Neurological Seizures

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  • http://www.epilepsy.com/node/3006
  • http://www.epilepsy.com/node/3007
  • Wears a helmet
  • http://www.youtube.com/watch?v=Ws-USSsSPH0
  • Prevention not Cure
  • ;

Transcript

  • 1. Seizure Disorders
  • 2. Seizures: Electrical Activity
    • Abrupt, uncontrolled electrical discharges of cerebral neurons that interrupts normal brain function
    • May be a symptom of an underlying illness or may be spontaneous
  • 3. Epilepsy
    • Group of syndromes characterized by spontaneous reoccurring seizures
    • When seizures continue to occur for unknown reasons or because of an underlying problem that cannot be corrected, the condition is known as epilepsy.
  • 4. Classification of Seizures Generalized Seizures Partial Seizures
  • 5. Generalized Seizure
    • Affects entire brain
    • No warning
    • Loss of consciousness
  • 6. Types of Generalized Seizures
    • Tonic –clonic (grand mal)
      • Loss of consciousness
      • Fall to ground
      • Tonic- muscles stiffness & Clonic-extremity jerking
      • Excessive salivation
      • Cheek biting
      • Incontinence may occur
    • Tonic – muscle stiffness
    • Clonic-muscle contraction and relaxation (jerking)
    • Absence seizures – disconnects from the world for a few seconds (staring, glaring)
    • Myoclonic seizures – involves jerking only for a few seconds
  • 7. Partial Seizures (Simple or Complex)
    • Local onset
    • May or may not loose consciousness
    • Begin in a specific area of brain
    • May generalize and turn into tonic-clonic seizures
  • 8. Causes of Seizure Disorder
    • Idiopathic (unknown)
    • Birth injury
    • CNS defects or infection
    • Head trauma
    • Brain tumors
    • CVA- cerebral vascular disease
    • Chronic disease
    • Metabolic disorders
  • 9. PRECIPITATING FACTORS
    • Fatigue
    • Decreased physical health
    • Alcohol ingestion
    • Emotional stress
    • Flashing lights
    • Menstrual cycle
    • Hypoglycemia
    • Sleep deprivation
    • Stimulants
    • Withdrawal
    • Substance abuse
    • High Fever
    • Electrolyte imbalance
    • Hypoxia
  • 10. Diagnostic Studies
    • MOST USEFUL diagnostic tool is an accurate and comprehensive description of the seizures and health history
    • Electroencephalogram (EEG)
      • Not completely reliable
    • CT/CAT, MRI, PET scans
    • Labs (e.g. electrolytes/drug screen) to R/O other medical causes
  • 11. Electroencephalography: EEG
  • 12. Clinical Manifestations
    • Determined by the site of the electrical disturbance
    • May involve
      • Changes in consciousness
      • Motor
      • Sensory/senses
      • Emotional
      • Combinations
  • 13. Signs & Symptoms
    • May have a variety of presentations
    • Prodrome
      • epileptic cry
    • Sensory changes
      • Deja vue
      • Aura- Smells, sights, numbness, tingling, emotional changes
    • May have motor symptoms
  • 14. Complications of Seizure
    • Greatest risk with loss of consciousness
    • Trauma from fall
    • Head injury
    • Drowning
    • Auto accident
  • 15. Phases of Seizure
    • Pre-ictal-before the seizure
      • May have warning
    • Ictal-during seizure
    • Postictal-after the seizure
      • Usually lethargic, sleepy, memory loss
  • 16. During a Seizure…
  • 17. During a Seizure…
  • 18. During a Seizure…
  • 19. During a Seizure…
  • 20. During a Seizure…
  • 21. During a Seizure…
  • 22. Seizure Management
    • Monitor seizure activity and time event
    • Maintain patent airway
      • Support head or neck
      • Turn patient on side to prevent aspiration
    • Prevent or minimize injury
      • Do not restrain; stay with client
      • Ease patient to floor
      • Protect head
      • Loosen restrictive clothing
      • Do not place anything in mouth
    video
  • 23. Nursing Interventions: post seizure
    • Assess VS, LOC (GCS), pupils
    • May require O2 or suctioning
    • Patient will usually sleep
    • Reorient pt when arouses
    • Allow to rest
    • Dextrose if hypoglycemic
    • Administer prescribed meds
  • 24. Seizure Precautions
    • Hospital at bedside:
      • Oxygen
      • Suction
      • Oral Airway
      • IV access
      • Bed in low position
      • Side rails up
        • Padded side rails controversial
    • No padded tongue blades
  • 25. Drug Therapy: Antiepileptic Drugs
    • Stabilize nerve cell membranes
    • Prevent the spread of epileptic discharges
    • 80% of patients controlled with medication
  • 26. Common Medications
    • Phenytoin (Dilantin)
    • Carbamazepine (Tegretol)
    • Valproic acid (Depakene)
    • Barbiturates -Phenobarbital
    • Succinimides -Zarontin
    • Benzodiazepines – Valium, Ativan
    • Clonazepam –Klonopin
    • Newer Antiseizure Drugs
    • Neurontin
    • Lamictal
    • Felbatol
    • Topamax
    • Cerebyx
  • 27. Education
    • Medication
    • Therapeutic drug levels
    • Drug-drug and food-drug interactions
    • Stress compliance with medications
    • Do not stop abruptly
    • What to do if you miss a dose
    • Client and Family Education
    • Care of client during a seizure
    • When to call 911
    • Seizure precautions
    • Keep seizure diary
    • Rest; Manage stress
    • Take medications as prescribed
  • 28. Status Epilepticus
    • State of continuous seizure activity
    • Neurological emergency
    • Uses up all brain energy stores
    • May cause permanent brain damage
    • Tonic-clonic Status Epilepticus can lead to a respiratory or cardiac arrest and death
  • 29. Emergency Care
    • Status Epilepticus
      • Establish airway
      • Administer oxygen
      • IV antiseizure drugs
        • Lorazepam (Ativan) or Diazepam (Valium): a short-acting benzodiazepine
        • Phenytoin (Dilantin) long-acting
      • Stat labs
  • 30. Surgical Management
    • Remove the epileptic focus
    • Prevent spread of epileptic activity
    • Involves resection of brain tissue/ lobe
  • 31. Brain Mapping
  • 32. Video with EEG
  • 33. Alternative Therapies: Do NOT REPLACE DRUGS
    • Biofeedback
    • Ketogenic Diet-high fat low carb
      • Body burns fat instead of glucose for energy
    • Vagal nerve stimulation
      • Implantation of a device to stimulate the vagal nerve
      • To abort the seizure
  • 34. Psychosocial
    • Social stigma
    • Unable to drive
    • Fear of embarrassment
    • Effects of medications
  • 35. Complications of Status Epilepticus
    • Aspiration
    • Cerebral hypoxia
    • Musculoskeletal trauma
    • Death
  • 36. Referrals and resources
    • Refer to community resources
    • Resources: Epilepsy Foundation Of America, National Epilepsy League