure Triggers
 Missed medication (#1 reason)
 Stress/anxiety
 Hormonal changes
 Dehydration
 Lack of sleep/extreme fatigue
 Photosensitivity
 Drug/alcohol use; drug interactions
 Symptoms of seizures
 Most Common Symptoms  Abdominal pain
 Diarrhea  Chest pain
 Knee pain
 Foot pain
 Sore throat
 Sleep paralysis  Neck pain
 Insomnia  Vaginal discharge
 Erectile dysfunction  Morning sickness
 Blood in urine  Anemia
 Conjunctivitis
 Constipation
 Heel pain
 Back pain  Vaginal itching
 Night sweats
 Diagnostic investigation
 History collection
 Physical examination
 Neurological examination
 CBC
 MRI
 CT scan
 EEG
 Laboratory studies
 Electrolytes
 Glucose
 Ca
 Mg
 Liver and renal function test
 Urianalysis
 Toxicology screen
 Lumbar puncture
 Diferential Diagnosis

 Psychological disorders
 Metabolic disturbances
 Migraine
 Sleep disorders
 Movement disorders
 Treatment
Partial Tonic- Absence Myoclonic
clonic Atonic

Carbamazepine Valproic acid Ethosuximide Valproic Acid

Phenitoiin Lamotrigine Valproic Acid
Valproic acid
Lamotrigine
 Nursing Diagnosis
 Ineffective breathing pattern related to neuromuscular
impairment secondary to prolonged tonic phase of seizure
or during postictal period as evidenced by abnormal
respiratory rate,rhythm, and or depth.

 Ineffective Tissue Perfusion (cerebral) related to seizure

activity.

 Risk for Injury related to seizure activity

 Ineffective Coping related to psychosocial and economic

consequences of epilepsy
 Cont….
 Ineffective breathing pattern related to neuromuscular impairement
secondary to prolonged tonic phase of seizure or during postictal period
as evidenced by abnormal respiratory rate,rhythm, and/ or depth.

 Nursing Goal : Normal breathing pattern adequate to meet oxygen needs.

 Nursing Interventions
 Airway management
 Monitor respiratory and oxygenation status to determine presence and extend
of problem and to initiate appropriate interventions.
 Position patient (side lying) to maximize ventilation potential.
 Identify patient requiring actual/potential airway insertion to facilitate
intubation as necessary.
 Perform endotracheal or nasotracheal suctioning to maintain airway as
needed.
 Seizure management
 Loosen clothing to prevent restricted breathing.
 Apply oxygen as appropriate to maintain oxygenation and prevent hypoxia.
 Cont..
Ineffective Tissue Perfusion (cerebral) related to seizure
activity
 Nursing goal : Maintaining Cerebral Tissue Perfusion
 Nursing Interventions
 Maintain a patent airway until patient is fully awake after
a seizure.
 Provide oxygen during the seizure if cyanotic changes
occurs.
 Stress the importance of taking medications regularly.
 Monitor serum levels for therapeutic range of
medications.
 Monitor patient for toxic adverse effects of medications.
 Monitor platelet and liver functions for toxicity due to
medications.
 Cont..
 Risk for Injury related to seizure activity
 Nursing Goal : Preventing Injury
 Nursing Interventions
 Provide a safe environment by padding side rails and removing clutter which
may be harmful to the patient.
 Monitor compliance in taking antiseizure medications to determine risk for
seizure.
 Keep suction, Ambu bag,mouth piece at the bedside to maintain airway and
oxygenation if needed.
 Place the bed in a low position.
 Do not restrain the patient during a seizure.
 Do not put anything in the patient’s mouth during a seizure.
 Place the patient on side during a seizure to prevent aspiration.
 Protect the patient’s head during a seizure. If seizure occurs while
ambulating or from chair, cradle head or provide cushion/support for
protection against head injury.
 Stay with the patient who is ambulating or who is in a confused state during
seizure.
 Provide a helmet to the patient who falls during seizure.
 Manage the patient in status epilepticus.