Seizures

Seizures

1. What is a seizure?

   • Caused by abnormal or uncontrolled neuronal discharges that can stay in one area or spread to other areas of the brain
   • Convulsion refers to the involuntary, violent spasms of the large skeletal muscles
     • Not all seizures have convulsions
   • Triggers include strobe/flickering lights or the occurrence of small fluid & electrolyte imbalances.
     • Occurs more often when pt. is sleep deprived
   • Known causes:
     • Infectious disease, such as meningitis and encephalitis
       • Trauma:
         • 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
         • Direct blows to the skull causing brain sweling
         • Presence of toxic substances, ingestion of poison (chemical trauma)

2. Effects on life

   • Antiseizure drugs decrease effectiveness of birth control
   • Moat antiseizure drugs are pregnancy category D
   • Eclampsia is severe pregnancy hypertension. Some women will have seizures within 72 hours after delivery
     • Nagnesium sulfate, for whatever reason, treats eclamptic seizures
   • Epileptics cannot drive.
     • Seizures can limit participation in school, employment, and social activity.
       • Chronic depression can result
         • Nursing care includes identifying at risk patients, documenting pattern and type of seizure, and implementing safety precautions

3. Types

   • Determining cause of recurrent seizures is important for appropriate drug selection
   • Partial
     • Simple
       • Hallucinations; intense emotion; twitching of arms, legs, and fingers
     • Complex
       • Aura before seizure' confusion or sleepiness after seizure; attempting to remove clothes; not responding to verbal commands
   • Generalized
     • Absence (petit mal)
       • Lasts a few secs; starting into space and not responding to commands
         • Seen most often in children
           • May be misdiagnosed as ADHD or daydreaming
     • Atonic (drop attacks)
       • Falling/stumbling for no reason; lasts a couple secs
     • Tonic-clonic (grand mal)
       • Preceding aura
         • 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
   • Special
     • Febrile
       • Tonic-conic activity lasting 1-2 min; rapid return to consciousness.
         • Mostly in children btwn 3 months & 5 yrs old
     • Myoclonic
       • Large jerking movement of major muscle group; falling from sitting or dropping object being held
     • Status epilepticus
       • Continuous seizure activity that can lead to coma & death
         • Medical emergency