Review of seizure disorders (generalised & partial) and status epilepticus.

1. SEIZURES / STATUS EPILEPTICUS

2. SEIZURES / STATUS EPILEPTICUS
• Seizures: a disorder of the
electrical activity of the brain
• Seizures can be provoked (TBI,
SAH, CVA, ect.) or unprovoked
(genetic, metabolic, ect.)
• Seizures can be classified as
Generalized & Partial

3. SEIZURES / STATUS EPILEPTICUS
Generalized
seizures
effect both
hemispheres
of the brain
Partial seizures
effect a
localized
region of the
brain
• Generalized and partial seizures have different clinical presentation.
• There are multiple types of generalized and partial seizures.

4. SEIZURES / STATUS EPILEPTICUS
Seizures
Partial Seizures
Complex
Partial
Simple Partial
Generalized Seizures
Tonic - Clonic
(Grand Mal)
Absence (Petit
Mal)
Myoclonic
Tonic Atonic

5. SEIZURES / STATUS EPILEPTICUS

6. GENRALIZED SEIZURES
• Generalized Tonic-Clonic (GTC):
– Abrupt → Tonic (stiffening) → Clonic (muscle jerking) → Confusion/Decreased
LOC/Weakness/Paralysis
– Generalized seizures (generalized tonic-clonic seizures [GTCS]) classically
involve loss of consciousness and a phasic tonic stiffening of the limbs,
followed by repetitive clonic jerking.*
– Most GTCS are self-limited without intervention.*
– EEG shows bisynchronous epileptiform activity in both cerebral hemispheres.*
* BMJ Best Practice http://ca.bestpractice.bmj.com.libraryproxy.nshealth.ca:2048/best-practice/monograph/112/overview/conditions.html

7. GENRALIZED SEIZURES
• Absence:
– Brief loss of consciousness (loss of expression, eye blinking,
starring)
• Myoclonic
– Brief muscle jerking of the upper extremities
• Tonic:
– Sudden stiffness (tonic) → collapse
• Atonic:
– Sudden loss of muscle tone (atonic) → collapse

8. PARTIAL SEIZURES
• Simple Partial (Focal):
– Short duration without a loss of LOC
– Varied symptoms
(motor/sensory/autonomic/psychological)
– Motor: jerking / twitching
– Sensory: numbness / tingling / burning
– Autonomic: flushing / tachycardia / nausea
– Psychological: hallucinations / anxiety /
panic / abnormal behaviour
– Can progress to a GTC seizure

9. PARTIAL SEIZURES
• Complex Partial:
– Short duration without a loss of LOC
– Movement of one side of the body or one
specific body part
– Premonitory sensation or experience (fear,
epigastric sensation, déjà vu, jamais vu)
– Automatisms (picking at clothes, smacking of
the lips)
– Temporary aphasia
– Staring and loss of contact with the
environment

10. Seizures
• Seizures can be provoked (Metabolic/Trauma
SAH/CVA/ETOH/Drugs) or unprovoked
(unknown cause).
• Epilepsy is defined as recurrent seizures. It
can be unprovoked (unknown cause) or
secondary from a previous cerebral insult (i.e.
head injury)

11. :
• Most seizures are brief (2-3 minutes)
• Partial or focal seizures effect only one region
of the brain
• Simple or Complex partial seizures may
progress to a GTC seizure
• Generalized seizures effect the whole brain
• Seizures can be provoked (direct insult) or
unprovoked (indirect insult)

12. NURSING CARE OF SEIZURES:
❶ Nursing Interventions:
• GCS / VS / ABC’s
• Padded bed rails
• Close observation
• Patient & Family Education
❷ Benzodiazepines PRN:
• Enhances the inhibitory effect of GABA
• Lorazepam / Diazepam / Midazolam IV PRN

13. NURSING CARE OF SEIZURES:
❸ Anticonvulsants Medications
• Administer anticonvulsants as scheduled
• Phenytoin:↓ Na+
• Valproic Acid: ↓ Na+ ↑ GABA
• Carbamazepine: ↓ Na + ↑GABA
• Lamotrigine: ↓Na+
• Topiramate (Topamax): ↓Na + ↑GABA
• Gabapentin: ↓ Ca + ↑ GABA

14. STATUS EPILEPTICUS
• Generalized Tonic - Clonic Seizures:
Postical
(recover)
Clonic
(muscle
jerking)
Tonic
(muscle
stiffing)
Sudden
Onset (loss
of LOC)
2-5 minutes duration 10-30
minutes

15. STATUS EPILEPTICUS
Ketamine IV
MgSo4 IV
Steroids IV

16. STATUS EPILEPTICUS
• Prolonged status epilepticus results in a down
regulation of GABA receptors and an up
regulation of excitatory receptors.
Glutaminergic!!!!

17. STATUS EPILEPTICUS
• Prolonged Status Epilepticus results
in neuronal cellular necrosis and
• The goal of treatment is to achieve
burst suppression on the EEG (no
seizures).
• SAT/SBT trails do not apply to these
patients. Decreasing sedation may
result in seizures.

18. STATUS EPILEPTICUS
❶ Benzodiazepines: ↑ GABA
❷ Propofol: GABA-like effect
❸ Barbituates: ↑↑ GABA
❹ Ketamine: ↓ NMDA
❺ Magnesium: ↓ NMDA (?)

19. Thank You