Seizure Disorders in Children By Paula Peterson, APRN, FNC, PNP LPN2007, November/December 2007 2.0 ANCC/AACN contact hours Online: www.nursingcenter.com © 2007 by Lippincott Williams & Wilkins. All world rights reserved.

Seizures and Epilepsy A seizure is defined as a transitory disturbance in consciousness or in motor, sensory, or autonomic function caused by uncontrolled electrical discharges in the brain Epilepsy refers to disorders characterized by recurrent seizures rather than a single seizure - Categorized by causes and types of seizures

Causes of Seizures brain injury trauma infection metabolic and neurodegenerative diseases cortical malformation

Classification of Seizures Symptomatic - symptom of underlying disease Idiopathic - caused by genetically inherited trait Cryptogenic - unknown cause Partial - uncontrolled electrical activity in area of brain Generalized - affects both hemispheres of brain at once

Types of Partial Seizures Simple - person remains alert Complex - person experiences aura, with altered consciousness during seizure and confusion following the seizure

More Seizure Types Absence seizures - “staring episodes,” also called petit mal seizures Atonic seizures - sudden loss in muscle strength, often resulting in a fall Infantile spasms - brief flexion/extension of the upper body, usually not seen after 18 to 24 months of age

More Seizure Types Tonic seizures - usually occur during sleep involving most of the brain, causing increased muscle tone Clonic seizures - rhythmic jerking movements of the entire body Tonic-clonic seizures - also known as “grand mal” seizures, whole-body jerking movements with loss of bowel, bladder, and consciousness

Seizure Syndromes Juvenile myoclonic epilepsy - inherited, myoclonic seizures late in childhood, responds to medication but rarely resolves Benign rolandic epilepsy - common seizure syndrome with good prognosis for the child to outgrow Lennox-Gastaut syndrome - early childhood onset, no cure, treated with medications

Causes of Lennox-Gastaut brain malformations perinatal asphyxia severe head injury central nervous system infection inherited genetic or metabolic conditions unknown in 30% to 35% of cases

Febrile Seizures Brought on by fever in infants and children Classified as typical or atypical Typical febrile seizure- occurs in 2% to 5% of children ages 6 months to 5 years of age, usually during first day of acute infection

Atypical Febrile Seizure Febrile seizure that recurs in a 24-hour period Risk of epilepsy after is associated with risk factors for seizure disorders Often accompanied with Todd’s paralysis (transient paralysis of a limb)

Diagnostic Tools History and physical - emphasis on seizure event is most valuable tool Lab tests - complete blood cell count, metabolic panel Brain imaging studies - Computed tomography scan, magnetic resonance imaging

Diagnostic Tools Electroencephalogram - to correlate with seizure activity and electrical discharges in the brain Possibly a spinal tap for spinal fluid specimen

Managing Seizure Disorders Medication is mainstay Goals: - freedom from seizures and adverse events - avoid drug interactions - adherence to therapy - minimal interference with daily life Challenge to the health care provider is to meet these goals with monotherapy

Other Management Options When medications have limited success: ketogenic diet vagal nerve stimulation surgery

Ketogenic Diet rigid food plan high fat, essential proteins, low carbohydrates requires high level of family commitment mixed results of decrease in seizures with medication small number of children seizure-free

Vagal Nerve Stimulation Surgical implantation (usually in patient’s neck) of a device delivering electrical stimulation to the vagus nerve Decrease in seizures reported with quicker recovery, not seizure-free

Caring for Your Patient Education of family and/or support system is key Education about what to do during seizure Education about medications and treatments Referrals for family support