2. • Seizure is a paroxysmal, uncontrolled electrical
discharge of neurons in the brain that
interrupts normal function.
• Seizures may accompany a variety of
disorders, or they may occur spontaneously
without any apparent cause.
3. • Epilepsy is a condition in which a person has
spontaneous recurring seizures caused by a
chronic underlying condition.
• In the United States, it is estimated that more
than 3 million people have active epilepsy,
with 200,000 new cases diagnosed each year.
• National trends show that the incidence of
epilepsy is
4. Incidence
• increasing in older adults.
• New cases of epilepsy are more common in African
Americans and in socially disadvantaged populations.
• Males are slightly more likely to develop epilepsy
than females.
• People at high risk for developing epilepsy include
those with Alzheimer’s disease or those who have had a
stroke.
• The risk is also increased in the child of a person who
has epilepsy
5. Etiology and Pathophysiology
• Seizure disorders have many possible causes,
with the most common causes varying by age.
• The most common causes of seizure disorder
during the first 6 months of life are severe
birth injury, congenital defects involving the
central nervous system (CNS), infections, and
inborn errors of metabolism
6. • In people between 2 and 20 years of age, the primary
causes are birth injury, infection, trauma, and genetic
factors.
• In individuals between 20 and 30 years of age, seizure
disorder usually occurs as the result of structural
lesions, such as trauma, brain tumors, or vascular
disease.
• After 50 years of age, the primary causes of seizure
disorders are stroke and metastatic brain tumors.
• However, nearly 30% of all epilepsy cases are
idiopathic, called idiopathic generalized epilepsy (IGE),
meaning they are not attributable to a specific cause
7. pathophysiology
• The etiology of recurring seizures (epilepsy) has long been
attributed to a group of abnormal neurons (seizure focus) that
seem to undergo spontaneous firing.
This firing spreads by physiologic pathways to involve
adjacent or distant areas of the brain. If this activity spreads
to involve the whole brain, a generalized seizure occurs.
The factor that causes this abnormal firing is not clear.
Any stimulus that causes the cell membrane of the neuron to
depolarize induces a tendency for spontaneous firing
8. Clinical Manifestations and types of
seizure
• The specific clinical manifestations of a seizure
are determined by the site of the electrical
disturbance.
9. Phases of seizure
• Depending on the type,
• a seizure may progress through several phases:
• (1) the prodromal phase, with signs or activity
that precede a seizure
• (2) the aural phase, with a sensory warning
• (3) the ictal phase, with full seizure
• (4) the postictal phase, the period of recovery
after the seizure.
11. Generalized Seizures
• Generalized seizures involve both sides of the
brain and are characterized by bilateral
synchronous epileptic discharges in the brain
from the onset of the seizure.
• In most cases the patient loses consciousness
for a few seconds to several minutes.
13. Tonic-Clonic Seizures
• The most common generalized seizure is the
generalized tonic-clonic (formerly known as
grand mal) seizure.
• Tonic-clonic seizure is characterized by losing
consciousness and falling to the ground if the
patient is upright, followed by stiffening of the
body (tonic phase) for 10 to 20 seconds and
subsequent jerking of the extremities (clonic
phase) for another 30 to 40 seconds.
14. • Cyanosis
• excessive salivation,
• tongue or cheek biting
• incontinence may accompany the seizure
15. Typical Absence Seizures
• The absence seizure (formerly called petit mal) usually
occurs only in children and rarely continues beyond
adolescence.
• This type of seizure may cease altogether as the child
matures, or it may evolve into another type of seizure.
• The typical clinical manifestation is a brief staring spell
• resembling “daydreaming” that lasts only a few
seconds, so it often goes unnoticed.
• When untreated, the seizures may occur up to 100
times a day
16. Atypical Absence Seizures
• Another type of generalized seizure is atypical
absence seizure, which is characterized by a
staring spell accompanied by other signs and
symptoms, including brief warnings, peculiar
behavior during the seizure, or confusion after
the seizure
17. • It is longer lasting than a typical absence
seizure and may be associated with loss of
postural tone.
18. • Other Types of Generalized Seizures. Other
generalized seizures are myoclonic, atonic,
tonic, and clonic seizures
19. myoclonic seizure
• A myoclonic seizure is 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
clusters.
20. Atonic seizure
• An atonic (“drop attack”) seizure involves
either a tonic
• episode or a paroxysmal loss of muscle tone
and begins suddenly with the person falling to
the ground.
• Consciousness usually returns by the time the
person hits the ground, and normal activity
can be resumed immediately.
21. • Patients with this type of seizure are at a great
risk of head injury and often have to wear
protective helmets.
22. tonic seizure
• A tonic seizure involves a sudden onset of
maintained increased tone in the extensor
muscles.
• These patients often fall.
• .
23. Clonic seizures
• Clonic seizures begin with loss of
consciousness and sudden loss of muscle
tone, followed by limb jerking that may or
may not be symmetric
24. Focal Seizures
• Focal seizures, also called partial or partial
• focal seizures, are the other major class of
seizures
• Focal seizures begin in one hemisphere of the
brain in a specific region of the cortex, as
indicated by the EEG.
• They produce signs and symptoms related to
the function of the area of the brain involved
25. Complications
• Physical.
• Status epilepticus is a state of continuous
seizure activity or a condition in which
seizures recur in rapid succession without
return to consciousness between seizures
26. • It is the most serious complication of epilepsy
and is a neurologic emergency.
• Status epilepticus can occur with any type of
seizure.
• During repeated seizures the brain uses more
energy than can be supplied.
27. • Neurons become exhausted and cease to
• function.
• Permanent brain damage may result.
• Tonic-clonic status epilepticus is the most
dangerous because it can cause ventilatory
insufficiency, hypoxemia, cardiac
dysrhythmias, hyperthermia, and systemic
acidosis, all of which can be fatal
28. Psychosocial
• Perhaps the most common complication of
seizure disorders is the effect it has on a
patient’s lifestyle.
• The patient may develop ineffective coping
methods because of the psychosocial
problems related to having a seizure disorder.
29. Diagnostic Studies
• The most useful diagnostic tools are an
accurate and comprehensive description of
the seizures and the patient’s health history
30. • The EEG is a useful diagnostic adjuvant to the
history, but only if it shows abnormalities.
• Abnormal findings help determine the type of
seizure and help pinpoint the seizure focus.
• Ideally, an EEG should be done within 24
hours of a suspected seizure
31. • A complete blood count, serum chemistries,
studies of liver and kidney function, and a
urinalysis should be done to rule
out metabolic disorders.
• A CT scan or MRI should be done in any new-
onset seizure to rule out a structural lesion.
• Cerebral angiography, single-photon emission
computed tomography (SPECT), magnetic
resonance spectroscopy (MRS), MRA, and
positron emission tomography (PET) may be used
in selected clinical situations
32. Collaborative Care
• The primary drugs to treat generalized tonic-
clonic and focal seizures are phenytoin
(Dilantin), carbamazepine (Tegretol),
phenobarbital, divalproex, and primidone
(Mysoline).
• The drugs used to treat absence and
myoclonic seizures include ethosuximide
(Zarontin), divalproex, and clonazepam
• (Klonopin)
33. • Other antiseizure drugs include gabapentin,
topiramate,
lamotrigine (Lamictal), tiagabine (Gabitril), levetiracetam
• (Keppra), and zonisamide (Zonegran).
• Some of these drugs are broad spectrum and appear to
be effective for multiple seizure types.
• Pregabalin (Lyrica) is used as an “add-on” for control of
• focal seizures that are not successfully managed with a
single medication
34. • Treatment of status epilepticus requires
initiation of a rapid- acting IV antiseizure drug.
• The drugs most commonly used are
lorazepam (Ativan) and diazepam (Valium).
Because these are short-acting drugs, their
administration is followed with long- acting
drugs such as phenytoin or phenobarbital
35. Surgical Therapy
• A significant number of patients whose
epilepsy is not controlled with drug therapy are
candidates for
surgical intervention to remove the epileptic focus or
prevent
spread of epileptic activity in the brain .
• The most common surgical intervention is an anterior
temporal lob resection.
• Approximately 70% of patients are essentially seizure
free after this procedure
36. • The benefits of surgery include cessation or reduction in
frequency of the seizures.
• An extensive preoperative evaluation is
important, including continuous EEG monitoring and other
specific tests to ensure precise localization of the focal point.
• Surgical candidates must meet three requirements:
• (1) a confirmed diagnosis of epilepsy
• (2) an adequate trial with drug therapy without satisfactory
results
• (3) a defined electro clinical syndrome (type of seizure
disorder).
37. Other Therapies
• Vagal nerve stimulation is used as an
adjunct to medications when surgery is not
feasible.
• The exact mechanism of action is unknown,
but it is thought to interrupt the
synchronization of epileptic brain wave
activity and stop excessive discharge of
neurons
38. Diet
• The ketogenic diet is a special high-fat, low-
carbohydrate
diet that has been used to control seizures in some
people with epilepsy.
• When a person is on this diet, ketones are produced
and pass into the brain and replace glucose as an energy
source.
• The diet may be effective for some patients with drug-
resistant epilepsy, but the long-term effects of the diet
are not clear.
• Patients on this diet who use anticoagulants need close
monitoring for bleeding
39. • Biofeedback to control seizures is aimed at
teaching the patient to maintain a certain
brain wave frequency that is refractory to
seizure activity.
• Further trials are needed to assess the
effectiveness of biofeedback for seizure control.
40. Nsg diagnosis
• • Ineffective breathing pattern related to
neuromuscular impairment
• • Ineffective self-health management related
to drug therapy and lifestyle adjustments
• • Risk for injury related to loss of
consciousness during seizure activity and
postictal physical weakness
41. interventions
• When a seizure occurs, carefully observe and
record details of the event because the
diagnosis and subsequent treatment
• . Note all aspects of the seizure.
42. • Both subjective data (usually the only type of data in
the
aural phase) and objective data are important.
• Note the exact onset of the seizure (which body part
was affected first and how); the course and nature of
the seizure activity (loss of consciousness, tongue
biting, automatisms, stiffening, jerking, total lack of
muscle tone);
• the body parts involved and their sequence of
involvement; and autonomic signs, such as dilated
pupils, excessive salivation, altered breathing, cyanosis,
flushing, diaphoresis, or incontinence.
43. • After the seizure the patient may require
repositioning to open and maintain the
airway, suctioning, and oxygen.
• A seizure can be frightening for the patient
and for others who witnessed it.
• Assess the level of their understanding and
provide information about how and why the
event occurred.
