SEIZURES AND EPILEPSY 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
6. Aton Atonic ic Seiz Seizur ure e Characterized by sudden loss of muscle tone, lasting for seconds, followed by postictal confusion. •
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GENERALIZED SEIZURES 1. TonicTonic-Clo Clonic nic Seiz Seizure ure 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. To Toni nic c Sei Seizu zure res s Characterized by an abrupt increase in muscle tone, loss of consciousness, and loss of autonomic signs lasting from 30 seconds to several minutes. 3. Clon Clonic ic Seiz Seizur ures es Characterized by muscle contraction and relaxation lasting for several minutes. 4. Abse Absenc nce e Seiz Seizur ure e 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. Myocl Myocloni onic c Seizu Seizure re Characterized by brief jerking or stiffening of the extremeties, which may occur singly or in groups. May be symmetric or asymmetric. • •
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PARTIAL SEIZURES Known as focal or local seizures, begin in a part of one cerebral hemisphere. Complex Partial Seizure Simple Partial Seizure 1. Comple Complex x Partia Partiall Seizure Seizures s 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 Simple Part Partial ial Seizu Seizures res 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. Unclassi Unclassified fied or Idiopathi Idiopathic c Occur for no known reason and do not fit into the generalized or partial classifications. • •
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ETIOLOGY 1. Primary Primary or Idio Idiopat pathic hic is n not ot associated with any identifiable brain lesion. 2. Seco econdary 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 • • • • •
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Complete description of the type of seizure and event surrounding the seizure. Identify presence of Aura. DIAGNOSTIC TESTS EEG CT Scan MRI PET Laboratory studies to determine metabolic or genetic disorders. NURSING DIAGNOSES Risk for falls related to impaired balance. Ineffective coping related to uncertainty and inadequate level of perception of control. Risk for ineffective breathing pattern related to neuromuscular dysfunction. Potential for status epilepticus. DRUG THERAPY Major component of management. Introduces one drug at a time to achieve seizure control. Dosage of medications are adjusted to achieve therapeutic blood levels without causing major side effects. DRUG INDICATIO NURSING NS INTERVENTIONS Divalproex All types of Monitor for (Depakote) seizures. hairloss, tremor, Valproic increased liver Acid enzymes, bruising (Depakene and N/V. ) Monitor CBC, PT, PTT and AST Gabapenti Partial Watch for n Seizures increased appetite (Neurontin) and weight gain. Monitor for ataxia, irritability, dizziness and fatigue. Phenobarbi Generalize Note that this is tal d tonicless desirable than clonic other AEDs seizures, because of partial sedation. seizures Overdose can be fatal. Monitor for drowsiness, sleep disturbances, cognitive impairment and depression. Phenytoin All types Monitor for gastric
except absence, myoclonic, and atonic seizures, for status epilepticus.
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distress, gingival hyperplasia, anemia, ataxia, and nystagmus. Check CBC and Calcium levels. For IV, Flush catheter with saline before and after administration.
CLIENT AND FAMILY EDUCATION Emphasize that AEDs must not be stopped. Look for alternative employment. Chart 45-4, page 953. SEIZURE PRECAUTIONS Depending on hospital policy. Oxygen and Suctioning equipment with an airway available. Saline lock in hospitalized client without IV line. Side rails up at all times. Keep bed in lowest position. Never insert padded tongue blades. SEIZURE MANAGEMENT Observe and document the time that the seizure lasted. Direct the client away from the activity to prevent injury. Turn the client to the sides. Remove objects that might injure the client. Administer oxygen after the seizure. Do not restrain the client. •
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STATUS EPILEPTICUS Characterized by prolonged seizures lasting more than 5 minutes or repeated seizures over the course of 30 minutes. Sudden withdrawal from AEDs Infections Acute alcohol withdrawal Head trauma Cerebral Edema Metabolic disturbances It is a Neurologic Emergency. Notify physician and establish an airway. Administer oxygen. Establish IV access with a large bore catheter and Plain NSS. Put client on the ICU. ABGs are assessed. Medications: •
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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.
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