1. Seizure Disorders

2. Seizures
Abrupt, uncontrolled electrical discharges of cerebral neurons that interrupts normal brain function
May result in: alteration LOC, motor/sensory ability, and/or behavior
May be a symptom of an underlying illness or may be spontaneous

3. Causes of Seizures Over ½ are Idiopathic (unknown) Other causes:
Birth injury
CNS defects or infection
Head trauma
Brain tumors
CVA- cerebral vascular disease
Chronic disease
Metabolic disorders

4. Epilepsy
A chronic disorder characterized by recurrent unprovoked seizure activity
spontaneous reoccurring seizures
When seizures continue to occur for unknown reasons or because of an underlying problem that cannot be corrected, the condition is known as epilepsy.

5. PRECIPITATING FACTORS
Fatigue
Decreased physical health
Alcohol ingestion
Emotional stress
Flashing lights
Menstrual cycle
Hypoglycemia
Sleep deprivation
Stimulants
Withdrawal
Substance abuse
High Fever
Electrolyte imbalance
Hypoxia

6. Classification of Seizures
Partial Seizures
Generalized Seizures

7. Generalized Seizure Affects entire brain No warning
Loss of consciousness

8. General Seizures
Tonic - Clonic Seizures

9. Type
Description
Tonic
Clonic
2-5 min; muscle rigidity
Loss of consciousness; rhythmic jerking of extremities, biting, salivation, incontinence.
muscle contraction and relaxation (jerking)
muscle stiffness
Absence
Brief loss of consciousness (staring/glaring)
Myoclonic
Brief jerking of extremities, symmetrical/asymmetrical
Atonic
Sudden loss of muscle tone; client falls; “drop attack”

10. Partial Seizures (Simple or Complex)
Local onset
May (Complex) or may not (Simple) loose consciousness
Begin in a specific area of brain (in a part of one cerebral hemisphere)
May generalize and turn into tonic-clonic seizures

11. Diagnostic Studies
MOST USEFUL diagnostic tool is an accurate and comprehensive history/description of the seizures and health history
Electroencephalogram (EEG)
Not completely reliable
CT/CAT, MRI, PET scans
Labs (e.g. CBC, chemistry, UA, kidney and liver studies; electrolytes/drug screen) to R/O other metabolic/medical causes

12. Electroencephalography: EEG

13. Video with EEG

14. Clinical Manifestations
Determined by the site of the electrical disturbance
May involve
Changes in consciousness
Motor
Sensory/senses
Emotional

15. Phases of Seizure Activity
Prodromal- precedes a seizure activity with a sign or activity ( e.g. epileptic cry)
Pre-ictal or aura – period right before a seizure in which a sensory warning may be present
Deja vu
Aura- Smells, sights, numbness, tingling, emotional changes
Ictal-during seizure
Postictal-after the seizure
Usually lethargic, sleepy, memory loss

16. Complications of Seizure
Greatest risk with loss of consciousness
Trauma from fall
Head injury
Drowning
Auto accident

17. During a Seizure…
Assist client to floor if standing/sitting position

18. During a Seizure…

19. Loosen restrictive clothing
During a Seizure…
Loosen restrictive clothing

20. During a Seizure… Never restrain the client

21. During a Seizure…

22. During a Seizure…
If seizure lasts longer than 5 minutes… MD

23. Seizure Precautions Acute care settings No padded tongue blades
IV access
Bed in low position
Side rails up
Padded side rails controversial
At bedside: Oxygen, Suction, Oral Airway
No padded tongue blades

24. Seizure Management (Summary) DURING a Seizure
Prevent or minimize injury
Ease patient to floor if standing or sitting
Protect head
Maintain patent airway
Support head or neck
Turn patient on side to prevent aspiration
Monitor seizure activity and time event
Call MD if lasting > 5 min
Do not restrain; stay with client
Loosen restrictive clothing
Do not place anything in mouth
video

25. Nursing Interventions: Post seizure
Assess VS, LOC (GCS), pupils
May require O2 or suctioning
Patient will usually sleep
Reorient pt when arouses
Allow to rest
Dextrose if hypoglycemic
Administer prescribed meds

26. Status Epilepticus State of continuous seizure activity
Period of one continuous seizure lasting longer then 10 minutes or several seizures occurring during a 30 minute time frame
Neurological emergency
Tonic-clonic Status Epilepticus can lead to a respiratory or cardiac arrest and death

27. Emergency Care During a Status Epilepticus Establish airway
Administer oxygen (face mask or NC)
IV antiseizure drugs
Lorazepam (Ativan) or Diazepam (Valium): a short-acting benzodiazepine
Phenytoin (Dilantin) long-acting
Cerebyx
Stat labs

28. Drug Therapy: Antiepileptic Drugs
Stabilize nerve cell membranes
Prevent the spread of epileptic discharges
80% of patients controlled with medication

29. Common Medications Phenytoin (Dilantin) Carbamazepine (Tegretol)
Valproic acid (Depakene)
Barbiturates -Phenobarbital
Succinimides -Zarontin
Benzodiazepines – Valium, Ativan
Clonazepam –Klonopin
Newer Antiseizure Drugs
Neurontin
Lamictal
Felbatol
Topamax
Cerebyx
Dilantin- gingival hyperplasia (teach to brush and floss teeth after everymeals, use soft bristle toothbrush, regular dental care, gum massage
Phenytoin (Dilantin):
Phenytoin is effective in treating all types of partial and tonic-clonic seizures but NOT absence seizures.
It is one of the most widely used agents.
Benzodiazepines: Drug of choice by IV for termination of status epilepticus
Diazepam (Valium) --Adverse Effects:
by injection: shock, coma, acute alcohol intoxication, infants < 30 days old
by tabet: children less than 6 months; acute narrow angle glaucoma, untreated open angle glaucoma, during or within 14 days of MAO inhibitor therapy; safe use in pregnancy not established
Clonazepam (Klonopin)
Clonazepam is useful in treating myoclonic seizures in children and absence seizures.
Clonazepam may also be used (sometimes in combination with other drugs) to treat:
 akinetic seizures
 Lennox-Gastaut syndrome
 absence seizures refractory to succinimides or valproic acid (Depakene, Depakote)
 infantile spasms
 restless legs.
Adverse effects:
The most common side effect with long-term clonazepam use is lethargy and drowsiness.
Barbiturates:
Phenobarbital (Luminal):
Phenobarbital is effective in treating generalized tonic-clonic seizures and partial seizures.
It is one of the most widely used agents because of its efficacy, low toxicity and low cost.
Primidone (Mysoline):
Primidone is effective against tonic-clonic and partial seizures.
Primidone's antiseizure efficacy is due both to the drug itself and to its active metabolites, especially phenobarbital.
Sedation
Vertigo, nausea, vomiting, ataxia, nystagmus, diplopia. feeling of intoxication immediately after ingestion
Valproic acid (Depakene, Depakote)
Valproic acid (Depakene, Depakote) is effective in partial and generalized seizures
 Valproic acid (Depakene, Depakote) is also effective in treatment of absence seizures.

30. Education Medication Therapeutic drug levels
Drug-drug and food-drug interactions
Stress compliance with medications
Do not stop abruptly
Client and Family Education
Care of client during a seizure
When to call 911
Seizure precautions
Keep seizure diary
Rest; Manage stress
Take medications as prescribed
States laws re: driving and operating machineries

31. Surgical Management Remove the epileptic focus
Prevent spread of epileptic activity
Involves resection of brain tissue/ lobe

32. Brain Mapping

33. Alternative Therapies: Do NOT REPLACE DRUGS
Biofeedback
Ketogenic Diet-high fat low carb
Body burns fat instead of glucose for energy
Vagal nerve stimulation
Implantation of a device to stimulate the vagal nerve
To abort the seizure

34. Psychosocial Social stigma Unable to drive Fear of embarrassment
Effects of medications

35. Referrals and resources
Refer to community resources
Resources: Epilepsy Foundation Of America, National Epilepsy League