Seizure

Seizure/epilepsy

1. Seizure Disorders BY: Ekta S Patel Assistant Professor

2. DEFINITION Seizures are sudden, abnormal electrical discharges from the brain that result in changes in sensation, behavior, movements, perception, or consciousness . Epilepsy is a chronic disorder of recurrent seizures . An isolated , single seizure does not constitute epilepsy.

3. An epileptic syndrome consists of recurrent episodes of one or more of the following manifestations: Loss of consciousness. Convulsive movements or other motor activity. Sensory phenomena . Behavioral abnormalities.

4. ETIOLOGY Epi l ep s y oc c u r s when per m ane n t c han g es i n t he brain cause it to be too excitable or irritable. As a r e s ult , the b r a in sen d s ou t a b norm al sig n a ls . This leads to repeated unpredictable seizures .

5. Epilepsy may be due to a medical condition or injury that affects the brain or the cause may be unknown. The common causes for epilepsy include: Stroke or TIA. Dementia (like Alzheimer’s disease).

6. Traumatic brain injury. Infections including brain abscess, meningitis, encephalitis, and HIV/AIDS . Brain problems that are present at birth (congenital birth defects). Brain injury that occurs during or near birth.

7. Metabolism disorders present at birth ( phenylketonuria ). Brain tumor. Abnormal blood vessels in brain. Other illness that damages or destroys brain tissue.

8. Pathophysiology

9. CLINICAL MANIFESTATIONS Epilepsy may be classified according to age of onset, cause, area of origin, abnormalities on EEG, and clinical manifestations of seizures .

10. According to the International classification of Epileptic seizures , based on clinical seizure type and on EEG findings during seizures ( the ictal period) and between seizures (the interictal period). There are two major categories: PARTIAL SEIZURES: the neurologic abnormality may be limited to a specific part or focus of brain. GENERALIZED SEIZURES: additionally the seizure may involve the entire cortical surface (cerebral cortex).

11. 1. Partial seizures: Simple Partial seizures. Complex partial seizures. 2. Generalized seizures: Absence seizure. Myoclonic seizure. Clonic seizure. Tonic seizure. Generalized tonic-clonic seizure. Atonic seizure.

12. Depending on the types, a seizure may progress through several phases: The prodromal phase (with signs or activity which precede a seizure). The aural phase , with a sensory warning (aura is an unusual sensations of smell / taste/ butterflies in stomach / feeling of opposite or unfamiliar and intense feeling). The ictal phase (with full seizure). The postictal phase (period of recovery after seizure).

13. 1. Partial seizures (focal origin): These are most common type of epilepsy . The first clinical & electroencephalographic changes indicate initial activation of neurons in one part of cerebral hemisphere .

14. n o i m pai r me n t of consciousness It has 4 types that do not impair consciousness. I. Simpl e part i al s ei z u r es

15. I. Motor manifestations : These arise from a focus in motor cortex .

16. Because the hand and fingers have largest cortical representations , many focal motor seizures begin with convulsive movement in the upper extremity. Involuntary movements may spread centrally & involve the entire limb, including one side of face & lower extremity. This progression or spread is known as the ‘’ Jacksonian march’’. The client also may exhibit changes in posture or spoken utterances

17. II. Somato-sensory manifestations: If the epileptogenic focus is in the parietal region the client experiences sensory phenomena such as numbness & tingling in the affected area. If the focus is in the occipital region, the client may experience bright, flashing lights in the field of vision opposite the side of focus.

18. Likewise the client can have changes in speech or taste with involvement of the posterior temporal area of dominant hemisphere .

19. III. Autonomic manifestations: – Seizures of the autonomic system produce epigastric sensations, pallor sweating, flushing (being red face), piloerection/goose flesh ( involuntary erection or bristling of hairs ), pupillary dilation, tachycardia, and tachypnea .

20. However abnormality may be subtle (tough in perceiving) and detected only by a trained observer. This type usually last 2-3 minutes but can last up to 15 minutes. Th e cli e n t i s usuall y u n a w a r e o f a n y acti v ity durin g t h e seizure and may be confused or drowsy postictally. Attempts to restrain (control) the client during a seizure may induce combative and un-cooperative behavior.

21. II. P artia l s e i z ure s e v o l ving t o s e c o n da r y g enera l i z ed seizures : These seizures start from a particular focus , & then the electrical discharges spread throughout the brain . Clinically , the client first shows focal manifestations; for example : one side of the face moves , and then the whole body becomes involved . Consciousness is lost if the discharges spread throughout the brain.

22. 2. Generalized Seizures: These seizures lead to a loss of consciousness . They can be convulsive or non convulsive. Generalized seizures involve both hemispheres. About one third of seizures are generalized.

23. Thes e a r e ab r up t period s of st aring a n d l a p s e s of awareness lasting a few seconds to a few minutes. 1. Absence seizures :

24. 2) Myoclonic seizures : These types involves sudden uncontrolled jerking movements of either a single muscle group or multiple groups, sometimes causing the client to fall. The client loses consciousness for a moment and then is confused postictally. These seizures often occur in morning. Clients often report that they spill their coffee with their seizures.

25. 3) Clonic seizures: The clinical manifestations of clonic seizures include rhythmic muscular contraction & relaxation lasting several minutes. Distinct phases of clonic seizures are not easily observed.

26. 4) Tonic seizures : These include an abrupt increase in muscular tone & muscular contraction. In addition with tonic seizures there is a loss of consciousness and the presence of autonomic manifestations. Tonic seizures may last from 30 seconds to several minutes.

27. Generalized tonic clonic seizures : (10%) Formerly known as ‘’grandmal’’ seizures. T on i c cl o ni c sei z u r es a r e the t y p e of sei z u r es m o s t closely associated with epilepsy .

28. The client is usually incontinent and may bite the lips , tongue , or inside of the mouth. Excessive saliva is blown from the mouth, which creates frothing at lips.

29. An entire tonic clonic phase seizure may last from 2-5 minutes, after which the client enters the postictal phase, during which the client relaxes & remains totally unresponsive for a time. The client may rouse (awake) briefly & then go into a postictal sleep lasting 30 minutes to several hours. This sleep may be followed by general fatigue, depression , confusion , or headache , all of which gradually resolve.

30. The client has complete amnesia for the seizure episode and may feel nauseated, stiff, and sore. Bruising may occur as the result of falls. Petechial hemorrhages may develop on the face & chest due to vasovagal responses (development of inappropriate cardiac slowing and arteriolar dilatation ).

31. The tonic clonic seizure vary in frequency from many times daily to once or twice a year. Tonic only and clonic only seizure may also occur.

32. 6) Atonic seizures : These are associated with a total loss of muscle tone. They may be mild, with the client briefly nodding the head (a gesture in which the head is tilted in alternating up and down arcs ), or the client may fall to the floor. Consciousness is impaired only briefly.

33. COMPLICATIONS Fracture of bone. Impair intelligence. Socially stigmated. Reduced quality of life. A complication called ‘’sudden unexpected death in epilepsy’’.

34. MANAGEMENT Go a ls of mana g eme n t of clie n ts wi t h se i z u r es and epilepsy are To prevent injury during seizures, To eliminate factors that precipitate seizure, and To control seizures to allow a desired lifestyle.

35. During the seizures the major goals are : To maintain the airway. To prevent injury to client. To observe the seizure activity. To administer appropriate anticonvulsant drugs .

36. In a hospi t al s e t t i n g , s uct i o n equipme n t sh o ul d be readily available. T h e pe r s o n e x per i encing a sei z u r e us u al l y r equi r es protection from the environment. Objects should be moved out of the way so that the client does not strike his/her head or extremities.

37. Any tight clothing around the person’s neck is loosened. Put a pillow or folded blanket under the affected person’s head, but not flex the neck sharply or close the airway. Turning the client to his/her side displaces the tongue and usually opens the airway once the tonic phase has ceased. Do not attempt to open the airway with your fingers. A jaw thrust maneuver (head tilt - chin lift) will open the airway without the potential to harm the client or the caregiver.

38. The factors that precipitate seizure should be eliminated , if possible. Eating a balanced diet, restricting excessive cafeine and alcohol intake, sleeping well, avoiding seizure triggers ( means initiations ) (ex.- flashing lights), and minimizing emotional stress may be helpful in preventing seizures. Observer’s descriptions of a seizure can be helpful in making a diagnosis. Instruct the family & unlicensed assistive personnel to make the following observations:

39. How long did the seizure last ? Where in the body did the seizures begin and how did it progress? Did the client’s eyes or head deviate? Were the respirations labored or frothy? Was the client incontinent? Did the client lose consciousness? Wh a t w e r e the t ypes of mo v eme n ts and wh a t body parts moved ?

40. Medications are used to control seizures : Currently available anti-epileptic drugs appear to act primarily by blocking the initiation or spread of seizures. Ex. Phenytoin , Fosphenytoin sodium , Carbamazepine, Valproic acid , Lamotrigine. ( thes e i n hib i t s o diu m- depen d e n t action po t e n t i a l s, blocking the burst and firing of neurons).

41. Assessment. Nursing Diagnosis. Risk for trauma related to loss of large or small muscle co-ordination as evidenced by abnormal body spasm. Risk for ineffective airway clearance related to tracheo-bronchial obstruction as evidenced by oral secretions. Low self esteem or situational low self -esteem related to stigma associated with condition as evidenced by verbalization about changed lifestyles. NURSING MANAGEMENT: e x posu r e and u n f amiliari t y with r esou r c es – K n o wl e d g e d e f i cie n t / d e fici t r el at e d t o lack of as evidenced by questions & statement of concerns.

42. Goals: Seizures activity control. Complications or injury prevented. Disea s e p r oce s s o r p r ogn o sis , t h e r a p eutic r egim e n , and limitations understood. Plan in place to meet needs after discharge. Interventions: Nurse has to set the action priorities: Prevent or control seizure activity. Protect patient from injury. Maintain airway or respiratory function. Promote positive self-esteem. Provide information about disease process, prognosis, and treatment needs.

43. REFRENC E S Black JM, Hawks JH, A textbook of Medical Surgical Nursing , 8 th Edition, 2 nd Volume, Published by Saunders Publication, Page No. 1811. Chintamani, A textbook of Lewis’s Medical Surgical Nursing : Assessment & Management of Clinical Problems , Published by Mosby publication, Page no. 1498. Research refrence: http://journals.lww.com/cancernursingonline/Abstract/2005/07000 /Symptom_Clusters Concept_Analysis_and_Clinical.5.aspx https://nurseslabs.com/4-seizure-disorder-nursing-care-plans/ https://medlineplus.gov/ency/article/000694.htm http://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve- disorders/seizure-disorders/seizure-disorders

44. Thank-you