SEIZURES AND EPILEPSY
Atonic Seizure
SEIZURE - Is an abnormal, sudden,
excessive, uncontrolled electrical discharge
of neurons within the brain that may result
in alteration in consciousness, motor or
sensory ability, and/or behavior.
• No known reason.
• Pathologic condition of the brain.
EPILEPSY - Is a chronic disorder
characterized by recurrent, unprovoked
seizure activity.
• Abnormality in electrical neuronal
activity.
• Imbalance in neurotransmitters.
• Combination of both.
TYPES OF SEIZURES
• Generalized Seizures
• Partial Seizures
• Unclassified Seizures
GENERALIZED SEIZURES
1. Tonic-Clonic Seizure
• Last for 2-5 minutes.
• TONIC phase is characterized by
stiffening or rigidity on the
muscles, particularly of the arms
and legs, and immediate loss of
consciousness.
• CLONIC phase or rhythmic jerking
of all extremeties follows it.
• Biting of tongue, incontinent urine
or feces, fatigue, confusion and
lethargy.
2. Tonic Seizures
• Characterized by an abrupt
increase in muscle tone, loss of
consciousness, and loss of
autonomic signs lasting from 30
seconds to several minutes.
3. Clonic Seizures
• Characterized by muscle
contraction and relaxation lasting
for several minutes.
4. Absence Seizure
• More common in children and
tends to be hereditary.
• With brief periods of loss of
consciousness and blank staring,
as though the person is
daydreaming.
• Returns to baseline immediately
after.
5. Myoclonic Seizure
• Characterized by brief jerking or
stiffening of the extremeties,
which may occur singly or in
groups.
• May be symmetric or asymmetric.
6.
• Characterized by sudden loss of
muscle tone, lasting for seconds,
followed by postictal confusion.
PARTIAL SEIZURES
Known as focal or local seizures, begin in a
part of one cerebral hemisphere.
• Complex Partial Seizure
• Simple Partial Seizure
1. Complex Partial Seizures
• Cause loss of consciousness or
“black out” for 1-3 minutes.
• Automatism may occur such as
lip smacking, patting, picking at
clothes, amnesia.
• Affects the temporal lobe so also
known Psychomotor or temporal
lobe seizure.
2. Simple Partial Seizures
• Client remains conscious.
• Aura – “deja vu”, offensive smell,
sudden onset of pain.
• Unilateral movement of
extremity, unusual sensations,
autonomic or psychic motors such
as changes in heart rate, skin
flushing and epigastric
discomfort.
UNCLASSIFIED SEISURES
1. Unclassified or Idiopathic
• Occur for no known reason and
do not fit into the generalized or
partial classifications.
ETIOLOGY
1. Primary or Idiopathic is not
associated with any identifiable brain
lesion.
2. Secondary
• Brain lesion
• Metabolic Disorders
• Acute alcohol withdrawal
• Electrolyte Imbalance
• Heart Diseases
HEALTH PROMOTION AND ILLNESS
PREVENTION
• Take medication as prescribed and
notify health care provider if unable
to take medications.
• Balanced diet, proper rest and stress
reduction techniques.
• Keep a seizure diary.
• Follow laws of driving motor vehicle.
• Employ clients.
ASSESSMENT
 • Complete description of the type of except distress, gingival
seizure and event surrounding the absence, hyperplasia,
seizure. myoclonic, anemia, ataxia,
• Identify presence of Aura. and atonic and nystagmus.
DIAGNOSTIC TESTS seizures, Check CBC and
• EEG for status Calcium levels.
• CT Scan epilepticus. For IV, Flush
• MRI catheter with
saline before and
• PET
after
• Laboratory studies to determine administration.
metabolic or genetic disorders.
NURSING DIAGNOSES
CLIENT AND FAMILY EDUCATION
• Risk for falls related to impaired
• Emphasize that AEDs must not be
balance.
stopped.
• Ineffective coping related to
• Look for alternative employment.
uncertainty and inadequate level of
• Chart 45-4, page 953.
perception of control.
SEIZURE PRECAUTIONS
• Risk for ineffective breathing pattern
• Depending on hospital policy.
related to neuromuscular
dysfunction. • Oxygen and Suctioning equipment
with an airway available.
• Potential for status epilepticus.
DRUG THERAPY • Saline lock in hospitalized client
without IV line.
• Major component of management.
• Side rails up at all times.
• Introduces one drug at a time to
achieve seizure control. • Keep bed in lowest position.
• Dosage of medications are adjusted • Never insert padded tongue blades.
to achieve therapeutic blood levels SEIZURE MANAGEMENT
without causing major side effects. • Observe and document the time that
DRUG INDICATIO NURSING the seizure lasted.
NS INTERVENTIONS • Direct the client away from the
Divalproex All types of Monitor for activity to prevent injury.
(Depakote) seizures. hairloss, tremor, • Turn the client to the sides.
Valproic increased liver • Remove objects that might injure the
Acid enzymes, bruising client.
(Depakene and N/V. • Administer oxygen after the seizure.
) Monitor CBC, PT, • Do not restrain the client.
PTT and AST
Gabapenti Partial Watch for STATUS EPILEPTICUS
n Seizures increased appetite • Characterized by prolonged seizures
(Neurontin) and weight gain. lasting more than 5 minutes or
Monitor for ataxia, repeated seizures over the course of
irritability, 30 minutes.
dizziness and  Sudden withdrawal from AEDs
fatigue.  Infections
Phenobarbi Generalize Note that this is  Acute alcohol withdrawal
tal d tonic- less desirable than
 Head trauma
clonic other AEDs
 Cerebral Edema
seizures, because of
partial sedation.  Metabolic disturbances
seizures Overdose can be • It is a Neurologic Emergency.
fatal. • Notify physician and establish an
Monitor for airway.
drowsiness, sleep • Administer oxygen.
disturbances, • Establish IV access with a large bore
cognitive catheter and Plain NSS.
impairment and • Put client on the ICU.
depression. • ABGs are assessed.
Phenytoin All types Monitor for gastric • Medications:
  Diazepam
 Lorazepam – DOC and
aministered 2-4mg over a 2
minute period up to 8mg is
reached.
 Diazepam Rectal Gel
 Phenytoin is administered at
50mg/min up to 100mg/min.
- Monitor drug levels 6-12 hours
after loading dose then 2
weeks after oral phenytoin.
SURGICAL MANAGEMENT
Vagal Nerve Stimulation
• Performed to control medically
intractable simple or complex partial
seizures with or without secondary
generalization.
• Stimulating device is implanted in
the left chest wall.
• An electrode lead is attached to the
left vagus nerve then connected to a
generator.
• Client under GA and takes about 2
hours.
• Physician delivers intermittent VNS.
• Typical amount is 30 sec. On and 5
minutes off.