Pathophysiology
Epilepsy
Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures. These
electrical instabilities in the brain can result in brief lapses of attention or muscle jerks to severe and
prolonged convulsions.
Seizures are the manifestation of abnormal hypersynchronous or hyperexcitable discharges of cortical
neurons. Epileptic symptoms occur because the normal signaling between the nerve cells and the brain
has been disrupted, possibly due to abnormality in brain wiring or imbalance of nerve-signaling
chemicals called neurotransmitters, or a combination of the two. Epileptic seizures have many causes,
including a genetic predisposition for certain types of seizures, head trauma, stroke, brain tumors,
alcohol or drug withdrawal, repeated episodes of metabolic insults, such as hypoglycemia, and other
conditions.
Some common types of seizures include the following:
Generalized tonic-clonic (grand mal) seizures: This type of seizure affects the whole brain. During
the seizure, the muscles in the body become rigid (stiff), then shake and contract (called convulsions).
The person having the seizure usually loses consciousness (faints). He or she may also clench the jaw,
bite the tongue or cheek, or lose control of the bladder.
Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children
and are characterized by staring into space or subtle body movements such as eye blinking or lip
smacking. These seizures may occur in clusters and cause a brief loss of awareness.
Partial (focal) seizures: This type of seizure affects only one part of the brain. The symptoms may
vary, depending on where in the brain the seizure starts. For example, a partial seizure may cause
changes in emotions, or to the senses (for example, hallucinations, numbness, tingling, or other changes
to vision, taste, smell, touch, or hearing). This type of seizure may also cause muscle contractions (for
example, causing the person to move the head in an unusual way, or jerk an arm or a leg). Or, the
seizure may cause staring spells, sometimes with unusual repetitive movements, such as moving the
mouth or the lips, chewing or swallowing, or hand movements.
Before a seizure begins, some people experience dizziness, emotional changes, or changes
in vision(such as hallucinations), smell (smelling an odor that isn’t there), or touch (such as numbness
or tingling). This is called an aura.
Nursing Interventions:
1- Ensure safety and initiate seizure precautions for patients at-risk for seizures. This includes having
suction set up and working, having an ambu-bag in the room, padding side rails, not restrain them
or putting anything in their mouth if a seizure occurs, having all side rails up.
2- Protect the patient’s tongue, if his mouth is open, by placing a soft object between his teeth.
3- Turn the patient’s head to the side to maintain patent airway
4- Assess, monitor and document seizure activity
5- Administer anticonvulsant (PRN and scheduled) medications per orders
6- Reevaluate any medications that may lower the seizure threshold (some antibiotics, antidepressants,
narcotics, and many more may do this)
7- Educate patient and family on hospital procedures, and when to notify staff
8- Reassure patient after the seizure subsides by telling him that he’s all right, orienting him to time
and place, and informing that he’s had a seizure.
9- Provide emotional support