 “ A disease marked by recurrent seizures…”  Taber’s Cyclopedic Medical Dictionary, 19 th ed.

 Do you have to have epilepsy to have seizures?  No!!!  It is important to distinguish between an epileptic and a non-epileptic seizure.  Epilepsy is a chronic seizure disorder.

 “» Currently affects more than 300,000 children under the age of 14.  » May be time limited or long term. Early recognition and treatment are keys to the best possible outcome.  » May be associated with serious, difficult- to-treat syndromes, including infantile spasms, Lennox-Gastaut syndrome, genetically related conditions, and developmental disorders.  » Social impact in childhood is often severe, producing isolation and loss of self esteem.”

 Seizures are most common in the first 2 years of life.  In very young infants, the most common cause:  Birth injuries (brain trauma, bleeding, or lack of oxygen)  Brain defects at birth  Acute infections often cause seizure activity in late infancy and early childhood, but become infrequent in middle childhood.  In children older than 3 years, the most common factor for seizures is idiopathic epilepsy.

 Seizure activity is believed to be caused by spontaneous electrical discharge initiated by a group of hyper-excitable cells referred to as the epileptogenic focus. The cells show an increase electric excitability in response to physiologic stimuli, such as: Cellular dehydration Abnormal blood glucose levels Electrolyte imbalances Fatigue Emotional stress Endocrine changes

 Partial Seizures  Simple-Partial with Motor Signs  Simple-Partial with Sensory Signs  Complex-Partial (Psychomotor)  Generalized Seizures Tonic-Clonic Seizures (formally called Grand Mal) Absence seizures (formally called Petit Mal or lapses) Atonic and Akinetic seizures (known as drop attacks) Myoclonic seizures Infantile spasms

 Simple partial seizures have simple symptoms and are accompanied by no alteration of consciousness (also called an aura). Simple partial seizures with motor signs Simple partial seizures with sensory signs  Complex partial seizures involve complex symptoms and impairment of consciousness. These seizures may begin with an aura. Complex partial seizures (Psychomotor seizure)

 Simple Partial seizure are caused by abnormal electric discharges from epileptogenic foci limited to region in the cerebral cortex. Focal seizures may arise from any area of the cerebral cortex, but the frontal temporal and parietal lobes are the ones most affected.

 Simple partial seizures with motor signs Characterized by: Localized motor symptoms Manifestations : Aversive seizure (most common in children), eye or eyes and head turn away from the side of focus. Awareness of movement or loss of consciousness Rolandic (Sylvan) seizure Tonic –clonic movements involving the face, salivation, arrested speech, most common during sleep. Jacksonian March (rare in children) Orderly, sequential progression of clonic movements beginning in a foot, hand, or face and moving or “marching” to adjacent body parts.

 Simple partial seizures with sensory signs Characterized by various sensations: Numbness, tingling, prickling, paresthesia or pain Originates in one area (e.g. face or extremities) Spreads to other parts of the body Motor phenomena such as posturing or hypertonia (increase in muscle tone) Uncommon in children that are younger than 8 years old.

 Complex partial seizures (Psychomotor seizure) Involve complex symptoms and impairment of consciousness. These seizures may begin with an aura, a simple partial seizure that is usually a sensation or sensory phenomenon that reflects the complicated connections and integrative functions of that area of the brain.

 Generalized seizures  Occur without a focal onset, appear to rise in the reticular formation, and the clinical observation indicate that the initial involvement is from both hemispheres of the brain. Frequent loss of consciousness. No aura. Episodes occur at any time day or night, and the interval between episodes may be from minutes to years. Tonic-Clonic Seizures (formally called Grand Mal) Absence seizures (formally called Petit Mal or lapses) Atonic and Akinetic seizures (known as drop attacks) Myoclonic seizures Infantile spasms

Manifestations: Symmetric tonic Eyes roll upward Immediate loss of consciousness If standing: falls to floor or ground Stiffens in generalized Contraction of entire body musculature Arms usually flexed, legs, head, and neck extended May utter peculiar cry  Clonic phase last about 30 seconds, but can vary from only a few seconds to a half hour. Manifestations: Violent jerking movements as the trunk and extremities undergo rhythmic contraction and relaxation. Requires emergency intervention.

 Tonic- Clonic Seizures (Grand Mal) Most common and most dramatic of all seizure manifestations. Occur without warning. Tonic phase lasts approximately seconds

 Absence Seizures (Petit Mal)  Characterized by: onset usually between 4-12 years of age more common in girls then boys usually cease in puberty

 Absense Seizures  Manifestations: Brief loss of consciousness Minimal or no alteration in muscle tone Abrupt onset May suddenly develop into 20 or more attacks daily Event often mistaken for daydreaming Appear without warning or aura Usually last about 5-10 seconds Able to maintain postural control Seldom falls Minor movements such as lip smacking Twitching of eyelids or face Amnesia for episode

 Atonic and Akinetic seizures Characterized by: onset usually between 2 and 5 years of age, sudden momentarily loss of muscle tone and postural control. Manifestations: loss of tone causes child to fall to the floor violently, unable to break fall by putting out hand, may incur a serious injury to face, head or shoulder, loss of consciousness momentarily.

 Myoclonic Seizures  A variety of seizure episodes, may occur in association with other seizure forms.  Characterized by: sudden brief contractures of muscles, occur single or respectively, may or may be symmetric, may or may not lose consciousness.

 Infantile spasms  Most often occur between 6 to 8 months of life  Twice as common in males as in females  Child may have multiple seizures during day without drowsiness or sleepiness.

 Status Epilepticus Continuous Seizure >30 minutes Child does not pre-seizure level of consciousness  Treatment: Maintain adequate airway Administer oxygen Maintain hydration Monitor vital signs (alterations may indicate impending cardiac arrest or respiratory depression) Drug therapy Control and prevent seizures Relax muscles Provide respiratory support

 epsy/ epsy/  Also see Box pages in Wong for more detailed information.

Goals of treatment  Control seizures or reduce frequency  Discover and correct the cause  Help the child to live as normal a life as possible Treatment methods: - Drug Therapy with EEG monitoring - Surgery

 Goal is to ↑ threshold of basal level of neuronal excitability to ↓ seizures  Diminish amount of drugs taken to improve quality of life  Carbamazepine  Phenytoin  Fosphenytoin  Valproic acid  Gabapentin  Lamotrigine Serum drug levels must be monitored Absolute control is only achieved in 50-70% of children

 Drugs are taken long term and must be evaluated – is it still working?  Dosage increased as child grows  Protocol for withdrawal of drug therapy: - seizure free for 2 years - normal EEG (repeat EEG’s every 6 months – 2 yrs) * recurrence likely during first year * withdraw med gradually over 1-2 wks

When is it deemed necessary? When…  Seizures caused by hematoma, tumor, or progressive cerebral lesion  Repetitive, incapacitating seizure activity caused by focal brain abnormality

Detailed history of patient may help to determine triggering factors influencing seizure activity. Triggering factors may include:  Changes in dark-light pattern  Sudden loud noises  Startling or sudden movements  Drastic changes in temp  Dehydration  Fatigue  Hyperventilation  Hypoglycemia  Caffeine  Insufficient protein

Observe and Document the seizure:  Order of events, duration, type  Time of onset, pre-seizure events, behavior, crying, facial expressions, body positioning  Movements: position changes, lack of movement and muscle tone  Describe eyes, mouth, respiratory effort Box in Wong, pg. 1708

 Protect child from injury If the child is standing or sitting in a chair, ease them to the ground  Stay calm  Do not try to stop the seizure!!  Ensure privacy  Ensure open airway by laying child on his/her side Refer to Wong, pg for emergency care

 Emotional aspect of disease  Explanation of drug therapies and side effects  Physical care  Behavioral changes in children  Promote healthy, normal lifestyle with emphasis on safety precautions

 Deficient Knowledge r/t: Condition, Therapeutic Regimen, Seizure Control  Impaired Social Isolation  Risk for: Trauma, Injury, or Suffocation  Fear  Anxiety  Powerlessness  (Risk for) Situational Low Self-Esteem  Risk for Aspiration  Caregiver Role Strain  Effective Therapeutic Regimen Management