Exam 15: Seizures
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| Seizure | brief episode of abnormal electrical activity in the brain
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| Convulsion | It is defined as a sudden, violent involuntary series of contractions of a group of muscles that may be paroxysmal and episodic, as in a seizure disorder, or transient and acute as after a head concussion.
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| Epilepsy | a group of neurological disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or all of these.
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| Aura | a sensation, as light or warmth, which may precede an attack of migraine or an epileptic seizure.
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| Status Epilepticus | a medical emergency (airway compromised) characterized by continual seizures occurring without interruptions.
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| Postictal Period | the rest period of variable length that follows a tonic-clonic seizure.
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| Manifestations of Epilepsy | (1) Associated with paroxysmal, uncontrolled electrical discharges in the neurons
(2) Results in sudden, violent, involuntary contractions of a group of muscles
(3) Patterns vary depending on what area of the brain from which seizure arises
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| Tonic-Clonic (Grand Mal) - the most common type. | Usually proceeded by an aura.
LOC for several minutes.
aura, tonic-clonic movements, incontinence, Pt may fall to ground.
During the postictal period, the patient may have a headache, and sleep for 1-2 hours following the seizure.
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| Absence (Petit Mal) | Usually occurs during childhood and adolescence, and normally decrease in frequency as a child gets older.
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| Absence (Petit Mal) Characterization | sudden (without warning) impairment in LOC with little or no tonic-clonic movement.
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| Absence (Petit Mal) Clinical signs | include a sudden vacant facial expression with the eyes focused straight ahead. Most motor activity ceases, except for a slight twitching of the eyelids.
No postictal period following seizure.
No aura.
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| Psychomotor Seizure | Similar to absence seizure, but last longer and is associated with changes in awareness, a distortion of feeling and thinking and partially coordinated motor activity.
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| Psychomotor Seizure Clinical Signs | include partially conscious behavior, antisocial behavior (violent acts/exposing self), urinary incontinence, autonomic complaints (shivering).
Aura with complex hallucinations or illusions.
Postictal periods )confusion, amnesia, and a need for sleep).
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| Jacksonian (local or partial) Seizure | Occurs almost entirely in patients with structural brain disease.
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| Jacksonian (local or partial) Seizure Characterized by | Spasms of musculature that begin in a certain area of the body and move throughout a portion or all of the body.
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| Jacksonian (local or partial) Signs | Commonly begins in hand, foot or face (depending on focus) and may end in a grand mal seizure.
Aura manifested by numbness, tingling or crawling feeling.
May be a postictal period depending on the severity of the seizure.
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| Myoclonic | May antedate grand mal by months or years.
May be very mild or have rapid forceful movements.
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| Myoclonic Signs | sudden involuntary contraction of a muscle group, usually in extremity and no LOC.
No aura.
No postictal period.
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| Akinetic | Characterized by a peculiar generalized tonelessness.
Person falls in a flaccid state and is unconscious for a minute or two.
Rarely is there an aura.
No postictal period.
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| Seizures Dx testing | EEG.
Brain Scan.
Serum Electrolytes.
EEG & TV.
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| Anti-convulsants | ↑ seizure threshold
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| Indications for use of anti-convulsants | 1) Grand mal and petit mal seizures.
2) Generalized myoclonic seizures.
3) Psychomotor and focal seizures.
4) Status epilepticus.
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| Surgical Management of the Patient with Epilepsy/Seizures: | Brain tumors.
Brain abscesses.
Cysts.
Cortical scars due to cerebral trauma/birth injuries.
Treatment with drugs has been ineffective.
Intractable convulsive attacks with hemiplegia or increasing neurological deficits.
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| Seizure Assessment (During) | 1. Pt turned to side to keep airway patent.
2. Remove breathing obstructions.
3. Loosen restrictive clothing.
4. Protect from injury, DO NOT RESTRAIN!
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| Seizure Assessment (After Seizure) | 1. Keep bed flat until episode is over.
2. Loosen clothing that could not be earlier.
3. VS.
4. Inspect mouth.
5. Change bedding if soiled.
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| Nursing Assessment (Seizure) | 1. 1st thing Pt does.
2. Parts involved.
3. Pupils.
4. Incontinence.
5. Duration.
6. Consciousness.
7. Paralysis.
8. Ability to speak.
9. End movements.
10. Post-ictal seizures.
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| Anti-Convulsant Agents Use | Decrease incidence and severity of seizures due to various etiologies.
More than one anticonvulsant is used to control seizures on a long-term basis.
Many regimens are evaluated by monitoring serum levels.
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| Anti-Convulsant Agents Action | Depress abnormal neuronal discharges in the CNS that may result in seizures.
Prevent the spread of seizure activity, depressing the motor cortex, raising seizure threshold, or altering levels of neurotransmitters, depending on the agent.
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| Barbiturates: Use | generalized tonic-clonic (grand mal), partial, febrile seizures in children.
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| Barbiturates: Examples | 1) pentobarbital (Nembutal).
2) phenobarbital (Luminal).
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| Benzodiazepines: Types | clonazepam (Klonopin).
diazepam (Valium).
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| clonazepam (Klonopin): | Prophylaxis: petit mal, petit mal variant, myoclonic, akinetic seizures.
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| diazepam (Valium): | Treatment of status epilepticus/uncontrolled seizures.
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| Hydantoins: Types | fosphenytoin (Cerebyx).
phenytoin (Dilantin, diphenylhydantoin, DPH, Phenytek)
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| fosphenytoin (Cerebyx): | Short-term parenteral (IV/IM) in acute generalized tonic-clonic seizures.
Status epilepticus.
Preventing and treating seizures occurring during neurosurgery.
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| phenytoin (Dilantin, diphenylhydantoin, DPH, Phenytek): | generalized tonic-clonic, focal, psychomotor seizures.
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| Valproates Use | absence seizures.
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| Valproates Examples | divalproex sodium (Depakote, Depakote ER).
valproate sodium (Depacon).
valproic acid (Depakene).
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| Misc. Drugs | carbamazepine (Tegretol)
gabapentin (Neurontin).
lamotrigine (Lamictal).
levetiracetam (Keppra).
oxcarbazepine (Trileptic) and tiagabine (Gabatril).
topiramate (Topamax).
zonisamide (Zonegran).
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| Misc Drug: carbamazepine (Tegretol) | focal, generalized tonic-clonic (Adults).
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| Misc Drug: gabapentin (Neurontin) | indicated for partial seizures and for secondary generalized seizures. (Adjunctive therapy).
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| Misc Drug: lamotrigine (Lamictal) | focal, generalized tonic-clonic (Adults).
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| Misc Drug: levetiracetam (Keppra) | indicated for partial seizures and for secondary generalized seizures. (Adjunctive therapy).
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| Misc Drug: oxcarbazepine (Trileptic) and tiagabine (Gabatril) | indicated for partial seizures and for secondary generalized seizures. (Adjunctive therapy).
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| Misc Drug: topiramate (Topamax) | indicated for partial seizures and for secondary generalized seizures. (Adjunctive therapy).
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| Misc Drug: zonisamide (Zonegran) | indicated for partial seizures and for secondary generalized seizures. (Adjunctive therapy).
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| Fetal hydantoin syndrome may occur | offspring of patients who receive phenytoin during pregnancy.
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