Seizures (Convulsions or fits )

 Defined as sudden alteration in normal brain activity

that causes abnormal motor, sensory, autonomic or
psychic activity (or a combination of these) .

 Seizures are caused by sudden excessive discharge of

abnormal electrical activity from cerebral neurons.
 Terminology
Epilepsy
Recurrent seizures are termed as epilepsy.
-isa neurological disorder marked by sudden
recurrent episodes of sensory disturbance, loss of
consciousness, or convulsions, associated with
abnormal electrical activity in the brain.
Terminology
Status epilepticus
-is defined as a continuous seizure lasting more than 30
min, or two or more seizures without full recovery of
consciousness between any of them.

-is a single seizure lasting more than five minutes or two

or more seizures within a five-minute period without
the person returning to normal between them
-is a medical emergency
Etiology of Seizures:
Idiopathic:
 Genetic or developmental defects

Acquired:
1. Cerebrovascular disease
2. Fever (childhood)
3. Head injury
4. Hypertension
5. CNS infections
6. Metabolic and toxic conditions e.g. renal failure,
hyponatremia, hypocalcemia, hypoglycemia,
pesticide exposure
7. Brain tumor
8. Drug and alcohol withdrawal
9. Allergies
Pathophysiology
Idiopathic and acquired

Electrical disturbance in the nerve cells of the brain

Emit abnormal, recurring, uncontrolled electrical

discharges

Excessive neuronal or paroxysmal discharges

Instability of the nerve cell membrane

(excitatory and inhibitory occurs)
Decrease threshold firing and firing excessively
(excess of acetylcholine)

Polarization abnormalities

Ionic(ions) imbalance, alter chemical of neuron

Seizures
 Phases (stages) of seizures

Aura – symptom that occurs just before a seizure

– Warning sign before the seizure
– Sense of déjà vu
– Lightheadedness
– Dizziness
–Unusual and inappropriate emotions
– Intense feelings of discomfort - feeling that something bad will
happen).
– Altered vision and hearing (may or may not include hallucinations)

Tonic Lasts for a few seconds (shortest part of seizure)

phase
-Quick loss of Consciousness ,Muscle stiffening, will fall

May have Cyanosis -Up rolling eyeball

-Face turn aside and bite the tongue

Phases of seizures
Clonic Powerful symmetrical jerking movement on
hand and legs
Muscles start to contract and relax rapidly,
causing convulsions, may salivate, urine
incontinence & feces
Lasts within 1-5 minutes then patient turns
unconscious
Patient may roll and stretch as the seizure
spreads.
Post ictal Sudden recollection of the past event
phase Hallucination (visual, taste and smell)
Inappropriate moodiness
 Types of Seizures (International classification)
International League against Epilepsy 2017

Focal onset Generalized

onset seizures Unknown
seizures
Tonic clonic(Grand Epileptic
Simple focal mal) spasms
seizures
Complex focal Tonic
seizures
Clonic

Absence
(petit mal)

Atonic

Myoclonic
 Types of Seizures (International classification)
International League against Epilepsy

Classification Sub
classification

Focal onset Simple Motor, somato sensory,

(Older term focal psychic or autonomous
Partial seizures symptoms
onset No impairment of
seizure) consciousness

Complex Motor, somato sensory,

focal psychic or autonomous
seizures symptoms
Impairment of consciousness
 International League against Epilepsy

Classificati Sub
on classificati
on

Generalize Tonic muscles suddenly become stiff. If they are standing they often
d onset fall.
Clonic seizure involving bilaterally rhythmic jerking
Tonic- The tonic phase comes first: All the muscles stiffen. The person
clonic loses consciousness and falls to the floor.
The tongue or cheek may be bitten, so bloody saliva may
come from the mouth.
After the tonic phase comes the clonic phase: The arms and
usually the legs begin to jerk rapidly and rhythmically, bending
and relaxing at the elbows, hips, and knees. After a few
minutes, the jerking slows and stops.
Bladder or bowel control sometimes is lost as the body
relaxes.
Consciousness returns slowly, and the person may be drowsy,
 Types of Seizures (International classification)
International League against Epilepsy

Classification Sub
classification
Generalized Atonic Person’s muscles suddenly relax and they
onset become floppy-Drop attacks

Absence Seizures start suddenly and are

characterized by staring, loss of expression,
unresponsiveness and, stopping any activity
they are doing
Myoclonic Single or series of jerks (brief muscle
contractions). Each jerk is typically
milliseconds in duration.
 Terminologies
Motor Tonic Psychic aphasia
Clonic symptoms attention , memory
Atonic impairment
Myoclonic déjà vu
Jacksonian hallucinations
paralysis Illusions
paresis memory impairment
pedaling
Somato auditory Autonomous Flushing
sensor gustatory symptoms hyperventilation
y olfactory hypoventilation
somatosensory nausea or vomiting
vestibular pallor
visual palpitations
 Investigations:
Aim at determining the type of seizures
1. Detailed history of the patient and family: illness or
head injuries that may have affected the brain,
hereditary, liver or renal disease
2. Complete physical assessment, Neurological
assessment
3. Blood tests : BUSE (Na decrease), liver function
test
4. Blood sugar decrease
5. Skull X-ray, CT Brain, EEG
Investigations:

Electroencephalography (EEG)
Presence of abnormal electric activity
Location of seizure focus
Type of seizure disorder
 Treatment
Anticonvulsants
Phenobarbital (Phenobarbitone)
Primidone
Carbamazepine-Tegretol
Sodium Valproate (Valproic Acid)-Epilim
Gabapentin
Vigabatrin
Phenytoin
Ethosuximide
Lamotrigine
Topiramate
Zonisamide
Benzodiazepines
acts by enhancing gamma-aminobutyric acid activity in the brain

Clonazepam

Diazepam

Midazolam

Nitrazepam
Cap: Dilantin( Phenyntoin Sodium)
Tab: Tegretol
Cap: Neurontin(Gabapentin)
Tab: Epilium( Sodium Valporate)
Tab: Lamictal(Lamotrigine)
Anticonvulsants – Characteristics
Controls seizure without impairing with normal
function of CNS.

Can’t cure seizure – can control.

Need to take at all times .

Nursing responsibilities:
Before administering
Check for any history of allergy to anticonvulsants.
E.g. Steven Johnson syndrome

Verify five Rights .

Anticonvulsant- Dilantin reaction
Steven Johnson Syndrome
 Nursing responsibilities cont:
While administering these drugs as IV, monitor patients respiration
and pulse.
Observe - CNS side effects like confusion, dizziness, slurred speech
and dimmed vision .
Following administration
Assist the patient while ambulating.
Maintain seizure chart
Nursing responsibilities
Health education
The exact dose .

Do not increase or decrease dosage.

Don’t discontinue anticonvulsants abruptly. severe recurrent

convulsions.
Nursing responsibilities
Health education
The drug should be withdrawn over a period.

No seizures for over 1 year with prophylactic,

gradual discontinuation of drugs.

Driving –free fits one year,

No heavy goods or public service vehicle

Nursing responsibilities
Health education
 Diving or swimming to be avoided.

 Beginning of the treatment- CNS symptoms decreased

mental alertness, drowsiness, vertigo and ataxia.

 Avoid hazardous activities .

 Lessen GI distress large amount of fluids after food.

 Avoid alcohol. increase the toxicity of the drug.

Nursing responsibilities
Health education
Dilantin - gingival hyperplasia-use soft toothbrush, massage gums,
and floss daily.

ID card with seizure note.

Operating machines- AVOID

 Nursing assessment
Document-Circumstances before attack; visual, auditory , tactile emotional
,sleep pattern , hyperventilation
Description of movement –Where stiffness started; type of movement;
parts involved; progression of movement; Whether the beginning was
witnessed .
Position of eyes and head; presence of automatisms like lip smoking or
repeated swallowing
Incontinence of urine or feces
Duration Presence of unconsciousness
Behavior after attack
Drug history-suddenly stop; change drug; increase dosage
 Nursing interventions during
seizure
1. Provide privacy and protect the patient from curious onlookers (the
patient who has an AURA may have time to seek a safe, private place.
2. Ease the patient to the floor if possible. Push aside clutters /any furniture
that may injure the patient during the seizure
3. Protect the head with a pad to prevent injury from striking a hard surface
4. Loosen constrictive clothing
5. if possible, place the patient on one side with the head flexed forward,
which allows the tongue to fall forward.
6. keep the patient on one side to prevent aspiration. Make sure the airway is
patent
7. If the patient is in bed remove pillows and raise side rails and pad side rails
Nursing Interventions During
seizures
8. Do not attempt to try open jaws that are
clenched in a spasm or to insert anything. Broken
teeth and injury to the lips and tongue may result
from such an action.

9. No attempt should be made to restrain the

patient during the seizure, because muscular
contractions are strong and restraint can produce
injury.
Nursing interventions after the
Seizures
There is usually a period of confusion after a Grand
Mal seizures, calm the patient , and orientate to
the environment
A short apneic period may occur during or
immediately after a generalized seizure
Nursing interventions after the
Seizures
1. The patient, on awakening should be orientated
to the environment

2. if the patient becomes agitated after a seizure

(post-ictal), use persuasion & gentle restraint to
assist him or her to stay calm
 Patient education
Check for triggers-skipped meals; lack of sleep;
emotional stress; menstrual cycle.
Importance of follow up medication regime . Don’t
skip;stop;change dose or change drug without the
physician consultation.
Medication side effects and precautions
Life style modification
Medic alert card /bracelet
Moderate life style-exercise, nutritional diet and mental
activity.
First aid for seizures