SEIZURE
DEFINITION: a sudden surge of electrical activity in the brain
Types of Seizures & Signs and Symptoms:
1. Focal/partial seizures – seizure activity to one part of the brain hemisphere
o Focal seizure with retained awareness – does not impair awareness or
consciousness. Also called as “simple partial seizure.”
o Focal seizure with loss of awareness – does not involve convulsions, but it
does impair awareness or consciousness. Also called as “complex partial
seizure.”
2. Generalized seizures – seizure activity in the left and right part of the brain
hemisphere.
o Absence seizure
- älso called as “petit mal.”
- Usually begins with a brief change in level of conciousnessn
indicated by blinking or rolling of eyes, a blank stare, and slight
mouth movements.
- Lasts 1 to 10 seconds only.
- No confusion after the seizure and the person can usually resume
full activity immediately
- Occurs most commonly in children
- it is a non-convulsive seizure but may progress to tonic-clonic
seizure.
o Tonic-clonic seizure
- Also called as “grand ma;”or “convulsive seizure.”
- Usually begin with a loud cry, precipitated by air rushing from the
lungs through the vocal cords.
- Loses consciousness and falls to the ground.
- The body stiffens (tonic phase) and then alternates between
episodes of muscle spasm and relaxation (clonic phase)
- Tongue biting, incontinence, labored breathing, apnea, and
subsequent cyanosis
- Seizure stops in 2-5minutes
o Myoclonic seizure
- Are brief, involuntary muscular jerks of the body or extremities
- Commonly occurring in the morning
o Clonic seizure
- Characterized by bilateral rhythmic movements
- Loses control of bodily functions and begins jerking in various parts
of the body.
o Tonic seizure
- Sudden stiffening of muscle tone, usually of the arm, but possibly
including legs.
o Atonic seizure
- Characterized by a general loss of postural tone and a temporary
loss of consciousness.
- They occur in young children
- Also called as “drop attacks” because it causes the child to fall
3. Status epilepticus – a continuous seizure state that can occur in all seizure types.
- The most life threatening is generalized tonic-clonic status
epilepticus, a continuous generalized tonic-clonic seizure
- Accompanied by respiratory distress leading to hypoxia or anoxia
ANATOMY AND PHYSIOLOGY
Begin in the thalamus and other subcortical structures,
MODIFIABLE FACTORS: NON MODIFIABLE FACTORS:
Abnormal levels of sodium or glucose Family history
in the blood Congenital brain defects
Brain infection
Brain injury
Brain tumor
Drug abuse
Electric shock
Fever
Withdrawal from alcohol or certain
medicine
COMPLICATIONS
Hypoxia or anoxia from airway occlusion
Traumatic injury
Brain damage
Depression and anxiety
PATHOPHYSIOLOGY
Mossy cell death (excitatory neurons)
GABAergic basket cells (inhibitory neurons)
Granule cells (repetitive burst firing)
Seizure
DIAGNOSTIC PROCEDURE
1. Electroencephalogram (EEG)
Definition An electrophysiological monitoring method to record electrical activity
of the brain
Normal Generalized epileptiform discharges often have an anterior
Values/Findings maximum, but these are seen synchronously throughout the entire
brain.
Significance To detects electrical activity in your brain.
2. Computerized tomography (CT) scan
Definition Uses X-rays to obtain cross-sectional images of your brain
Normal Increase intracranial pressure results from a structural abnormality of
Values/Findings the brain or its surroundings.
Significance Able to diagnose or suggest the abnormality in seizure
NURSING DIAGNOSIS
1. Chronic low self-esteem/disturbed personal identity related to perceived
neurological functional change/weakness.
Desired Outcomes:
Verbalized understanding of negative evaluation of self and reasons for this
problem
Participate in treatment program to promote change in self-evaluation
Demonstrate behaviors/lifestyle changes to promote positive self-image
Verbalize increased sense of self-worth in relation to current situation
Participate in family/group/community activities to enhance change
Nursing Intervention Rationale
Promote therapeutic relationship To gain client’s trust
Use positive I-messages rather Assist client to develop internal sense of self-esteem
than praise
Give reinforcement for progress Positive words of encouragement promote
noted continuation of efforts, supporting development of
coping behaviors.
2. Impaired social interaction related to unpredictable nature of condition & self-
concept disturbance
Desired Outcomes
Verbalize awareness of factors causing or promoting impaired social interaction
Identify feelings that lead to poor social interactions
Express desire/be involved in achieving positive changes in social behaviors and
interpersonal relationships
Give positive self-reinforcement for changes that are achieved
Develop effective social support system; use available resources appropriately
Nursing Intervention Rationale
Have client list behaviors that cause Once recognized, client can choose to
discomfort change as he or she learns to listen and
communicate in socially acceptable
ways.
Provide positive reinforcement and discuss Encourages continuation of desired
impact. behaviors/efforts for change
Work with client to alleviate underlying Because they often impede positive
negative self concepts social interactions. Attempts at trying to
connect with another can become
devastating to self-esteem and
emotional well-being.
3. Risk for trauma/suffocation
Desired Outcomes:
Identify and correct potential risk factors in the environment
Demonstrate appropriate lifestyle changes to reduce risk for injury
Identify resources to assist in promoting a safe environment
Recognize need for/seek assistance to prevent accidents/injuries.
Nursing Intervention Rationale
Implement interventions regarding safety To lessen the risk.
issues when planning for client care
Provide quiet environment and reduced Helps limit confusion or overstimulation
stimulation,as indicated for clients at risk for such conditions as
seizures, etc.
Review client’s therapeutic regimen on To prevent healthcare-related
continual basis when under direct care complications
DRUG STUDY
Drug # 1 Drug # 2
Generic Carbamazepine- Treatment of Lamotrigine - Treatment of
Name partial seizures with complex patient 2 yearrs and older with
symptomatology, generalized primary generalized tonic-clonic
tonic-clonic seizures, mixed seizures.
seizure patterns, pain relief of
trigeminal neuralgia.
Trade Name Carbatrol Lamictal
Drug PHARMACOTHERAPEUTIC: PHARMACOTHERAPEUTIC:
Classification Iminostilbene derivative. Phenyltriazine.
CLINICAL: Anticonvulsant, CLINICAL: Anticonvulsant.
antineuralgic, antimanic,
antipsychotic.
Side Effects Frequent (greater than 10%): Frequent (38%–14%): Dizziness,
Vertigo, som- nolence, ataxia, headache, diplopia, ataxia,
fatigue, leucopenia, rash, urticaria, nausea, blurred vision,
nausea, vomiting. drowsiness, rhinitis.
Occasional (10%–1%seizur ): Occasional (10%–5%): Rash,
Headache, diplopia, blurred vision, pharyngitis, vomiting, cough,
thrombocytopenia, dry mouth, diarrhea, dysmenorrhea, fever,
edema, fluid retention, increased insomnia, dyspepsia.
weight.
Rare: Constipation, tremor,
Rare (less than 1%): Tremors, anxiety, pruritus, vaginitis,
visual disturbances, hypersensitivity reaction.
lymphadenopathy, jaundice,
involuntary muscle movements,
nystagmus, dermatitis.
Nursing 1. Assess for clinical improvement 1. Report occurrence of rash
Responsibilit (decrease in intensity, (drug discontinuation may be
y frequency of seizures) necessary).
2. Assess for clinical evidence of 2. Assist with ambulation if
early toxicity (fever, sore throat, dizziness, ataxia occurs.
mouth ulcerations, unusual 3. Do not abruptly discontinue
bruising/bleeding, joint pain). medication after long-term
3. Do not abruptly discontinue therapy.
medication after long-term use 4. Avoid alcohol.
(may precipitate seizures). 5. Avoid tasks that require
4. Do not ingest grapefruit alertness, motor skills until
products response to drug is
5. Report serious skin reactions. established.
6. May cause photosensitivity
reaction; avoid exposure to
sunlight, ultraviolet light.
