Seizure And Epilepsy Seizure And Epilepsy DisordersDisorders

ByBy

Dr. Hanan Said AliDr. Hanan Said Ali

ObjectivesObjectivesDefine Define a Seizure and epilepsy.a Seizure and epilepsy. Identify the Identify the aetiology of aetiology of a Seizure and a Seizure and

epilepsy.epilepsy. Describe the Describe the Pathophysiology of Pathophysiology of a a

Seizure and epilepsy.Seizure and epilepsy. Identify the Identify the Clinical Manifestations of Clinical Manifestations of a a

Seizure and epilepsy.Seizure and epilepsy. Mention the Mention the treatment oftreatment of a Seizure a Seizure

and epilepsy.and epilepsy. Identify the Initial Nursing InterventionsIdentify the Initial Nursing Interventions

Seizure And Epilepsy Seizure And Epilepsy DisordersDisorders

A SeizureA Seizure Is a paroxysmal, uncontrolled electrical Is a paroxysmal, uncontrolled electrical

discharge of neurons in the brain that discharge of neurons in the brain that interrupts normal functions.interrupts normal functions.

They may accompany a variety of disorders, They may accompany a variety of disorders, or they may occurs spontaneously without or they may occurs spontaneously without any apparent cause.any apparent cause.

EpilepsyEpilepsy Is a condition in which a person has Is a condition in which a person has

spontaneously recurring seizures caused by spontaneously recurring seizures caused by chronic underlying conditionschronic underlying conditions..

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

AetiologyAetiology In first 6 months of lifeIn first 6 months of life Severe birth injury , congenital Severe birth injury , congenital

defects , involving the CNS infection defects , involving the CNS infection and inborn errors of metabolism.and inborn errors of metabolism.

In clients between 2 and 20 years of In clients between 2 and 20 years of ageage

Birth injury , infection, trauma, and Birth injury , infection, trauma, and genetic factorsgenetic factors

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Aetiology Cont.Aetiology Cont. In individuals between 20- 30 years of In individuals between 20- 30 years of

ageage Structural lesions, such as trauma, brain Structural lesions, such as trauma, brain

tumours or vascular disorderstumours or vascular disorders

After 50 years of ageAfter 50 years of age Cerebrovascular lesions and metastatic Cerebrovascular lesions and metastatic

brain tumoursbrain tumours

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

PathophysiologyPathophysiology A seizure can caused by any process that A seizure can caused by any process that

disrupts the cell membrane stability of a neuron.disrupts the cell membrane stability of a neuron.

The point at which the cell membrane becomes The point at which the cell membrane becomes destabilized and an uncontrolled electrical destabilized and an uncontrolled electrical discharge discharge begins is known as seizures discharge discharge begins is known as seizures threshold.threshold.

People have lower seizures threshold, more People have lower seizures threshold, more prone to seizureprone to seizure..

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Pathophysiology Cont.Pathophysiology Cont.The area of the brain from which the The area of the brain from which the

epileptic activity arises is found to have epileptic activity arises is found to have scar tissuesscar tissues

The scaring is thought to interfere with The scaring is thought to interfere with the normal chemical and structural the normal chemical and structural environment of the brain neurons, environment of the brain neurons, making them more likely to fire making them more likely to fire abnormally.abnormally.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Clinical ManifestationsClinical ManifestationsThe major categories are partial (focal) The major categories are partial (focal)

generalized and unclassified.generalized and unclassified.

Subdivisions based on the person's Subdivisions based on the person's behaviourbehaviour

1- 1- Ictal Ictal refers to the time during the seizurerefers to the time during the seizure

2- 2- Interictal Interictal refers to the time between seizure refers to the time between seizure activity.activity.

3- 3- PostictalPostictal refers to the time immediately after refers to the time immediately after a seizure as the client recovers a seizure as the client recovers

Seizure And Epilepsy Disorders Cont.Seizure And Epilepsy Disorders Cont.

Clinical Manifestations Cont.Clinical Manifestations Cont.

Partial seizuresPartial seizuresSimple partial seizuresSimple partial seizures, no , no

impairment of consciousness, impairment of consciousness, twitching of extremity, speech twitching of extremity, speech arrest, speciral visual sensations arrest, speciral visual sensations (e.g. Seeing lights), feeling of fear (e.g. Seeing lights), feeling of fear or doomor doom

There is no postictal state.There is no postictal state.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders ContCont..Clinical Manifestations Cont.Clinical Manifestations Cont.

Partial seizuresPartial seizuresComplex partialComplex partial, is a simple partial , is a simple partial

siezure with progression to impairment siezure with progression to impairment of consciousness.of consciousness.

It begin as simple partial and progress It begin as simple partial and progress to complex.to complex.

It include lipsmacking, chewing, or It include lipsmacking, chewing, or picking at clothespicking at clothes

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Clinical Manifestations Cont.Clinical Manifestations Cont.

Partial seizuresPartial seizuresComplex partial generalized to Complex partial generalized to

generalized tonic- clonic seizures .generalized tonic- clonic seizures .

It begins as complex partial, then It begins as complex partial, then progress to tonic- clonic as in progress to tonic- clonic as in generalized seizures.generalized seizures.

Postictal state present.Postictal state present.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Clinical Manifestations Cont.Clinical Manifestations Cont.

Generalized seizuresGeneralized seizures

Impair consciousness from the start.Impair consciousness from the start. Absence seizures:Absence seizures: Do not include motor signs and may Do not include motor signs and may

last less than 1- minute.last less than 1- minute. There will be brief loss of There will be brief loss of

consciousness, staring, unresponsive consciousness, staring, unresponsive and no postictal state.and no postictal state.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Clinical Manifestations Cont.Clinical Manifestations Cont.

Generalized seizuresGeneralized seizures Tonic- clonic seizuresTonic- clonic seizures

It involves rhythmic jerking of muscles, It involves rhythmic jerking of muscles, possibly tongue biting and urinary and possibly tongue biting and urinary and fecal incontinence.fecal incontinence.

Atonic seizuresAtonic seizures, there will be , there will be impairment consciousness for only few impairment consciousness for only few seconds and brief loss of muscle tone, seconds and brief loss of muscle tone, which may cause client to fall or dropwhich may cause client to fall or drop

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Clinical Manifestations Cont.Clinical Manifestations Cont.

Generalized seizuresGeneralized seizures Myoclonic seizuresMyoclonic seizures, , There will be impaired There will be impaired

consciousness for few seconds or not at all consciousness for few seconds or not at all and brief jerking of muscle group which may and brief jerking of muscle group which may cause the client to fall.cause the client to fall.

Status epilepticalStatus epilepticalIs an episode of seizures activity lasting at Is an episode of seizures activity lasting at

least for 30 minutes or repeated seizures least for 30 minutes or repeated seizures without full recovery between seizureswithout full recovery between seizures

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders

ContCont..DiagnosisDiagnosis History including the risk factors.History including the risk factors. Physical examinationPhysical examination Diagnostic tests (EEG, CT, MRI, PET)Diagnostic tests (EEG, CT, MRI, PET)

TreatmentTreatment

1- Hydantoin (phenytoin- Dilantin)1- Hydantoin (phenytoin- Dilantin) These blocks potentiation and propagation of These blocks potentiation and propagation of

electrical dischargeelectrical discharge It take as 10-20 mg/LN.saline at least 7-14 daysIt take as 10-20 mg/LN.saline at least 7-14 days

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

It is important to monitor side effects as It is important to monitor side effects as ataxia, fatigue, drowsiness and GIT ataxia, fatigue, drowsiness and GIT disturbance as, nausea, anorexia, disturbance as, nausea, anorexia, vomiting.vomiting.

2- Barbiturates (phenobarbitol- Luminal)2- Barbiturates (phenobarbitol- Luminal)Used to manage tonic- clonic, simple Used to manage tonic- clonic, simple

partial, and complex partial seizures and partial, and complex partial seizures and statuse epilepticus.statuse epilepticus.

The nurse has to monitor side effect as The nurse has to monitor side effect as sedation, drowsiness and depression.sedation, drowsiness and depression.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders

ContCont..3- Succinimides3- Succinimides It raises threshold to stimuli used to It raises threshold to stimuli used to

manage absence seizures.manage absence seizures.

4- Others4- Others

Carbamazepine (Tegretol)Carbamazepine (Tegretol) It blocks synaptic potentiation.It blocks synaptic potentiation.

Valpord acid (Depakene)Valpord acid (Depakene)Used to manage absence seizures.Used to manage absence seizures.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Emergency Management of Tonic- Clonic S.Emergency Management of Tonic- Clonic S.

Assessment FindingAssessment FindingAura- Peculiar sensation ( Symptoms) Aura- Peculiar sensation ( Symptoms)

that precedes seizures.that precedes seizures.Loss of consciousness.Loss of consciousness.Bowel and bladder incontinence.Bowel and bladder incontinence.Tachycardia, Diaphoresis, Warm skin.Tachycardia, Diaphoresis, Warm skin.Pallor, flushing or cyanosis.Pallor, flushing or cyanosis.Tonic phase – Continuous muscle Tonic phase – Continuous muscle

contraction. contraction.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont. Hypertonic phase – extreme muscular rigidity Hypertonic phase – extreme muscular rigidity

lasting 5 to 15 seconds.lasting 5 to 15 seconds.

Clonic phase – rigidity and relaxation alternate Clonic phase – rigidity and relaxation alternate in rapid succession.in rapid succession.

Postical phase – Lethargy, altered level of Postical phase – Lethargy, altered level of consciousness.consciousness.

Confusion and headache.Confusion and headache. Repeated tonic clonic seizure for several Repeated tonic clonic seizure for several

minutes.minutes.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders ContCont..

Initial Nursing InterventionsInitial Nursing InterventionsEnsure client airway.Ensure client airway.Assist ventilation if client does not breath.Assist ventilation if client does not breath.Suction as neededSuction as neededStay with client until seizures have Stay with client until seizures have

passed.passed.Protect client from injury during seizures. Protect client from injury during seizures.

Do not restrain . Bed side rails .Do not restrain . Bed side rails .Remove or loosen tight clothing.Remove or loosen tight clothing.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Initial Nursing Interventions ContInitial Nursing Interventions Cont..Monitor vital signs ( avoid using glass Monitor vital signs ( avoid using glass

thermometer) , Loc, O2 saturation , GCS thermometer) , Loc, O2 saturation , GCS , pupil size and reactivity., pupil size and reactivity.

Reassure and orient the client after Reassure and orient the client after seizures.seizures.

Never force an airway between a Never force an airway between a patient’spatient’s

Clenched teeth.Clenched teeth.Give dextrose for hypoglycaemia.Give dextrose for hypoglycaemia.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Guidelines to help nurse to care of Guidelines to help nurse to care of status epilepticus.status epilepticus.

Protect airway and provide oxygen.Protect airway and provide oxygen.

Establish IV access for medication Establish IV access for medication and fluids.and fluids.

Draw blood for electrolytes, ABG.Draw blood for electrolytes, ABG.

Seizure And Epilepsy Disorders Seizure And Epilepsy Disorders Cont.Cont.

Guidelines to help nurse to care of status Guidelines to help nurse to care of status epi.epi.

Administer lorazepam (Ativan) 4 to 8 Administer lorazepam (Ativan) 4 to 8 mg over 2 to 4 minutes or diazepam mg over 2 to 4 minutes or diazepam (valium) 5 to 20 mg over 5 to 10 (valium) 5 to 20 mg over 5 to 10 minutes to stop seizures.minutes to stop seizures.

Administer anticonvulsants usually Administer anticonvulsants usually phenytoin 15 to 20 mg/ kg in normal phenytoin 15 to 20 mg/ kg in normal saline at 50 mg/ minsaline at 50 mg/ min

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