Ch. 59: Seizure disorders
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| Paroxysmal, uncontrolled electrical discharge of neurons in brain, interrupting normal function. May accompany other disorder or occur spontaneously w/o apparent cause. | seizure
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| Seizures resulting from metabolic disturbances are not considered epilepsy if what happens? | If seizures cease when underlying condition is treated.
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| What are some metabolic disturbances assocated with seizures? | acidosis; electrolyte imbalance; hypoglycemia; hypoxemia; alcohol or barbiturate withdrawal; dehydration or water intoxication
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| This is a condition in which a person has spontaneously recurring seizures caused by underlying chronic condition. | epilepsy
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| People at high risk to develop epilepsy include? | Those with Alzheimer's disease or those who have had a stroke, and also in a person who has a parent who has epilepsy.
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| What are some common causes of seizures during the first 6 months of life? | severe birth injury; congenital birth defects involving CNS; infections; inborn errors of metabolism
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| What are some common causes of seizures from ages 2 to 20? | birth injury; infection; trauma; genetic factors
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| What are some common causes of seizures b/t ages of 20 and 30? | structural lesions such as trauma, brain tumor, vascular disease
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| What are some common causes of seizures after the age of 50? | stroke; metastatic brain tumors
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| Describe the etiology of epilepsy. | Abnormal neurons undergo spontaneous firing. Firing spread to adjacent or distant areas of the brain. If activity involves whole brain, generalized seizure occurs. Cause of abnormal firing is unclear.
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| This is the most common generalized seizures. It is characterized by loss of consciousness and falling. Body stiffens (tonic) w/ subsequent jerking of extremities (clonic). | tonic-clonic seizures (grand mal)
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| How long does the tonic phase last for? | 10-20 seconds
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| How long does the clonic phase last for? | another 30-40 seconds
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| What might occur with a tonic-clonic seizure? | cyanosis, excessive salivation, and tongue or cheek biting
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| In tonic-clonic seizures this phase is characterized by muscle soreness, fatigue, pt may sleep for hours, may not feel normal for hours to days and has no memory of seizure. | postictal phase
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| Symptom of this seizure is staring spell "daydreaming.' It lasts only a few seconds & often goes unnoticed. May occur up to 100 times/day if untreated. | typical absence seizure (petit mal)
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| What are the CM of atypical absence seizures? | Characterized by staring spell w/other manifestations such as brief warnings, peculiar behavior during seizure, and confusion after.
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| What is the difference with typical and atypical absence seizures? | Atypical seizures are longer lasting and may be associated with loss of postural tone.
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| Focal seizures are divided according to their clinical expression into? | simple focal seizures and complex focal seizures
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| With this seizure the person remains conscious. | simple focal seizure
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| With this seizure the person has a change or loss of consciousness and produces a dreamlike experience. | complex focal seizure
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| In simple focal seizures the person may experience what? | Unusual feelings or sensations that can take many forms such as sudden & unexplainable feelings of joy, anger, sadness, or nausea. They may hear, smell, taste, see, or feel things that are not real.
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| In complex focal seizures the person may do what? | Display strange behavior such as lip smacking, automatisms (counting out change or picking items from a grocery shelf), doesn't remember an activity started before & continued during seizure, usu. lasts a few seconds.
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| This is a state of constant seizure or condition when seizures recur in rapid succession w/o return to consciousness b/t seizures. It is the most serious complication of epilepsy & is a neurologic emergency. Can involve any type of seizure. | status epilepticus
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| These are a form of status epilepticus in which the sedated patient seizes, but w/o external signs b/c of the sedating medication. | subclinical seizures
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| In status epilepticus what happens to the brain? | Causes the brain to use more energy than is supplied. Neurons become exhausted & cease to function resulting in permanent brain damage.
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| This is the most dangerous type of status epilepticus & can cause ventilatory insufficiency, hypoxemia, cardiac arrhythmias, hyperthermia, & systemic acidosis. It can be fatal. | tonic-clonic status epilepticus
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| How does epilepsy affect a person's lifestyle? | Social stigma still exists. Discrimination/limitations in employment & education. Driving sanctions. Pt may develop ineffective coping methods b/c of the psychosocial problems associated w/seizures.
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| What diagnostics are done for seizures? | CBC, serum chemistries, liver & kidney function, UA to rule out metabolic disorders; CT or MRI to rule out structural problems; health hx; EEG
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| Most seizures do not require emergency medical care b/c they are self-limiting & rarely cause bodily injury but immediate medical care is needed if? | Status epilepticus occurs; significant bodily harm occurs; or the event is a first-time seizure.
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| How are seizure disorders primarily treated? | with antiseizure drugs; must be taken regularly and continuously, often for a lifetime
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| What is the goal of drug therapy? | Preventing seizures with minimum toxic side effects from drugs.
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| This drug is used as "add-on" for control of focal seizures that are not successfully managed with a single medication. | pregabalin (Lyrica)
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| What drugs are used for status epilepticus? | Initially, rapid-acting IV lorazepam (Ativan) or diazepam (Valium) followed by long-acting drugs such as phenytoin or phenobarbital.
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| What can happen if antiseizure drugs are discontinued abruptly? | this can precipitate seizures
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| What are some common side effects of antiseizure drugs? | Involve the CNS and include diplopia, drowsiness, ataxia, and mental slowing.
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| What surgical procedure can be done to possibly fix the seizure disorder? | anterior temporal lobe resection
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| What are the 3 requirements for surgery? | Diagnosis of epilepsy confirmed. Adequate trial w/drug therapy w/o satisfactory results. Electroclinical syndrome defined (type of seizure disorder).
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| This is an adjunct to medications when surgery is not feasible. It is thought to interrupt synchronization of epileptic brain-wave activity & stop excessive discharge of neurons. | vagal nerve stimulation
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| What is vagal nerve stimulation? | A surgically implanted electrode in the neck that is programmed to deliver the electrical impulses to the vagus nerve. The pt can activate it w/a magnet when he/she senses a seizure is imminent.
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| What are some adverse effects of vagal nerve stimulation? | coughing, hoarseness, dyspnea, and tingling in the neck
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| What type of diet has been effective in controlling seizures in some? | a ketogenic diet: high fat, low carb diet; ketones pass into the brain & replace glucose as an energy source
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| This is aimed at teaching the patient to maintain a certain brain wave frequency that is refractory to seizure activity. | biofeedback
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| What are some safety measures you should promote to the patient? | Wear helmet if risk for head injury. General health habits (diet, exercise). Assist to identify events or situations precipitating seizures & avoid if possible. Instruct to avoid excessive alcohol, fatigue, & loss of sleep.
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| What should the nurse do when a seizure occurs? | Observe, treat, & document seizure. Maintain patent airway, support head, turn to side, loosen constictive clothing, ease to floor. Don't restrain pt or place objects in mouth. May require positioning, suctioning, or O2 after seizure.
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