Seizures central nervous system

1. SALALE UNIVERSITY COLLEGE OF HEALTH SCIENCE
DEPARTMENT OF ADULT HEALTH NURSING
TITLE: Seizure Disorder
SUBMITTED TO : Mr Bikila T (Ass’t Professor)
Prepared by: Mulunesh Mosisa
ID 187/15 OCT 2023
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2. OUTLINES
• Introduction.
• Definition.
• Etiology.
• Pathophysiology.
• Clinical manifestations.
• Diagnostic evaluation.
• Complications.
• Management
• prevention
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3. Objectives
• At the end of this course the student will be able to :
• Define seizure disorder
• Describe Type of seizure disorder
• Identify the etiology of seizure disorder
• Understand pathophysiology of seizure disorder
• understand Clinical manifestation of seizure disorder
• Identify diagnosis and management of seizure disorder
• Describe nursing management, complication and prevention of
seizure disorder
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4. Introduction
• Seizure disorders is disturbance of brain’s electrical
activity periodically,resulting in some degree of
temporary brain dysfunction.
• Normal brain function requires an orderly organized ,
coordinated discharge of electrical impulses.
• Electrical impulses enable the brain to communicate
with spinal cord, nerves and muscles as well as within
itself .
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5. DEFINITION
• Seizures are sudden, abnormal electrical discharges from
the brain that results in changes in sensation, behavior,
movements, perception, or consciousness.
• Epilepsy is a chronic disorder of recurrent seizures.
• It is neurological disorder in which a person has two or
more unprovoked seizures that occur more than 24 hours
apart.
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6. ETIOLOGY
• High fever
• Traumatic brain injury.
• Infections including brain abscess, meningitis, encephalitis
and HIV/AIDS.
• Brain problems that are present at birth (congenital birth
defects),brain tumor, abnormal blood vessels in brain.
• Brain injury that occurs during or near birth.
• Metabolism disorders present at birth (phenylketonuria).
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7. PATHOPHYSIOLOGY
Due to etiological factors
The
The integrity of the neuronal cell membrane is altered
The cell begins firing with increased frequency & amplitude
When the intensity of the discharges reaches the threshold
The neuronal firing spreads to adjacent neurons
Ultimately resulting in a seizure.
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8. Types of seizure
• PARTIAL SEIZURES: The neurologic abnormality may be
limited to a specific part or focus of brain.
• GENERALIZED SEIZURES: additionally the seizure may
involve the entire cortical surface (cerebral cortex).
1. Partial seizures:
Simple Partial seizures.
Complex partial seizures
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9. 2. Generalized seizures:
• Absence seizure.
• Myoclonic seizure.
• Clonic seizure.
• Tonic seizure.
• Generalized tonic-clonic seizure.
• Atonic seizure.
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10. Phases
Depending on the types, a seizure may progress through
several phase.
The prodromal phase: with signs or activity which precede a
seizure).
The aural phase: with a sensory warning (aura is an unusual
sensations of smell /taste/ butterflies in stomach /feeling of
opposite or unfamiliar and intense feeling)
The ictal phase (with full seizure).
The postictal phase (period of recovery after seizure).
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11. Partial seizures (focal origin)
• These are most common type of epilepsy.
• The first clinical and ECG changes indicate initial activation
of neurons in one part of cerebral hemisphere.
• Simple partial seizures (no impairment of consciousness).
• Four types
1) Motor manifestations: arise from a focus in motor cortex.
seizures occur in part of body innervated by motor neurons
originating in the affected region of cortex.
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12. Cont…
• The hand and fingers have largest cortical representations,
many focal motor seizures begin with convulsive
movement in the upper extremity.
• Involuntary movements may spread centrally & involve the
entire limb , including one side of face & lower extremity.
• This progression or spread is known as the “Jacksonian
march’’.
• The client also exhibit changes in posture or spoken
utterances.
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13. 2. Somato-sensory manifestations
:
• If the epileptogenic focus is in the parietal region, the
client experiences sensory phenomena such as
numbness & tingling in the affected area.
• If the focus is in the occipital region, the client may
experience bright, flashing lights in the field of vision
opposite the side of focus.
• The client can have changes in speech or taste with
involvement of the posterior temporal area of
dominant hemisphere.
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14. 3.Autonomic manifestations
• Seizures of the autonomic system produce epigastric
sensation, pallor, sweating, flushing( being red face)
,piloerection/ goose flesh (involuntary erection or
bristling of hair ), pupillary dilation, tachycardia and
tachypnea .
4 .Psychic manifestations
• Seizures arising in the anterior temporal lobe can
begin with psychic manifestations.
• These seizures frequently begin with an aura.
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15. Complex partial seizure : (impairment of consciousness)
• The most characteristics features of a complex partial
seizure are accompanying automatisms ( an action
performed unconsciously or involuntarily.
• These automatic behaviors include purposeless,
repetitive activities such as lip_ smacking,chewing,
patting a part of the body,or picking clothes while in a
dreamy state.
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16. Generalized Seizures
• These seizures lead to a loss of consciousness .
• They can be convulsive or non convulsive and involve both
hemispheres.
Absence seizures( petit mal): These are abrupt periods of
staring and lapses of awareness lasting a few seconds to a
few minutes.
Myoclonic seizures:sudden uncontrolled jerking
movements of either a single muscle group or
multiple groups, sometimes causing the client to fall.
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17. Cont…
Clonic seizures : clonic seizures include rhythmic muscular
contraction & relaxation lasting several minutes.
Tonic seizures :an abrupt increase in muscular tone
& muscular contraction. It can cause falls and injuries.
Generalized tonic clonic seizures (Grand mal) :
Tonic clonic seizures are the type of seizures most
closely associated with epilepsy.
An aura may or may not be present,sudden loss of
consciousness may occur.
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18. Cont…
Atonic seizures (Drop attack):a total loss of muscle tone.
• The client briefly nodding the head(a gesture in which
the head is tilted in alternating up and down arcs) ,or
the client may fall to floor.
• Consciousness is impaired only briefly.
.
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19. Clinical manifestations of a Seizure
• Extended blank stare
• "Empty" look in eyes
• Rapid blinking
• Eyes rolling upward
• Periods of unresponsiveness
• falling down
• Inability to pay attention
• Repetitive (tic-like) movements of body parts, usually
head, arms, legs
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20. C/M cont…
• Uncontrollable jerking and twitchs body movements
• Mouth movements with a dazed look
• Frothing at mouth
• Loss of consciousness
• Loss of body control
• Dazed walking
• Temporary confusion
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21. Diagnosis
• History of events.
• Physical examination including neurologic
examination &description of seizure activity.
• EEG (electroencephalogram). This test assists in
locating the focus of abnormal electrical
discharge.
 Establishing a diagnosis of epilepsy.
 Identifying the specific type of seizures.
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22. Diagnosis cont…
• CT scan & MRI: are used to rule out brain lesions .
• PET (positron emission tomography) & SPECT (single
photon emission computed tomography) may be
helpful to measure cerebral blood in clients
undergoing surgery for epilepsy.
• Lab studies may rule out other causes for the
seizures, RBS,CBC, KFT,LFT, Lumbar puncture, etc.
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23. COMPLICATIONS
• Fracture of bone.
• Impair intelligence.
• Unable to get job, driver’s license, life insurance.
• Socially stigmated.
• Reduced quality of life.
• A complication called ‘’sudden unexpected death in
• epilepsy’’
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24. MANAGEMENT
Goals of management of clients with seizures and epilepsy :
• To prevent injury during seizures,
• To eliminate factors that precipitate seizure, and
• To control seizures to allow a desired lifestyle.
• To maintain the airway.
• To administer appropriate anticonvulsant drugs.
• Any tight clothing around the person’s neck is loosened.
• Turning the client to his/her side .
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25. Medications are used to control seizures
• Currently available anti-epileptic drugs appear to act
primarily by blocking the initiation or spread of
seizures.
• Ex. Phenytoin .
• Fosphenytoin sodium.
• Carbamazepine.
• Valproic acid .
• Lamotrigine.
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26. Prevention
• Take all medication as prescribed.
• Sleep: lack of sleep is big contributing factors to seizures.
• eat regular meals, skipping meals can lead to
hypoglycemia which can trigger seizures.
• Avoid alcohol and drugs.
• Exercise ,exercise is linked to reducing stress levels.stress is
known trigger for seizures.
• Pay attention to fever.
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27. NURSING MANAGEMENT
• Preventing injuries and suffocation.
• Maintaining patient airway clearance and preventing
aspiration.
• Enhancing self esteem.
• Promoting adherence to therapeutic management.
• Initiating patient education and teachings.
• Administer medication and provide pharmacologic
support.
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28. Nursing Assessment
• Assess your patient for signs and symptoms of seizure
activity, such as his report of an aura or twitching of
muscle groups,especially in his face or hands.
• A neurological exam. A health care professional may
evaluate your behavior, motor abilities and mental
function.
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29. Nursing Diagnosis
• Risk for trauma related to loss of large or small muscle
co-ordination as evidenced by abnormal body spasm.
• Risk for ineffective airway clearance related to
tracheo-bronchial obstruction as evidenced by oral
secretions.
• Low self esteem or situational low self -esteem related to
stigma associated with condition as evidenced by
verbalization about changed lifestyles.
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30. Goals
• Seizures activity control.
• Complications or injury prevented.
• Disease process or prognosis, therapeutic regimen, and
limitations understood.
• Plan in place to meet needs after discharge.
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31. Nursing Interventions
• Prevent or control seizure activity.
• Maintain airway or respiratory function.
• Protect patient from injury
• Promote positive self-esteem
• Provide information about disease process, prognosis, and
treatment needs.
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32. Summary
• Seizure disorders is disturbance of brain’s electrical
activity periodically,resulting in some degree of
temporary brain dysfunction.
• Epilepsy is a chronic disorder of recurrent seizures.
• There are many types of seizures, and they have a range of
symptoms.
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33. REFRENCES
• Black JM, Hawks JH, A textbook of Medical Surgical
Nursing , 8th edition,2nd volume, published by saunders
publication,page No.1811.
• Chintamani, A textbook of Lewis’s Medical Surgical
Nursing :
Assessment & Management of Clinical Problems ,
Published by Mosby publication, page no.14498.
• https://nurseslabs.com/4-seizure-disorder-nursing-care-
plans/
• https://medlineplus.gov/ency/article/000694.htm
• http://www.msdmanuals.com/home/brain,-spinal-cord,-
and-nerve- disorder/ seizure_disorders/seizure _disorders
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