SEIZURES
Ecessive neuron discharge
Alteration in membrane potential
Abnormal cells (epileptic focus)
Any with a CNS imbalance can have seizures
Though tto be genetic
Risk Factors: tumors, vascular d/o, alcohol or drug withdrawal, brain trama, e- imbalance, AV
malformations, infections, systemic diseases, uremia, acid/base imbalance, low sodium, heavy metal
poisoning
S/S
Aura: sight, smell, sound, or taste (parietal, occipital have auras)
-same every time
Involuntary movements
Often related to temporal lobe seizures or complex partial seizures
Autonomic sx- d/t stimulation of autonomic nervous system
-pupil dilation, diaphoresis, etc
Post ictal period: flaccid extremities, lethargic or unresponsive for up to several hrs
Differential dx: is this seizure related to a dysrhythmia?
Syncope related to dysrhythmia
v-tach: looks like seizure
vasovagal response
narcolepsy
night terrors or somnambulism
panic or rage attack
psychogenic symptoms (pseudo-seizures)
D41138722
Jubiny@10311992
TIA
Migraine
Triggers: flashing lights, music, odors, fatigue, stress, illness, fever, menstrual cycle ASK PATIENT WHAT
TRIGGERS IT
Simple/partial (focal)-: comes from one side of the brain
Focal motor: (“marching/jacksonian” or tonic-clonic movement from upper or lower limb) arises from
motor strip
somatosensory- tingling of contralateral limb, face, or side of body (sensory strip)
Autonomic-temporal/posterior frontal lobe-- fight or flight symptoms: sweating, flushing, pallor,
epigastric
Visual: occipital lobe: flashing lights, unilateral or bilateral blurring, scotomas ( blind spot or partial
loss of vision in what is otherwise a perfectly normal visual field)
Motor strip- facial grimacing
Contraversive-head and eyes turned to opposite side (either side of frontal lobe)
Auditory- ringing or hissing noises- temporal lobe
Psychic (temporal)-distorted memory, time, déjà vu, hallucinations, frequently turns into complex partial
EEG will have discharge sin limited regoin
STUDY FOR EXAM- chart below
KNOW FOR EXAM: LOBULAR
Lobular seizures:
FRONTAL: simple or complex, inappropriate behaviors, short length
TEMPORAL: automatisms, psychic sx, olfactory or auditory hallucinations
PARIETAL: complex that may progress to generalized, usually have auras, visual or auditory
hallunications
OCCIPITAL: visual auras, visual hallucinations, abnormal eye movements
Complex partial:
Impairment of consciousness, not wakefulness- not conscious but can be woken ; cognitive, affective
sx-dreamy state; blak vacant expression, déjà vu, jamais vu (forget people they know), or fear
Psychomotor phenomena: chewing, wetting lips, autonomism (picking at cothing)
Dysphagia
Formed auditory hallucinations- hears music, etc
Formed visual hallucinations-sees house, trees that aren’t there
Olfactory hallucinations- bad or unusual smell
Can become more complex
Involves involuntary motor activities (automatisms)
Paranoia, aggression
May be confused with psychosis
EEG: 2-4Hz spike waves (don’t have to know)
Generalized: involves both hemispheres
-absence: petit mal- affects kids- staring, eye flutter, lasts 3-30 secs and may happen 100x a day
-myoclonic: sporadic jerking or muscle contractions, isolated to one area, seen in encephalopathy
-clonic: bilateral rhythmic movement followed by relaxation, eyes roll backward, frothing of mouth,
head turning to one side (look at eye to see where they move)
-tonic: stiffening of trunk, jaws shut close, incontinence, apneic periods
-generalized tonic-clonic (grand-mal): combo of both, may become cyanotic , body limp afterwards,
incontinence, snoring, hard to wake up afterwards
-atonic-drop seizure- muscles weaken and pt drops to the floor- CAN’T WAKE THEM UP FROM IT
GET A GOOD HX OF WHAT THE SEIZURES ARE
Status epilepticus
Seizure lasts > 5 min, or back-to-back seizures without regaining consciousness in between seizures
Usually bc they stopped their AED’s
Withdrawal from alcohol or drugs
Fever
Women with eclampsia
Can present with tonic clonic movement
MUST HAVE EEG
If consciousness not regained after seizure, they could have a general seizure, the consider sub clinical
seizure- do diligent assessment
Testing for seizures
CBC, BMP, toxicology screen
Anticonvulsant levels if epileptic-do a level of their usual AED
EEG- may miss seizures bc they are so localized or bc the seizure is over and there’s no EEG activity
CT of brain and head/trauma
MRI- IF FIRST EVER SEIZURE
PET scan can find foci if seizing
Subdural grids- look for areas where seizure is coming from
Treatment:
Avoid triggers, manage underlying condition, medical management/drug therapy(meds are decided
based on type of seizure as well as if the first line drug worked or not- dilaton, Depakote,Tegretol,
Lamictal
FIRST LINE AED’S – know for exam
Dilantin (phenytoin) – dose of 300-400mg/dL; loading dose 10-20 ; give slow IVP or cardiac
arrest<50mg/min, phlebitis
Surgical management- candidates are usually focused partial seizures(no generalized seizures); wont
have major neuro defects if its done
Mapping: done while patient is awake – ID’s visual, motor, sensory areas
Wada’s Test: language and memory lcation; put one side of brain to sleep- show them pictures, then
wake that side up and ask them if they remember the pictures
Lobectomy: lesionectomy, hemispheriectomy (only for infants)-vagal nerve stimulator
*ALL PTS AWAKE DURING SURGERY (PUT TO SLEEP TO TAKE OUT PART OF SKULL)
Most common tx:
Status epilepticus atuvan (lorazepam) 4-8 mgIV, then 1st line AED drug: Phenytoin (dilantin) load 20
mg/kg, then addition dilantin 5-10mg/kg, then intubate and propofol or versed drip then barbituates
- know for exam- for emergency situations: IV DILANTIN: know dosage: 300-400mg/d; L:10-20, SE:
ataxia, hirsutism, Pearls: give sow IVP or cardiac arrest <50mg/min, phlebitis
Propofol can be given -stops muscle movement
Lorazepam or midazolam next
For exam, just recognize these drugs:
Valproate (Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Managing a seizing patient:
Ease patient to floor unless in bed, take off glasses, don’t put anything in their mouth
DO NOT RESTRAIN- guide movements to prevent injury
Stay with patient and have someone put in PART/rapid response call
After seizure put pt on their side
Assess for patency of airway before turning them on the side
DOCUMENTATION- KNOW FOR EXAM
Was the seizure witnessed, who witnesses it ?
Warning signs: Any aura, smell?
What type of movements?
Did eyes deviate? Up, down, straight ahead?
Was pt conscious during seizure?
Any incontinence? (Indicative of generalized seizure)
What was the person’s behavior like after seizure? Aggression, sleepy, manic, crying?
Any injuries after? Up on a ladder? Laying on the couch?
Treatment done prior to seizure- did patient take an extra dose of their meds after the seizure, or did
they get it in the ambulance?
The client who just had a three (3)-minute seizure has no apparent injuries and is
oriented to name, place, and time but is very lethargic and just wants to sleep. Which
intervention should the nurse implement?
1. Perform a complete neurological assessment.
2. Awaken the client every 30 minutes.
3. Turn the client to the side and allow the client to sleep.
4. Interview the client to find out what caused the seizure.
3. Turn the client to the side and allow the client to sleep.
(During the postictal (after-seizure) phase, the client is very tired and should be
allowed to rest quietly; placing the client on the side will help prevent aspiration
and maintain a patent airway.)
Differential dx: is this seizure related to a dysrhythmia?
Syncope related to dysrhythmia
v-tach: looks like seizure
vasovagal response
narcolepsy
night terrors or somnambulism
panic or rage attack
psychogenic symptoms (pseudo-seizures)
D41138722
Jubiny@10311992