Seizures

Seizures

What is a seizure?
1. Caused by abnormal or uncontrolled neuronal discharges that can stay in one area or spread to other areas of the brain
2. Convulsion refers to the involuntary, violent spasms of the large skeletal muscles
  1. Not all seizures have convulsions
3. Triggers include strobe/flickering lights or the occurrence of small fluid & electrolyte imbalances.
  1. Occurs more often when pt. is sleep deprived
4. Known causes:
  1. Infectious disease, such as meningitis and encephalitis
    1. Trauma:
      1. Metabolic disorders causing hypoglycemia, hyponatremia, and water intoxication
        Vascular disease
        Changes in oxygenation caused by respiratory hypoxia or CO poisoning
        Changes in perfusion caused by things like hypertension, stroke, shock, and cardiac dysrhythmia
        Pediatric disorders
        Rapid increases in body temp causing febrile seizures
        Neoplastic disease
        Tumors, especially rapidly growing ones, occupy space and increase intracranial pressure
      2. Direct blows to the skull causing brain sweling
      3. Presence of toxic substances, ingestion of poison (chemical trauma)
Effects on life
1. Antiseizure drugs decrease effectiveness of birth control
2. Moat antiseizure drugs are pregnancy category D
3. Eclampsia is severe pregnancy hypertension. Some women will have seizures within 72 hours after delivery
  1. Nagnesium sulfate, for whatever reason, treats eclamptic seizures
4. Epileptics cannot drive.
  1. Seizures can limit participation in school, employment, and social activity.
    1. Chronic depression can result
      1. Nursing care includes identifying at risk patients, documenting pattern and type of seizure, and implementing safety precautions
Types
1. Determining cause of recurrent seizures is important for appropriate drug selection
2. Partial
  1. Simple
    1. Hallucinations; intense emotion; twitching of arms, legs, and fingers
  2. Complex
    1. Aura before seizure' confusion or sleepiness after seizure; attempting to remove clothes; not responding to verbal commands
3. Generalized
  1. Absence (petit mal)
    1. Lasts a few secs; starting into space and not responding to commands
      1. Seen most often in children
        May be misdiagnosed as ADHD or daydreaming
  2. Atonic (drop attacks)
    1. Falling/stumbling for no reason; lasts a couple secs
  3. Tonic-clonic (grand mal)
    1. Preceding aura
      1. Intense muscle contraction (tonic phase), followed by alternating contraction and relaxation (clonic phase)
        Crying at beginning; loss of bowel/bladder control; shallow breathing w/periods of apnea
        1-2 minutes
        Disorientation & deep sleep after seizure
4. Special
  1. Febrile
    1. Tonic-conic activity lasting 1-2 min; rapid return to consciousness.
      1. Mostly in children btwn 3 months & 5 yrs old
  2. Myoclonic
    1. Large jerking movement of major muscle group; falling from sitting or dropping object being held
  3. Status epilepticus
    1. Continuous seizure activity that can lead to coma & death
      1. Medical emergency

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