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Seizure Disorder

TYPES:
• Uncontrolled electrical discharge of neurons in the brain
• Partial – local onset; may or may not impair consciousness
o Simple
 Motor, somatosensory, sensory, autonomic, psychic
 No loss of consciousness
 Aura – visual, auditory, or olfactory occurrence that takes place prior to a
seizure and warns the patient a seizure is about to occur:
o Nausea o Dream state
o Aphasia o Surroundings appear strange
o Fear o Dizziness
o Indescribable feeling o Numbness
o Abdominal discomfort o Déjà vu,
o Unpleasant taste o Visual/auditory/ olfactory
disturbance
o Complex
 Automatisms: repetitive movements that may not be appropriate (lip-smacking,
fumbling, picking at clothing)

• Generalized
1. Absence
 Brief and staring spell
 Sudden stop of activity/starring
 No aura
 Abrupt onset
 Brief duration – seconds, not minutes
 Prompt recovery

2. Myoclonic
 Rapid contraction of muscles; brief

3. Tonic
 Stiffening of muscles with loss of balance
 Very sudden brief, probably some impairment of consciousness
 Associated with significant brain disease; poor prognosis

4. Atonic
 Loss of tone
 Drop attacks
 Very sudden loss of muscle tone
 Last a few seconds to 1 minute
 Patient may need to wear headgear for protection
 Poor prognosis

5. Tonic-clonic (grand mal)

 Muscle stiffening (tonic) alternating with muscle jerking (clonic)
 Often preceded by aura (partial progresses to generalized)
 Loss of consciousness
 Shallow breathing
 Cyanosis
 Excessive salivation
 Bladder/bowel incontinence
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DIAGNOSTIC:
1. Electroencephalogram (EEG)
 Prep: No caffeine or stimulants up to 4 hours before test; no sleeping pill evening before
test; allow only 4 hours sleep night prior to test; wash hair pre and post
 Only useful if patient seizes during test
 Useful diagnostic adjuvant to the history but only if it shows abnormalities
 Repeated often, continuous EEG monitoring may be needed to detect abnormalities
 NOT definitive test because some patient who do not have seizure disorder have
abnormal pattern whereas many patient with seizure disorder have normal EEG between
seizure
2. Description of Seizure
3. CT Scan / MRI – to rule out lesion
4. Blood and urine tests
 Electrolyte imbalances
 Hypoglycemia
 Dehydration
 Alcohol or barbiturate withdrawal
5. Health History
 Age
 First 6 months - birth injury, infection, congenital defects, increased
temperature
 2-20 years - birth injury, infection, congenital defects, trauma, increased
temperature
 20-30 years - trauma, brain tumor, vascular disease
 >50 years- brain metastasis, CVA
COMPLICATIONS:
 Status Epilepticus
 Continuous seizure activity; recur in rapid succession without return to consciousness
between seizures
 Most dangerous
 Can cause
 Ventillatory insufficiency
 Hypoxemia
 Cardiac arrhythmias
 Hyperthermias
 Systemic acidosis
 Severe Injury - related to decreased LOC, fall, head injury, drowning (seizing in bathtub)
 Psychosocial
 Disorder affects lifestyle; social stigma; experience discrimination in employment and
educational opportunities.

MEDICATIONS:
 During a Seizure
 Benzodiazepines
 IVP Valium (slow)
 IVP Ativan (diluted with NS or sterile H20; slow)
 Prevention…
 Dilantin (po or IV)
 IV: Don’t mix with dextrose
 IV: Give slowly- not faster than 50mg/min
 Can cause venous irritation therefore, it should be mixed with NS
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 Provide oral care to prevent/ control gingival hyperplasia
 Phenobarbital – (IV or po)
 Tegretol - (po)
 Neurontin (Gabapentin)-(po)
 Side Effects…
 Diplopia (double vision)
 Drowsiness
 Ataxia (uncoordinated muscle movement when voluntary movements are tried)
 Mental slowing
 Nystagmus (involuntary eye movements)
SURGERY:
 Removal of lobe of brain
 Used for patients whose epilepsy can’t be controlled with drugs
 EEG must find precise focal point of activity

SEIZURE PRECAUTIONS:
 Pad side rails
 Oral airway at bedside

ACUTE PHASE/ICTAL: NURSING DIAGNOSIS

 Risk for Injury
 Do not restrain
 Loosen constricting clothing
 Protect head and neck
 Turn patient / head to side
 Ease patient to floor if seated
 IV access / meds
 Stay with patient

POST-ACUTE PHASE/ POST-ICTAL: NURSING DIAGNOSES

 Ineffective Breathing Pattern OR
 Ineffective Airway Clearance
 Assess respiratory status
 Suction prn
 Oxygen prn
 Oral airway or endotracheal tube insertion prn
 Manual ventilation prn

POST- ICTAL NURSING CARE:

 Neuro check (memory loss, change in LOC)
 Vital signs
 Assess for muscle weakness and soreness
 Sleep period
 Re-orientation
 Provide privacy and quiet environment

OTHER NURSING DIAGNOSES

 Ineffective coping
 Ineffective therapeutic regimen management
 Fear
 Anxiety

PATIENT EDUCATION:
 Goal of treatment: Seizure prevention
 In general, how meds work: Stabilize nerve cell membrane and prevent spread of epileptic
discharge
 How long will meds have to be taken: Lifetime
 Why patients should not stop taking meds abruptly: This can precipitate seizures
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 May need more than one med: 1, 2, or 3 or more to prevent seizures
 Blood tests: Therapeutic levels of medications should be reached to help prevent seizure activity
 How to communicate that patient has seizure disorder: Medical alert bracelet
 Safety: Sensing aura and what to do should one occur; No driving; Shower- no tub baths