Seizure

m.sc. nursing

1. SEIZURE PREPARED BY Ms.Mahalakshmi. L M.Sc Nursing 2 nd Year

2. INTRODUCTION Seizure is a common neurological condition . A seizure occurs when the function of electrical system of bra i n disturb. Seizures occurs at any time or any place like during rest or work.

3. DEFINITION SEIZURE A sudden involuntary, time limited alteration in behavior , motor activity , autonomic function, consciousness, or sensation, accompanied by an abnormal electrical discharge in the brain.

4. Epilepsy A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsion , associated with abnormal electrical activity in the brain.

5. EPIDEMIOLOGY It is estimated that 1 is 26 people will develop epilepsy during his or her lifetime. The incidence of single unprovoked seizures 23-62 cases per 1,00,000 persons-years, while the incidences of acute symptomatic seizure is 29-39 cases per 1,00,000 population per year.

6. Causes CAUSES NEONATE Hypoxic ischemic encephalopathy Brain bleeds Infection Hypoglycemia Ischemic stroke

7. CHILDREN Febrile seizure Other reason Infections metabolic disorder Drugs Poisons Bleeding inside the brain

8. Adult Abnormal level of sodium or glucose in the blood Brain infection, including meningitis and encephalitis Brain injury Electric shock Vascular disease Idiopathic

9. RISK FACTOR A family history of seizure disorders Any injury to the brain from trauma, a stroke, previous infection and other causes Sleep deprivation Medical problems that affect electrolyte balance Heavy alcohol abuse Vascular disease Seizure in childhood

10. Types

11. Types of seizure Partial seizure Begins with an electrical discharge in one limited area of the brain Related to head injury , brain infection , stroke or tumor

12. SIMPLE PARTIAL SEIZURE Affect only a small region of the brain, often the temporal lobes and/or hippocampi. People who have simple partial seizures retain consciousness . Usually last for less then 2 mins .

13. Signs and symptoms MOTOR SEIZURE br i e f m u s cle c o n t r a c tio n s ( t wi t chin g , jerki n g , or s t i f f eni n g ), of t en beginning in the face, finger, or toe on one side of the body. twitching or jerking spreads to other parts of the body on the same side near the initial site. other motor seizures may involve movement of the eye and head. the seizure begins the same way each time. the patient remains conscious.

14. SENSORY SEIZURES seeing something that is not there, such as shapes or flashing lights, or seeing something as larger or smaller than usual hearing or smelling something that is not there feeling of pins and needles or numbness in part of the body the patient remains conscious.

15. PSYCHIC SEIZURES problems with memory garbled speech sudden emotions f o r n o appa r e n t r easo n s uc h as fear, depression, rage, or happiness.

16. COMPLEX PARTIAL SEIZURE May involve the unconscious repetition of simple actions, gestures or verbal utterances, or simply a blank stare and apparent unawareness of the occurrence of the seizure, followed by no memory of the seizure.

17. Signs and symptoms of complex seizure warning sign such as a feeling of fear or nausea loss of awareness confusion after the seizure loss of memory about events just before or after the seizure . Screaming or thrashing, either from sleep or while awake Aut om a tisms s u c h as m o ut h m o v eme n t s , p i ck i ng clothing, repeating words or phrases

18. GENERALIZED SEIZURE Begins with a widespread electrical discharge. Involves both side of the brain at once. Hereditary factor are important

19. ABSENCE SEIZURES involve an interruption to consciousness where the person experiencing the seizure seems to become vacant and unresponsive for a short period of time (usually up to 30 seconds). Slight muscle twitching may occur.

20. Signs and symptoms staring The patient suddenly stops what she is doing a few seconds of unresponsiveness (usually less than 10 seconds, but it can be up to 20 seconds) that can be confused with daydreaming no response when you touch your child The patient is alert immediately after the seizure The patient may have many seizures per day

21. Less common features include: repetitive blinking eyes rolling up head bobbing automatisms such as licking, swallowing, and hand movements aut ono m ic s ym p t o m s s u c h as d i l a t ed p u p i ls, fl u s hin g , pal l o r , r apid heartbeat, or salivation

22. MYOCLONIC SEIZURES involve an extremely brief (< 0.1 second) muscle contraction and can result in jerky movements of muscles or muscle groups.

23. Signs and symptoms one or many brief jerks, which may involve the whole body or a single arm or leg in juvenile myoclonic epilepsy, these jerks often occur upon waking the patient remains conscious

24. Clonic seizure Myoclonus that are regularly repeating at a rate typically of 2-3 second.in some cases , the length varies.

25. ATONIC SEIZURES involve the loss of muscle tone, causing the person to fall to the ground. These are sometimes called 'drop attacks' but should be distinguished from similar looking attacks that may occur in cataplexy.

26. Signs and symptoms sudden loss of muscle tone the patient goes limp and falls straight to the ground The patient remains conscious or has a brief loss of consciousness eyelids droop, head nods jerking the seizure usually lasts less than 15 seconds, although some may last several minutes the patient quickly becomes conscious and alert again after the seizure

27. Tonic seizure Usually last for less than 20 sec. In such seizure the tonic is greatly . Increase and the body , arms or legs marken sudden stiffening movements. Increase muscle on of extensor muscles. Conscious is usually preserved. Seizure must often occur during sleep usually involves all or most of the brain , affecting both side of the body

28. TONIC – CLONIC SEIZURES involve an initial contraction of the muscles ( tonic phase ) which may involve tongue biting, urinary incontinence and the absence of breathing. This is followed by rhythmic muscle contractions ( clonic phase ). This type of seizure is usually what is referred to when the term 'epileptic fit' is used colloquially

29. Signs and symptoms the patient cries out or groans loudly the patient loses consciousness and falls down in the tonic phase, the child is rigid, her teeth clench, her lips may turn blue because blood is being sent to protect her internal organs, and saliva or foam may drip from her mouth; she may appear to stop breathing because her muscles, including her breathing muscles, are stiff heart rate and blood pressure rise sweating tremor

30. in the clonic phase, the patient resumes shallow breathing; her arms and legs jerk quickly and rhythmically; her pupils contract and dilate at the end of the clonic phase, the child relaxes and may lose control of her bowel or bladder following the seizure, the child regains consciousness slowly and may appear drowsy, confused, anxious, or depressed

31. PATHOPHYSIOLOGY Seizure producing stimuli( trauma,highfever,brain injury ) a small group of abnormal neurons undergo prolonged depolarizations associated with the rapid firing of repeated action potentials .

32. These abnormally discharging epileptic neurons recruit adjacent neurons or neurons with which they are connected into the process the electrical discharges of a large number of cells become abnormally linked together creating a storm of electrical activity in the brain

33. Seizures may spread to involve adjacent areas of the brain or through established anatomic pathways to other distant areas

34. COMPLICATION Status epilepticus Social challenges anxiety

35. DIAGNOSTIC EVALUATION 1. HISTORY 2. PHYSICAL EXAMINATION 3 . NEUROLOGICAL EXAMINATION 4.BLOOD TESTS 5.ELECTROENCEPHALOGRAM

36. 6.CT SCAN 7.MAGNETIC RESONANCE IMAGING 8.FUNCTIONAL MRI (FMRI) 9.POSITRON EMISSION TOMOGRAPHY 10.SINGLE-PHOTON EMISSION COMPUTERIZED TOMOGRAPHY 11.NEUROPSYCHOLOGICAL TESTS

37. MANAGEMENT OF SEIZURE

38. NON-PHARMACOLOGICAL MANAGEMENT

39. KETOGENIC / LOW CARBOHYDATE DIET VAGAL NERVE STIMULATION (VNS)

40. SURGICAL MANGEMENT

41. Temporal lobe resection Lesionectomy Functional Hemispherectomy Corpus Callosotomy Extratemporal Cortical Resection

42. NURSING DIAGNOSIS Ineffective airway clearance related to obstruction of airway by secretions as evidenced by dyspnea Ineffective tissue perfusion related to seizure activity as evidenced by decreased oxygen saturation Risk for injury related to seizure activity Ineffective coping related to psychosocial & economic consequences of epilepsy as evidenced by patient is uncooperating

43. JOURNAL Incidence , Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants.

44. Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life ( QoL ), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA .

45. Results: A total of 292 patients (mean age 40.8 years, range 18–86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations ( n = 18, 6.2%), abrasions and bruises ( n = 9, 3.1%), fractures ( n = 6, 2.2%) and burns ( n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic- clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL . Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.