TOLENTINO, SABRINA CEDIE S.

BSN III B

TYPE PARTIAL Simple a.k.a. Aura

DESCRIPTION Seizures which affect only a small region of the brain, often the temporal lobes or hippocampi. People who have simple partial seizures retain consciousness.

CLINICAL MANIESTATIONS Some common symptoms of simple partial seizures are: preserved consciousness, sudden and inexplicable feelings of fear, anger, sadness, happiness or nausea, sensations of falling or movement, experiencing of unusual feelings or sensations, altered sensory function, feeling as though the environment is not real (derealization), detachment from the environment (depersonalization), a sense of spatial distortionthings close by may appear to be at a distance., dj vu (familiarity) or jamais vu (unfamiliarity), laboured speech or inability to speak at all, usually the event is remembered in detail

MEDICAL MANAGEMENT >Simple partial seizure of childhood is usually a self-limited condition; if no seizures with secondarily generalization occur, patient care need not include antiepilepsy drugs

NURSING MANAGEMENT >Patient education: Educate on diet e.g. Atkins diet, Ketogenic diet, mediumchain triglyceride diet >Restrictions of activity is not usually required

TOLENTINO, SABRINA CEDIE S. BSN III B

Complex

An epileptic seizure that is associated with bilateral cerebral hemisphere involvement and causes impairment of awareness or responsiveness, i.e. alteration of consciousness.

Generalized Absence

Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing. There may also be loss of memory (amnesia) surrounding the seizure event. The person may still be able to perform routine tasks such as walking. Witnesses may not recognize that anything is wrong. Also referred to Loss of axial tone as petit mal seizure, is Head nodding a type of seizure that Fall is characterized by a Increased tone sudden and Autonomic short seizure that can features last between 10 and Automatisms 30 seconds. During this time period, a person suffering from an absence seizure has impaired consciousness, which means that they are not aware of their surroundings or their

>Anti-epileptic drugs e.g. carbamazepine, topiramate >Epilepsy surgery e.g. temporal lobectomy, extratemporal resections, corpus callosotomy, placement of a vagus nerve stimulator, and hemispherectomy

>Advise to refrain from high risk activities >Educate on diet and medications

Anti-epileptics Ketogenic or medium-chain triglyceride diet Ethosuximide (Zarontin)

Monitor the entire seizure event, including prodromal signs, seizure behavior, and postictal state. Provide safe environment by padding side rails and removing clutter.

TOLENTINO, SABRINA CEDIE S. BSN III B

movements during this time. After the seizure has occurred, the person will abruptly resume consciousness. An absence seizure (formerly classified as petit mal), is a very uncommon seizure that begins suddenly and occurs without any warning signs. People experiencing absence seizures typically appear to stare without moving. Usually lasting less than 15 seconds, absence seizures can occur many times a day and may be mistaken for daydreaming. While the patient may not remember what happened during the seizure, theyll typically return to being instantly

Monitor complete blood count, urinalysis, and liver function studies for toxicity caused by medications. Provide oxygen during the seizure if the patient become cyanotic. Protect the patients head during the seizure. Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds to

TOLENTINO, SABRINA CEDIE S. BSN III B

alert as soon as the seizure is finished.

sedation. Remind the family the importance of following medication regimen and maintaining regular laboratory testing, medical check ups, and visual examination s. Monitor the entire seizure event, including prodromal signs, seizure behavior, and postictal state. Provide safe environment by padding side rails and

Myoclonic

Rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body. myoclonic seizures (myomeanin g muscle, clonic mean ing jerk) result in an increase in muscle tone. The areas of the brain stem

Rapid, jerklike movements that can affect the face, limbs, or axial musculature.

Valproic acid (sodium valproate) benzodiazepines Ketogenic diet

TOLENTINO, SABRINA CEDIE S. BSN III B

responsible for increasing and decreasing muscle tone are close together meaning atonic and myoclonic seizures probably begin in the same place. Patients experiencing sudden dramatic changes in muscle tone will often suffer from either or both types of seizures. Myoclonic seizures are often only one manifestation of a mixed seizure disorder, and they can be very serious. On rare occasions, a patient may suffer from a series of such jolts a serious type of epilepsy classified as infantile spasms.

removing clutter. Maintain a patent airway until the patient is fully awake after a seizure. Monitor complete blood count, urinalysis, and liver function studies for toxicity caused by medications. Do not restrain the patient Provide oxygen during the seizure if the patient become cyanotic Place the

TOLENTINO, SABRINA CEDIE S. BSN III B

patient on side during a seizure to prevent aspiration. Protect the patients head during the seizure. Remind the family the importance of following medication regimen and maintaining regular laboratory testing, medical check ups, and visual examination s. Monitor the entire seizure event, including prodromal

o Atonic

Means "without tone," so in an atonic seizure, muscles suddenly lose strength. atonic seizures cause

Drooping eyelids Head may nod Dropping of things Falls

Anti-epileptics

TOLENTINO, SABRINA CEDIE S. BSN III B

the muscles to go limp. The patients body may slump or crumple to the ground, possibly causing injury. The areas of the brain stem responsible for increasing and decreasing muscle tone are close together, which means atonic and myoclonic seizures probably begin in the same place. Patients experiencing sudden dramatic changes in muscle tone will often suffer from either or both types of seizures.

signs, seizure behavior, and postictal state. Provide safe environment by padding side rails and removing clutter. Maintain a patent airway until the patient is fully awake after a seizure. Monitor complete blood count, urinalysis, and liver function studies for toxicity caused by medications. Protect the patients head during the seizure.

TOLENTINO, SABRINA CEDIE S. BSN III B

Tell the patient to avoid alcohol because it interferes with metabolism of AEDs and adds to sedation. Remind the family the importance of following medication regimen and maintaining regular laboratory testing, medical check ups, and visual examination s.

TOLENTINO, SABRINA CEDIE S. BSN III B

TONICCLONIC

seizures are the easiest seizures to recognize. They happen most often in people with generalized epilepsy of unknown cause. A generalized tonicclonic seizure begins with a sudden loss of consciousness. During the first 15 to 30 seconds of the seizure, the entire body stiffens as the muscles contract. The back and neck are arched. Sometimes the person may cry out as the vocal cords contract and air is released from the lungs. The person may turn blue because he or she isn't breathing. This is the tonic phase of the seizure. During the next 30 to 45 seconds, the muscles jerk (convulse) in a rhythmic pattern. This is the clonic phase of the seizure. While the muscles are jerking, the

Hyperventilation and electrolyte imbalances Prolonged QT syndrome and other arrhythmias Dystonias including nocturnal paroxysmal dystonias Paroxysmal dyskinesia Encephalopathies and metabolic disorders Pseudoepileptic seizures Nocturnal paroxysmal events (eg, sleep apnea, night terrors) Paroxysmal abnormalities of tone (eg, opisthotonic posturing and clonus) In infants, apneic syndromes including gastroesophageal reflux and jitteriness of the newborn In toddlers and young school-aged children, simple faints and breath-holding spells

Valproic acid Phenytoin and carbamazepine (eg, lamotrigine, topiramate, zonisamide, levetiracetam) Phenobarbital For refractory generalized epilepsy, felbamate also is used as an agent of last resort and is very effective.. The agent rufinamide (Banzel)

-KETOGENIC DIET -ACTIVITY RESTRICTION -RISK FOR INJURY

TOLENTINO, SABRINA CEDIE S. BSN III B

person may bite his or her tongue or lose bladder or bowel control. An entire seizure lasts 1 to 2 minutes. After the seizure, the person will be unresponsive at first but will gradually wake up in 10 to 30 minutes. The person may be sleepy, confused, or dazed. The person may also feel tired, weak, or moody and may have a headache and muscle aches for the next 24 hours. CLONIC Tonic seizures are fairly uncommon. They occur mostly in people with Lennox-Gastaut syndrome. This is a severe form of generalized epilepsy that begins in early childhood. (Children with Lennox-Gastaut syndrome may also have atonicseizures.) Loss of consciousness occurs, and the muscles suddenly contract and cause the person to fall down. This phase tends to last about 10 to 20 seconds Aura. . A scream. Unresponsiveness Carbamazepine (Carbatrol,Tegretol , others) Phenytoin (Dilantin, Phenytek) Valproic acid (Depakene, Stavzor) Oxcarbazepine (Trileptal) Lamotrigine Contraception and antiseizure medications Mild side effects Pregnancy and seizures

TOLENTINO, SABRINA CEDIE S. BSN III B

When a tonic seizure occurs, the muscles in the body contract and the entire body stiffens. This occurs suddenly and without warning. And it often causes the person to fall down. People who have tonic or atonic seizures are likely to be injured when they fall. Children may have to wear helmets and restrict their activities to prevent serious injury.

(Lamictal) Gabapentin (Gralise, Neurontin) Topiramate (Topamax) Phenobarbital Zonisamide (Zonegran) Levetiracetam (Keppra) Tiagabine (Gabitril) Pregabalin (Lyrica) Felbamate (Felbatol) Ethosuximide (Zarontin) Lorazepam (Ativan) Clonazepam (Klonopin)