1. Seizure And Epilepsy Disorders By Dr. Hanan Said Ali

2. Objectives Define a Seizure and epilepsy. Define a Seizure and epilepsy. Identify the aetiology of a Seizure and epilepsy. Identify the aetiology of a Seizure and epilepsy. Describe the Pathophysiology of a Seizure and epilepsy. Describe the Pathophysiology of a Seizure and epilepsy. Identify the Clinical Manifestations of a Seizure and epilepsy. Identify the Clinical Manifestations of a Seizure and epilepsy. Mention the treatment of a Seizure and epilepsy. Mention the treatment of a Seizure and epilepsy. Identify the Initial Nursing Interventions Identify the Initial Nursing Interventions

3. Seizure And Epilepsy Disorders A Seizure Is a paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal functions. Is a paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal functions. They may accompany a variety of disorders, or they may occurs spontaneously without any apparent cause. They may accompany a variety of disorders, or they may occurs spontaneously without any apparent cause.Epilepsy Is a condition in which a person has spontaneously recurring seizures caused by chronic underlying conditions. Is a condition in which a person has spontaneously recurring seizures caused by chronic underlying conditions.

4. Seizure And Epilepsy Disorders Cont. Aetiology In first 6 months of life In first 6 months of life  Severe birth injury, congenital defects, involving the CNS infection and inborn errors of metabolism. In clients between 2 and 20 years of age In clients between 2 and 20 years of age  Birth injury, infection, trauma, and genetic factors

5. Seizure And Epilepsy Disorders Cont. Aetiology Cont. In individuals between 20- 30 years of age In individuals between 20- 30 years of age  Structural lesions, such as trauma, brain tumours or vascular disorders After 50 years of age After 50 years of age  Cerebrovascular lesions and metastatic brain tumours

6. Seizure And Epilepsy Disorders Cont. Pathophysiology A seizure can caused by any process that disrupts the cell membrane stability of a neuron. A seizure can caused by any process that disrupts the cell membrane stability of a neuron. The point at which the cell membrane becomes destabilized and an uncontrolled electrical discharge discharge begins is known as seizures threshold. The point at which the cell membrane becomes destabilized and an uncontrolled electrical discharge discharge begins is known as seizures threshold. People have lower seizures threshold, more prone to seizure. People have lower seizures threshold, more prone to seizure.

7. Seizure And Epilepsy Disorders Cont. Pathophysiology Cont. The area of the brain from which the epileptic activity arises is found to have scar tissues The area of the brain from which the epileptic activity arises is found to have scar tissues The scaring is thought to interfere with the normal chemical and structural environment of the brain neurons, making them more likely to fire abnormally. The scaring is thought to interfere with the normal chemical and structural environment of the brain neurons, making them more likely to fire abnormally.

8. Seizure And Epilepsy Disorders Cont. Clinical Manifestations The major categories are partial (focal) generalized and unclassified. The major categories are partial (focal) generalized and unclassified. Subdivisions based on the person's behaviour Subdivisions based on the person's behaviour 1- Ictal refers to the time during the seizure 2- Interictal refers to the time between seizure activity. 3- Postictal refers to the time immediately after a seizure as the client recovers

9. Seizure And Epilepsy Disorders Cont. Clinical Manifestations Cont. Partial seizures Simple partial seizures, no impairment of consciousness, twitching of extremity, speech arrest, speciral visual sensations (e.g. Seeing lights), feeling of fear or doom Simple partial seizures, no impairment of consciousness, twitching of extremity, speech arrest, speciral visual sensations (e.g. Seeing lights), feeling of fear or doom  There is no postictal state.

10. Seizure And Epilepsy Disorders Cont. Clinical Manifestations Cont. Partial seizures Complex partial, is a simple partial siezure with progression to impairment of consciousness. Complex partial, is a simple partial siezure with progression to impairment of consciousness.  It begin as simple partial and progress to complex.  It include lipsmacking, chewing, or picking at clothes

11. Seizure And Epilepsy Disorders Cont. Clinical Manifestations Cont. Partial seizures Complex partial generalized to generalized tonic- clonic seizures. Complex partial generalized to generalized tonic- clonic seizures.  It begins as complex partial, then progress to tonic- clonic as in generalized seizures.  Postictal state present.

12. Seizure And Epilepsy Disorders Cont. Clinical Manifestations Cont. Generalized seizures Impair consciousness from the start.  Absence seizures:  Do not include motor signs and may last less than 1- minute.  There will be brief loss of consciousness, staring, unresponsive and no postictal state.

13. Seizure And Epilepsy Disorders Cont. Clinical Manifestations Cont. Generalized seizures  Tonic- clonic seizures It involves rhythmic jerking of muscles, possibly tongue biting and urinary and fecal incontinence.  Atonic seizures, there will be impairment consciousness for only few seconds and brief loss of muscle tone, which may cause client to fall or drop

14. Seizure And Epilepsy Disorders Cont. Clinical Manifestations Cont. Generalized seizures  Myoclonic seizures, There will be impaired consciousness for few seconds or not at all and brief jerking of muscle group which may cause the client to fall. Status epileptical Status epileptical Is an episode of seizures activity lasting at least for 30 minutes or repeated seizures without full recovery between seizures

15. Seizure And Epilepsy Disorders Cont. Diagnosis History including the risk factors. History including the risk factors. Physical examination Physical examination Diagnostic tests (EEG, CT, MRI, PET) Diagnostic tests (EEG, CT, MRI, PET)Treatment 1- Hydantoin (phenytoin- Dilantin) These blocks potentiation and propagation of electrical discharge These blocks potentiation and propagation of electrical discharge It take as 10-20 mg/LN.saline at least 7-14 days It take as 10-20 mg/LN.saline at least 7-14 days

16. Seizure And Epilepsy Disorders Cont. It is important to monitor side effects as ataxia, fatigue, drowsiness and GIT disturbance as, nausea, anorexia, vomiting. It is important to monitor side effects as ataxia, fatigue, drowsiness and GIT disturbance as, nausea, anorexia, vomiting. 2- Barbiturates (phenobarbitol- Luminal) Used to manage tonic- clonic, simple partial, and complex partial seizures and statuse epilepticus. Used to manage tonic- clonic, simple partial, and complex partial seizures and statuse epilepticus. The nurse has to monitor side effect as sedation, drowsiness and depression. The nurse has to monitor side effect as sedation, drowsiness and depression.

17. Seizure And Epilepsy Disorders Cont. 3- Succinimides It raises threshold to stimuli used to manage absence seizures. It raises threshold to stimuli used to manage absence seizures. 4- Others Carbamazepine (Tegretol) It blocks synaptic potentiation. It blocks synaptic potentiation. Valpord acid (Depakene) Used to manage absence seizures. Used to manage absence seizures.

18. Seizure And Epilepsy Disorders Cont. Emergency Management of Tonic- Clonic S. Assessment Finding Aura- Peculiar sensation ( Symptoms) that precedes seizures. Aura- Peculiar sensation ( Symptoms) that precedes seizures. Loss of consciousness. Loss of consciousness. Bowel and bladder incontinence. Bowel and bladder incontinence. Tachycardia, Diaphoresis, Warm skin. Tachycardia, Diaphoresis, Warm skin. Pallor, flushing or cyanosis. Pallor, flushing or cyanosis. Tonic phase – Continuous muscle contraction. Tonic phase – Continuous muscle contraction.

19. Seizure And Epilepsy Disorders Cont. Hypertonic phase – extreme muscular rigidity lasting 5 to 15 seconds. Hypertonic phase – extreme muscular rigidity lasting 5 to 15 seconds. Clonic phase – rigidity and relaxation alternate in rapid succession. Clonic phase – rigidity and relaxation alternate in rapid succession. Postical phase – Lethargy, altered level of consciousness. Postical phase – Lethargy, altered level of consciousness. Confusion and headache. Confusion and headache. Repeated tonic clonic seizure for several minutes. Repeated tonic clonic seizure for several minutes.

20. Seizure And Epilepsy Disorders Cont. Initial Nursing Interventions Ensure client airway. Ensure client airway. Assist ventilation if client does not breath. Assist ventilation if client does not breath. Suction as needed Suction as needed Stay with client until seizures have passed. Stay with client until seizures have passed. Protect client from injury during seizures. Do not restrain. Bed side rails. Protect client from injury during seizures. Do not restrain. Bed side rails. Remove or loosen tight clothing. Remove or loosen tight clothing.

21. Seizure And Epilepsy Disorders Cont. Initial Nursing Interventions Cont. Monitor vital signs ( avoid using glass thermometer), Loc, O2 saturation, GCS, pupil size and reactivity. Monitor vital signs ( avoid using glass thermometer), Loc, O2 saturation, GCS, pupil size and reactivity. Reassure and orient the client after seizures. Reassure and orient the client after seizures. Never force an airway between a patient’s Never force an airway between a patient’s Clenched teeth. Clenched teeth. Give dextrose for hypoglycaemia. Give dextrose for hypoglycaemia.

22. Seizure And Epilepsy Disorders Cont. Guidelines to help nurse to care of status epilepticus. Protect airway and provide oxygen. Protect airway and provide oxygen. Establish IV access for medication and fluids. Establish IV access for medication and fluids. Draw blood for electrolytes, ABG. Draw blood for electrolytes, ABG.

23. Seizure And Epilepsy Disorders Cont. Guidelines to help nurse to care of status epi. Administer lorazepam (Ativan) 4 to 8 mg over 2 to 4 minutes or diazepam (valium) 5 to 20 mg over 5 to 10 minutes to stop seizures. Administer lorazepam (Ativan) 4 to 8 mg over 2 to 4 minutes or diazepam (valium) 5 to 20 mg over 5 to 10 minutes to stop seizures. Administer anticonvulsants usually phenytoin 15 to 20 mg/ kg in normal saline at 50 mg/ min Administer anticonvulsants usually phenytoin 15 to 20 mg/ kg in normal saline at 50 mg/ min

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