Seizures are caused by abnormal electrical activity in the brain. There are many types of seizures that can cause mild to severe symptoms depending on which part of the brain is affected. Seizures are generally managed through medication, emergency response during seizures, ongoing nursing assessment, and diagnostic evaluation by medical providers when needed.

1. MARY KATHERINE ROSS MICHELLE F. TIANO

2. SEIZURE
Seizures are symptoms of a brain problem. They happen because
of sudden, abnormal electrical activity in the brain. When people
think of seizures, they often think of convulsions in which a
person's body shakes rapidly and uncontrollably. Not all seizures
cause convulsions. There are many types of seizures and some
have mild symptoms. Seizures fall into two main groups. Focal
seizures, also called partial seizures, happen in just one part of
the brain. Generalized seizures are a result of abnormal activity
on both sides of the brain.

3. ANATOMY
SCALP SKULL
DURA

4. ANATOMY
• A tough 3-layer sheath that surrounds the brain and spinal cord
• Layers include the dura mater (strongest layer), arachnoid mater
(middle layer), and pia mater (closest to the brain)

5. ANATOMY
THE CEREBRUM
• Made up of two cerebral
hemispheres that are connected in
the middle
• It is the largest part of the brain
• Each area of the cerebrum
performs an important
function, such as language or
movement
• Higher thought (cognition) comes
from the frontal cortex (front
portion of the cerebrum)
• Outside of the cerebrum are blood
vessels
• There are fluid-filled cavities and
channels inside the brain

6. ANATOMY
THE CEREBELLUM
• Located in the lower, back part of
the skull
• Controls movement and coordination
THE BRAINSTEM AND PITUITARY GLAND
• Responsible for involuntary
functions such as breathing, body
temperature, and blood pressure
regulation
• Pituitary gland is the "master
gland" that controls other
endocrine glands in the body, such
as the thyroid and adrenal glands
• Pineal gland

7. ANATOMY
THE CRANIAL NERVES
• Twelve large nerves exit the
bottom of the brain to supply
function to the senses such as
hearing, vision, and taste
THE CEREBRAL BLOOD VESSELS
• A complicated system that supplies
oxygenated blood and nutrients to
the brain

8. ANATOMY
ANTERIOR CEREBRAL CIRCULATION
• The front of the brain is supplied
by the paired carotid arteries in
the neck.
POSTERIOR CEREBRAL CIRCULATION
• The back portion of the brain is
supplied by the paired vertebral
arteries in the spine.

9. PATHOPHYSIOLOGY
• A seizure occurs when a portion of the brain becomes overly excited or
when nerves in the brain begin to fire together in an abnormal fashion.
• Seizure activity can arise in areas of the brain that are malformed from
birth defects or genetic disorders or disrupted from
infection, injuries, tumors, strokes, or inadequate oxygenation.
• The pathophysiology of seizures results from an abrupt imbalance
between the forces that excite and inhibit the nerve cells such that the
excitatory forces take precedence.
• This electrical signal then spreads to the surrounding normal brain
cells, which begin to fire in concert with the abnormal cells.
• With prolonged or recurrent seizures over a short period, the risk of
future seizures increases as nerve cell death, scar tissue formation, and
sprouting of new axons occur.

10. PATHOPHYSIOLOGY
• Nerve cells between discharges normally have a negative charge
internally due to the active pumping of positively charged sodium ions
out of the cell.
• Discharge or firing of the nerve cell involves a sudden fluctuation of the
negative charge to a positive charge as ions channels into the cell open
and positive ions, such as sodium, potassium, and calcium, flow into the
cell. Both excitatory and inhibitory control mechanisms act to allow
appropriate firing and prevent inappropriate excitation of the cell.
• The pathophysiology of seizures can occur due to increased excitation of
the nerve cell, decreased inhibition of the nerve cell, or a combination
of both influences.

11. CAUSES
COMMOM CAUSES
• Alcohol abuse • Head injury • Low blood sugar
• Alcohol withdrawal • Insulin reaction • Petit-mal seizure
• Cancer • Low blood oxygen • Stroke
• Concussion • Low blood pressure • Vasovagal syncope
• Drug abuse • Encephalitis • Epilepsy
LESS COMMON CAUSES
• AIDS • Cerebral arteriovenous • Fat embolism
• Alzheimer's disease malformation • Heatstroke
Amyotrophic lateral • Depression • Hydrocephalus
sclerosis • Drug interaction • Hypocalcemia
• Amyloidosis • Drug side effect • Hypoglycemia
• Brain abscess • Drug toxicity • Hypomagnesemia
• Brain tumor • Drug withdrawal • Hypotension
• Cerebral aneurysm • Eclampsia • Intracerebral
• Cerebral hemorrhage • Epidural hematoma hemorrhage

12. CAUSES
• Kidney failure • Parkinson's disease • Thrombotic
• Lead poisoning • Phenylketonuria thrombocytopenic
• Liver failure • Pulmonary purpura
• Malaria embolism • Tourette's
• Meningitis • Reye's syndrome syndrome
• Multiple sclerosis • Subarachnoid • Whooping cough
• Neurofibromatosis hemorrhage • Thiamine
• Neurosyphilis • Subdural deficiency
• Organophosphate hematoma • Sarcoidosis
poisoning • Tay-Sachs disease

13. PROBLEMS
• Aspiration pneumonia
• Depression
• Injuries that occur during the seizure:
o Fractures
o Tongue laceration
o Dental injury
o Shoulder dislocation
• Learning disabilities
• Mallory-Weiss tear
• Medication side effects
• Status epilepticus:
o Seizure that lasts longer than 30 minutes
o Multiple episodes of seizure without complete recovery between
episodes
• Rhabdomyolysis

14. TYPES
I. PARTIAL SEIZURE
• SIMPLE PARTIAL SEIZURE : affect only a small region of the brain, often
the temporal lobes and/or hippocampi. People who have simple partial
seizures retain consciousness.
• COMPLEX PARTIAL SEIZURE : may involve the unconscious repetition of
simple actions, gestures or verbal utterances, or simply a blank stare
and apparent unawareness of the occurrence of the seizure, followed
by no memory of the seizure.
II. GENERALIZED SEIZURES
• ABSENCE SEIZURES : involve an interruption to consciousness where
the person experiencing the seizure seems to become vacant and
unresponsive for a short period of time (usually up to 30 seconds).
Slight muscle twitching may occur.
• MYOCLONIC SEIZURES : involve an extremely brief (< 0.1 second)
muscle contraction and can result in jerky movements of muscles or
muscle groups.

15. TYPES
• CLONIC SEIZURES : are myoclonus that are regularly repeating at a rate
typically of 2-3 per second. in some cases, the length varies.
• TONIC–CLONIC SEIZURES : involve an initial contraction of the muscles
(tonic phase) which may involve tongue biting, urinary incontinence and
the absence of breathing. This is followed by rhythmic muscle
contractions (clonic phase). This type of seizure is usually what is
referred to when the term 'epileptic fit' is used colloquially.
• ATONIC SEIZURES : involve the loss of muscle tone, causing the person
to fall to the ground. These are sometimes called 'drop attacks' but
should be distinguished from similar looking attacks that may occur in
cataplexy.
III. MIXED SEIZURES
• Mixed seizure is defined as the existence of both generalized and
partial seizures in the same patient.

16. TYPES
IV. CONTINUOUS SEIZURES
• STATUS EPILEPTICUS : refers to continuous seizure activity with no
recovery between successive seizures. When the seizures are
convulsive, it is a life-threatening condition and emergency medical
assistance should be called immediately if this is suspected. A tonic-
clonic seizure lasting longer than 5 minutes (or two minutes longer
than a given person's usual seizures) is usually considered grounds for
calling the emergency services.
• EPILEPSIA PARTIALIS CONTINUA : is a rare type of focal motor seizure
(hands and face) which recurs every few seconds or minutes for
extended periods (days or years). It is usually due to strokes in adults
and focal cortical inflammatory processes in children (Rasmussen's
encephalitis), possibly caused by chronic viral infections or
autoimmune processes.

17. SIGN & SYMPTOMS
I. ABSENCE SEIZURE
• staring
• the child suddenly stops what she is doing
• a few seconds of unresponsiveness (usually less than 10 seconds, but it
can be up to 20 seconds) that can be confused with daydreaming
• no response when you touch your child
• the child is alert immediately after the seizure
• the child may have many seizures per day
Less common features include:
• repetitive blinking
• eyes rolling up
• head bobbing
• automatisms such as licking, swallowing, and hand movements
• autonomic symptoms such as dilated pupils, flushing, pallor, rapid
heartbeat, or salivation

18. SIGNS & SYMPTOMS
II. MYOCLONIC SEIZURE
• one or many brief jerks, which may involve the whole body or a single
arm or leg
• in juvenile myoclonic epilepsy, these jerks often occur upon waking
• the child remains conscious
III. ATONIC SEIZURE
• sudden loss of muscle tone
• the child goes limp and falls straight to the ground
• the child remains conscious or has a brief loss of consciousness
• eyelids droop, head nods
• jerking
• the seizure usually lasts less than 15 seconds, although some may last
several minutes
• the child quickly becomes conscious and alert again after the seizure

19. SIGNS & SYMPTOMS
IV. TONIC-CLONIC SEIZURE
• the child cries out or groans loudly
• the child loses consciousness and falls down
• in the tonic phase, the child is rigid, her teeth clench, her lips may turn
blue because blood is being sent to protect her internal organs, and
saliva or foam may drip from her mouth; she may appear to stop
breathing because her muscles, including her breathing muscles, are
stiff
• heart rate and blood pressure rise
• sweating
• tremor
• in the clonic phase, the child resumes shallow breathing; her arms and
legs jerk quickly and rhythmically; her pupils contract and dilate
• at the end of the clonic phase, the child relaxes and may lose control of
her bowel or bladder
• following the seizure, the child regains consciousness slowly and may
appear drowsy, confused, anxious, or depressed

20. SIGNS & SYMPTOMS

21. SIGNS & SYMPTOMS
V. MOTOR SEIZURE
• brief muscle contractions (twitching, jerking, or stiffening), often
beginning in the face, finger, or toe on one side of the body
• twitching or jerking spreads to other parts of the body on the same
side near the initial site
• other motor seizures may involve movement of the eye and head
• the seizure begins the same way each time
• the child remains conscious
VI. SENSORY SEIZURES
• seeing something that is not there, such as shapes or flashing lights, or
seeing something as larger or smaller than usual
• hearing or smelling something that is not there
• feeling of pins and needles or numbness in part of the body
• the child remains conscious

22. SIGNS & SYMPTOMS
VII. AUTONOMIC SEIZURES
• changes in heart rate
• changes in breathing
• sweating
• goose bumps
• flushing or pallor
• the child remains conscious
• strange or unpleasant sensation in the stomach, chest, or head
• changes in heart rate
• changes in breathing
• sweating
• goose bumps
• flushing or pallor
• the child remains conscious

23. SIGNS & SYMPTOMS
VIII. PSYCHIC SEIZURES
• problems with memory
• garbled speech
• problems with memory
• garbled speech
• sudden emotions for no apparent reason, such as
fear, depression, rage, or happiness
• feeling as though she is outside her own body
• feelings of déjà vu, jamais vu, or knowledge of the future
COMPLEX PARTIAL SEIZURE
• warning sign such as a feeling of fear or nausea
• loss of awareness
• confusion after the seizure
• loss of memory about events just before or after the seizure

24. SIGNS & SYMPTOMS
• loss of awareness
• blank stare
• walking or running
• screaming, yelling, or thrashing, either from sleep or while awake
• automatisms such as mouth movements, picking at air or
clothing, repeating words or phrases
• confusion after the seizure
• loss of memory about events just before or after the seizure

25. MANAGEMENT
INITIAL INTERVENTION
PROPER INTERVENTIONS SHOULD TAKE PLACE AT THE TIME OF SEIZURE ACTIVITY
1. Staff observing the seizure activity should notify the nurse and provide an accurate
description of the clinical presentation. The nurse should document the reported
observations in the nursing notes.
2. Staff should notify the nurse immediately if the individual continues to seize for
more than two (2) consecutive minutes or the individual experiences two (2) or
more generalized seizures without full recovery of consciousness between seizures.
a. The nurse should assess the condition of the individual immediately after
receiving the call for assistance. The assessment should include the individual’s
level of cardio-pulmonary risk. Any action taken, including a request for
medical consultation, should be documented in the nursing notes.
b. The nurse should continue to follow the procedures outlined in the guideline
for Prolonged Seizure Activity, documenting reported observations, personal
observations, actions taken, and the individual’s response to treatment in the
nursing notes.

26. MANAGEMENT
NURSING ASSESSMENT
NURSING ASSESSMENT OF SEIZURE ACTIVITY SHOULD OCCUR AND BE DOCUMENTED
IN THE NURSING NOTES.
1. Appropriate information about what occurred during the ictal (active seizure)
phase should be documented. If the nurse does not actually witness the
seizure, persons present should be consulted to obtain the information.
2. The individual should be monitored during the postictal phase of the seizure. The
individual’s postictal condition and activity should be documented. 3. Any action
taken, including a request for medical consultation, should be documented in the
nursing notes.
DIAGNOSTIC REASONING
SIGNIFICANT OR UNUSUAL FINDINGS SHOULD BE REPORTED IMMEDIATELY TO THE
PRIMARY CARE PRESCRIBER
The decision of what to report is based on review of the seizure characteristics as well
as the seizure history which includes :

27. MANAGEMENT
1. current seizure medications and past history,
2. current frequency of seizures, date of last seizure, and type and characteristics of
seizures,
3. any complications or injuries related to the seizures,
4. neurological consultation reports including results of specified follow-up,
5. EEG reports and results, and
6. recent serum anticonvulsant levels.
PLANNING
PLANNING STRATEGIES RELATED TO SEIZURE MANAGEMENT SHOULD OCCUR AND BE
DOCUMENTED
1. The individual’s risk factors and actual or potential health problems should be
included in the health assessment report and also in the Single Plan as needed.
2. If the individual receives psychotropic medication, information about the
individual's seizure status and anticonvulsant medications should be discussed and
documented as part of the individual’s Psychotropic Drug Review Plan.

28. MANAGEMENT
3. Information regarding the type, frequency, and pattern of seizure activity;
precipitating and associated factors; and trends in seizure activity should be
included in the health section of the Single Plan.
4. Information about the potential and actual side effects of the prescribed
anticonvulsant medications should be included in the health section of the Single
Plan.
5. Training sessions for direct care staff as well as other team members should occur.
These sessions should include specific issues related to the individual’s seizures as
well as overall observation, management, documentation, and safety issues related
to seizure activity.
6. Specific nursing activities developed to eliminate and reduce seizures and to assist
the person become more independent in management of the seizure disorder
should be included in the Single Plan as needed. This may include activities related
to prevention of injuries and secondary complications.
IMPLEMENTATION
PLANS SHOULD BE IMPLEMENTED AND NURSING INTERVENTIONS DOCUMENTED
1. All orders for medication, treatment, and diagnostic procedures should be carried
out asprescribed by the primary care prescriber.

29. MANAGEMENT
2. The nursing notes should reflect that diagnostic procedures were completed as
ordered.
3. Appropriate injury protective practices should be initiated as prescribed by the
primary care prescriber or recommended by the Interdisciplinary Team. Team
recommendations should be included in the Single Plan.
4. The individual’s seizure activity should be accurately documented in the individual’s
record. Periodic review to identify trends and changes should be documented in
the nursing notes.
5. For additional information on documentation procedures, see the Nursing
Documentation Guideline.
EVALUATION
EVALUATION OF THE SEIZURE MANAGEMENT PLAN SHOULD OCCUR AND THE
RESULTS DOCUMENTED.
1. The nurse should monitor the results of seizure management program and make
recommendations to the primary care prescriber and interdisciplinary team for
changes based on the progress noted.
2. Side effects and untoward interactions of medications should be documented in
the nursing notes and reported immediately to the primary care prescriber.

30. MANAGEMENT
3. Trends and changes in seizure activity (type and/or frequency) should be
documented in the nursing notes and reported to the primary care prescriber.
4. Seizure records should be reviewed on a regular basis for accuracy and
completeness.
DIET
1. A well balanced diet should be eaten at regular times.
2. Coffee and other caffeinated beverages should be limited to a moderate amount.
3. Fluid intake should be between 1,000 to 1,500 ml per day (depending on the
weather).
4. Alcoholic beverages should be avoided.