Seizures
Training
The Center for Life Enrichment
Resource: MTTP Student Manual & Epilepsy.com
What is a Seizure?
 A seizure is a sudden disruption of the brain’s normal
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electrical activity
In some cases, a seizure can cause a loss of consciousness and
make the body twitch and jerk
People who have a repetitive pattern of seizure activity have a
condition called epilepsy
A large percentage of individuals with developmental
disabilities have epilepsy
There are more than 40 different seizure disorders
What to look for?
 The symptoms of a seizure depend upon the area of the brain affected
 For example, if the abnormal electrical discharge affects only a very small
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area of the brain, the individual might simply experience the symptom of an
odd smell or taste
 When large areas of the brain are involved, signs are more noticeable. The
person may jerk and have muscle spasms, known as convulsions
Seizures may also cause a loss of consciousness or altered consciousness, a
loss of bladder control and confusion
Most seizures last from 2-5 minutes and leave the person feeling tired and
confused
The individual may complain of a headache and sore muscles
Most people cannot recall what happened during the seizure
Types of Seizures
 There are over 40 different types of seizures. Some of the more
common types of seizures include:
 Febrile Seizures: associated with high fevers and occur in about 4% of
children up to 5 years of age
 Simple Partial Seizures: isolated to a small area of the brain and is not
associated with an impairment in consciousness
 Jacksonian Seizures: begin in an isolated part of the body and then
progressively spread or “march” to other parts of the body on the same side.
A Jacksonian seizure may become generalized
 Complex Partial Seizures (Psychomotor Seizures): impairment in
consciousness and usually lasts 2-4 minutes. The individual appears to lose
touch with his/her surroundings and becomes confused. He/she may
demonstrate repetitive or meaningless behaviors (e.g. aimless arm or leg
movements, utterances of meaningless sounds, etc.). Mild confusion will
remain immediately following the seizure
Types of Seizures Continued…
 Generalized Tonic-Clonic Seizures (Grand Mal Seizures): the electrical
malfunctions in the brain quickly spread to adjoining parts of the brain and the
entire brain malfunctions. It is characterized by the sudden onset of muscle tensing
and is often associated with an audible cry or moan. The individual loses
consciousness and may fall. The muscle tensing changes to muscle contractions
which cause jerking movements or convulsions. The individual often turns his/her
head to one side, clenches his/her teeth, and loses bladder control. The seizure
usually lasts less than 3 minutes. If it lasts 5 full minutes or longer, 911 should be
called. An exception would be if the neurologist writes an order/protocol for the
individual with different parameters for calling 911.When the seizure is over, the
person may initially be confused and extremely tired
 Three or more Tonic-Clonic Seizures in a row without full recovery in between is a
911 medical emergency because the person’s breathing is affected. Emergency
treatment is needed to stop the seizure activity and prevent permanent damage or
death
Types of Seizures Continued…
 Absence Seizures (Petit Mal Seizures): absence seizures are
generalized with sudden loss and regaining of consciousness and no aura
or warning. It is characterized by impairment of the level of
consciousness which may cause confusion, diminished awareness of the
environment, inability to respond to stimuli, and amnesia. They are not
associated with convulsive movements. The presentation may include
staring, fluttering of the eyelids, or facial muscle twitching. Absence
seizures rarely last longer than 30 seconds and are usually 1-10 seconds
in duration. Though brief, these seizures may occur as frequently as
100+ times per day. The seizure ends as suddenly as it began and the
individual resumes his/her activity, completely unaware of what has
happened
Individual/Caregiver Responsibilities
 The individual/caregiver should know:
 A person with a seizure disorder should wear a medical bracelet or necklace that
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identifies the disorder and any medications taken
Seizure control can be enhanced by following a healthy diet, getting plenty of sleep
and keeping stress levels to a minimum. Since fever can trigger seizures, take
medication to lower fever at the first sign of illness
If the individual’s seizures begin with an aura (a sensation that precedes the onset of a
seizure), he/she should get to a safe place and lie down until the seizure passes
If a seizure occurs, what to do
An individual can be protected from injuries that can cause seizures by wearing a
helmet when riding a bicycle, skateboard, or motorcycle, or when playing certain
sports, and wearing a seat belt when riding in a motor vehicle
First Aid for Seizures
1.
Stay calm, most seizures only last a few minutes
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Prevent injury by moving any nearby objects out of the way
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Pay attention to the length of the seizure
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Make the person as comfortable as possible
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Keep onlookers away
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Do not hold the person down
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Do not put anything in the person’s mouth
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Do not give the person water, pills, or food until the person is fully alert
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If the seizure continues for longer than five minutes, call 911. An exception
would be if the neurologist writes an order/protocol for the individual with
different parameters for calling 911
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Be sensitive and supportive, and ask others to do the same
Epilepsy Foundation’s Recommendations:
 If there is no specific protocol from the HCP, follow the Epilepsy’s
Foundations recommendation for “when to call for an ambulance”
 No need to call an ambulance if…
 Medical I.D. jewelry or card says “epilepsy”
And
 The seizure ends in under five minutes
And
 Consciousness returns without further incident
And
 There are no signs of injury, physical distress, or pregnancy
Epilepsy Foundation’s Recommendations Continued:
 An ambulance should be called if…
 The seizure has happened in water
 There’s no medical I.D. and no way of knowing whether the seizure is caused by
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epilepsy
The person is pregnant, injured, or diabetic
The seizure continues for more than five minutes. An exception would be if the
neurologist writes an order/protocol for the individual with different parameters for
calling 911
A second seizure starts shortly after the first has ended
Consciousness does not start to return after the shaking has stopped
 If the ambulance arrives after consciousness has returned, the person should be
asked whether the seizure was associated with epilepsy and whether emergency
room care is wanted
Documentation of Seizures
 Observe all seizure activity carefully and record the information accurately
 This record should be shared with the supervisor, delegating nurse, residential
provider/family, and the individual’s neurologist/HCP
 Staff’s accuracy in reporting seizure activity is critical in providing the HCP with information
necessary to prescribe an appropriate treatment plan
 Be alert to any changes the individual may show from his/her “usual pattern” of seizure
activity. Report these changes to your supervisor and delegating nurse immediately
 A seizure record must be maintained on all developmentally disabled individuals who receive
anticonvulsant medication(s) for the treatment of seizures
 Discontinuation of a Seizure Record for a DD individual who is “seizure free” but continues to
receive anticonvulsant medication(s) should be reviewed by the team for appropriateness and
parameters for reinstituting documentation should be outlined
Anticonvulsant Medications
 Anticonvulsant medications are used to control recurrent seizures known as
epilepsy/seizure disorder
 Anticonvulsants do not cure epilepsy
 Individuals on anticonvulsant medication must see their doctor regularly for
blood tests to monitor drug level in the bloodstream and to monitor for any
side effects. Side effects that should be reported to the RN CM/DN and doctor
include:
 Sluggishness
 Dizziness
 Hyperactivity
 Uncontrolled eye movements
 Speech or vision problems
 Nausea or vomiting
 Problems sleeping
Most Commonly Used Anticonvulsant Medications
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Carbamazepine (Tegretol, Carbatrol)
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Phenobarbital (Phenobarbital, Luminal)
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Phenytoin (Dilantin)
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Primidone (Mysoline)
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Valproic Acid (Depakene)
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Divalproex Sodium (Depakote)
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Tiagabine (Gabitril)
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Levetiracetam (Keppra)
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Clonzepam (Klonopin)
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Lamotrigine (Lamictal)
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Gabapentin (Neurontin)
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Topiramate (Topamax)
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Oxcarbazepine (Trileptal)
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Zonisamide (Zonegran)
Seizure Charting
 On the front of the Seizure Observation Record, observe all
seizure activity carefully and record the information
accurately
 On the back of the Seizure Observation Record, write a
comment in the spaces provided if any of the check marks on
the front of the Record need further explanation. If you have
reported the observed seizure activity to your supervisor,
RN CM/DN, or HCP, document this in the note/comment
section of the Record
Questions?