Seizures

INTRODUCTION
Seizures is an uncontrolled electrical activity in the
brain, which may produce a physical convulsion, minor
physical signs thought disturbance or a combination of
symptoms.
Seizures may accompany a variety of disorders or they
may occur spontaneously without any apparent cause.

DEFINITIONS
SEIZURES
Seizures is a paroxysmal, uncontrolled electrical discharge of
neurons in the brain that interrupts normal function.
Lewis’s
seizures are episodes of abnormal motor sensory autonomic or
psychic activities (or combination of these) that result from sudden
excessive discharge from cerebral neurons.
Hickey 2009

CONTD…..
CONVULSION: The word convulsion is sometimes used as synonym
for seizures but not all seizures are characterized by convulsions.
Convulsion or fits are abnormal, involuntary contraction of muscles in
seizures disorder.
EPILEPSY: It is disorder characterized by recurring seizures. Means
pattern of repeated seizures is referred to as epilepsy.

INCIDENCE
• Prevalence of seizures varies from 2.5 to 11.9 per 1000
population in different parts of India.
• India is home of 10 million seizures accounting for one to
fifth of global burden.

CLASSIFICATION
1. Partial seizures / Focal seizures.
1. Simple Partial seizures.
2. Complex partial seizures.
2. Generalized seizures:
1. Absence seizure.
2. Myoclonic seizure.
3. Clonic seizure.
4. Tonic seizure.
5. Generalized tonic-clonic seizure.
6. Atonic seizure.

1. Partial seizure / Focal seizure
Focal seizure begin in one hemisphere of the brain in the
specific region of the cortex as indicated by EEG.
1.(a). Simple focal seizure:
A. Remain conscious.
B. Experience unusual feelings or sensation that can take many
forms.
Example:-
They may experienced sudden and unexplainable feelings of joy
and anger sadness or nausea.
They also may hear, smell, taste, see or feel things that are not real

1.(b). COMPLEX FOCAL SEIZURE:
• Impairment / loss of consciousness.
• Display strange behaviour such as lip smacking automatism (repetitive
movement that may not be appropriate).
• Eg: patient may continue an activity started before the seizures such as
picking items from the grocery shelf but after the seizure they do not
remember the activity performed during the seizures.

2. Generalized seizures:
Generalized seizure involve both side of the brain and
are characterized by bilateral synchronous epileptic
discharge in the brain from the onset of the seizures.
In the most cases patients loses consciousness for a
few seconds to several minutes. There are 6 six types of
generalized seizures:-

2.(a). Tonic clonic seizures:
• Formally known as Grand mal seizures.
• Characterized by losing consciousness and falling to the ground if the
patient is upright.
• Stiffening of the body (tonic phase) for 10 – 20 seconds.
• Subsequent jerking of the extremities (clonic phase) for another 30 –
40 seconds.
• Cyanosis excessive salivation, tongue or cheek biting and incontinence
may accompany to seizures.
• In the postictals phase the patients usually has muscle soreness, tired
and may sleep for several hours

2.(b). Absence seizures
• Formally called Patit mal seizures.
• Usually occurs only in children and rarely continuous beyond
adolescence.
• The typical clinical manifestation is a brief staring spells resembling
day dreaming that last only a few seconds so it often goes unnoticed.
• When untreated the seizures may occur up to 100 times a day.

2.(c). Myoclonic seizures
• Characterized by a sudden excessive jerk of the body or
extremities.
• The jerk may be forceful enough to hurl the person to the
ground.
• These seizures are brief and may occur in cluster.

2.(d). Atonic seizures:
• Drop attack
• Seizure involve either tonic episode or a paroxysmal loss of muscle
tone and begin suddenly with the person falling to the ground.
• Consciousness usually returns by the time the person hits the ground
and normal activity can be resume immediately.
• Patients with this type of seizures are at the great risk of head injury
and often have to wear protective helmets.

2.(e). Tonic seizure:
• Involved a sudden onset of maintained increase tone in the
extensor muscle.
• This patients often falls.

2.(f). Clonic seizures:
• Begin with loss of consciousness and sudden loss of muscle tone,
followed by limb jerking that may or may not be symmetric.

ETIOLOGY
• Unknown
• Vascular insufficiency
• Head injury.
• Brain infection conditions
• Hyperglycemia.
• Toxemia in pregnancy
• Hypertension.
• Metabolic changes.
• Drug and alcohol withdrawal.
• Degenerative brain disorder.
• Hypoxemia.
• Fever
• CVA
• Brain tumour.
• Allergy.

PATHOPHYSIOLOGY
PROXYSMAL ELECTRICAL DISCHARGE IN CORTICAL NEURONS
SPONTANEOUS FIRING OF ABNORMAL NEURONS
THIS FIRING SPREADS BY PHYSIOLOGIC PATHWAYS TO INVOLVE ADJACENT OR DISTANT AREAS
OF THE BRAIN
BREAKDOWN OF NORMAL MEMBRANE CONDUCTIVE & INHIBITORY SYNAPTIC CURRENTS
LOCALLY WIDELY
FOCAL SEIZURE GENERALIZED SEIZURE

CLINICAL MANIFESTATION
• Temporary confusion.
• LOC
• Uncontrollable jerky movement of the extremeties.
• Muscle stiffness / rigidity.
• Loss of muscle tone.
• Excessive salivation.
• Tongue or cheek bite.
• Cyanosis.

DIAGNOSTIC EVALUATION
• ASSESSMENT – P/E, H/C
• Birth and development history.
• Significant illness and injuries.
• Family history.
• Febrile seizures.
• Comprehensive neurological assessment.
• Seizure history.

Contd….
• Diagnostic studies:
• CBC , Urine analysis
• LP for CSF analysis.
• CT, MRI, PET SCAN
• EEG
• MRS ( Magnetic resonance spectroscopy).

EMERGENCY MANAGEMENT
• Ensure patient airway.
• Protect patient from injury during seizure do not restrain, pad side
rails.
• Remove or loosen tight clothing.
• Establish IV access.
• Stay with patients until seizure has passed.
• Administer medications.
• Suction is needed.
• Assist ventilations if patient does not breath spontaneously after
seizure, anticipate need for intubation if gag reflex absent.

MANAGEMENT
• ANTISEIZURES DRUG:
I.GENERALIZED TONIC
CLONIC & FOCAL SEIZURE
II. ABSENCE &
MYOCLONIC SEIZURE
Carbamazepine
Divalproex.
Phenobarbitone.
Phenytoin.
Valproic Acid.
Clorazepam
Divalproex.
Ethosuximide.
Zonisamide.

SURGICAL MANAGEMENT
• COMPLEX FOCAL SEIZURE:
• Resectioning of epileptogenic tissue.
• FOCAL SEIZURE:
• Resectioning of epileptogenic tissue.
• GENERALIZED SEIZURE:
• Hemispherectomy or callosotomy.

NURSING DIAGNOSIS
• Ineffective breathing pattern related to neuromuscular impairment.
• Disturbed thought process related to personality changes.
• Ineffective tissue perfusion related to cerebral edema.
• Knowledge deficit related to lack of exposure.
• Risk for injury related to loss of consciousness during seizures activity
postictal physical weakness.

NURSING CARE AFTER SEIZURES
To assist behavioural and conditions of patients after seizures.
Instruct the patient that treatment of seizure will be long
duration.
Drug should not be discontinue without permission of physician.
Do not drive alone.
Advice patient to avoid swimming and horse riding.
Patient should sit on floor when he or she feels aura signs.

COMPLICATION
1. STATUS EPILEPTICUS:
It is the state in which a client has continuous seizures or
seizures lasting at least 30 minutes.
2. HEAD INJURY.

Seizures

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