Epilepsy and Seizures A.

partial or focal source of the seizures within the

 Seizure - is an abnormal, paroxysmal
electrical discharge from the cerebral cortex;
seen clinically as alterations in sensation,
behavior, movement, perception, or
consciousness. Symptoms are related to the
area of the cortex involved.
 Epilepsy - recurrent, stereotypic seizures
Epilepsy
• An alteration in normal brain activity that
causes distinct changes in behavior and body
functions.
• Cause: unknown
• Epilepsy should not be understood as a
single disorder, but rather as syndromic with
vastly divergent symptoms, all involving
episodic abnormal electrical activity in the
brain and numerous seizures.
Causes of Seizures
brain is localized
B. generalized seizure - or distributed
Intl Classification of Seizures
*Partial or focal seizures may be classified as:
1. Simple
2. Complex
*Generalized classified as: are further seizures
1. absence (petit mal)
2. myoclonic
3. tonic-clonic (grand mal)
4. atonic seizures
Simple Partial Seizure
• Have motor, somato - sensory, psychic or
autonomic symptoms without impairment of
consciousness
• Finger or hand may shake, jerky mouth,
dizziness, experiences unusual or unpleasant
sights, sounds or smell

• Congenital (epilepsy) Complex Partial Seizure

• High fevers
• Structural problems in the brain • Have impairment of consciousness (but not
• Metabolic disorders loss of consciousness) with simple partial
• Chemical disorders (poison, drugs) features, automatism
• Sudden high fever
• Remains motionless or moves automatically
PATHOPSYCHOLOGY but inappropriately, feels excessive
emotions of fear, anger, elation; does not
The brain has certain metabolic needs for oxygen remember episode when it is over
and glucose
/ Absence Seizure (General)
Ischemia and hemorrhage prevent oxygen and
glucose to enter the brain • These seizures are sometimes referred to as
/ petit mal seizures (French for "little illness")
Permeability of the cell ion and concentration • are brief - usually less than 20 seconds
(Sodium and Potassium) is changed • generalized epileptic seizures of sudden
/ onset and termination
Neurons become hyper excitable • Impairment of consciousness is the essential
/ ictal element and may be the only clinical
Hyper synchrony and abnormal discharges are symptom
produced (seizures)
/ Absence Seizures - manifestations
Message
/ • abrupt and sudden onset impairment of
Carried by neurons of the brain by means of consciousness
discharges that swing along them • interruption of ongoing activities
/ • blank stare
Impulses occur in "bursts" whenever a nerve cell • brief upward rotation of the eyes
has a task to perform • If patient is speaking, speech is slowed or
/ interrupted
Sometimes (unwanted) discharges continue to fire • if walking, stands transfixed
after a task is done • if eating, the food will stop on his way to the
/ mouth
Parts of the body controlled by errant cells may • Usually unresponsive when spoken to
perform erratically
/ Tonic - clonic (Grand mal) Seizures
Results in mild to moderate incapacitating
dysfunctions and decreased LOC • There is loss of consciousness - both
/ hemispheres of the brain are involved
Repetition of this mechanism means EPILEPSY • Episode usually lasts 1 - 2 minutes

Classification of Seizures
 • There is intense rigidity of body, may chew • Insert oral airway if possible (IF)
his tongue, incontinent feces or urine,
labored breathing During a Seizure - On bed
• LOC is lost (falls into coma) and may wake
up confused and disoriented • Provide privacy
• Lower the height of the bed
Atonic Seizures • Remove pillows
• Raise side rails
• There is brief loss of muscle tone, which • Loosen constrictive clothing
may cause patient to fall or drop something
• Also referred as "Drop attack" After a Seizure
• occurs in a few seconds
• Maintain privacy
Myoclonic Seizures • Keep patient on one side to prevent
aspiration • Maintain patent airway, monitor
• There is brief jerking of a muscle group, short apneic period
which may cause patient to fall • Reorient patient
• Occurs in a few seconds • Use gentle restraint if patient becomes
• Bilaterally massive epilepsy agitated or hostile

General Clinical Manifestations STATUS EPILEPTICUS -REPEATES

• Impaired consciousness
• Disturbed muscle tone or movement
• Disturbed behavior, mood sensation and
perception
• Disturbances of the autonomic functions
Diagnostic Exams
SEIZURES WITH IN 5 MINS.
Transient Ischemic Attack (TIA)
• A TIA is a "mini-stroke."
• Stroke symptoms go away within 24 hours.
• Every TIA is an emergency.

• EEG with or without video monitoring

• MRI
• CT scan
• SPECT Single Photon Emission
• Computed Tomography
• PET - Positron Emission Tomography
• Neuropsychological studies rule out
behavioral disturbances

Management
Drugs:

• Clonazepam
• Carbamazepine
• Ethosuxamide
• Felbamate
• Gabapentin
• Phenytoin
• Valproic Acid

Nursing Responsibilities:
Supportive:

• Promote safe environment

• Maintain patent airway
• Improve cognitive response
• Prevent secondary injury
• Maintain cerebral perfusion
• Reorient to reality

During a Seizure - Standing

• Provide privacy
• Ease patient to floor
• Protect the head to prevent injury
• Push aside furniture and obstacles
• Loosen constrictive clothing