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1. Seizure Disorders
Fcaulty: Ferzana Rahim(nursing lecturer)

2. Seizure Disorders
• SEIZURES
• Seizures are episodes of abnormal motor, sensory, autonomic,
or psychic activity (or a combination of these) resulting from
sudden excessive discharge from cerebral neurons.

3. Two main types:

6. causes of seizures
• Idiopathic (genetic, developmental defects)
• Acquired [vascular insufficiency, fever (childhood), head injury,
hypertension, central nervous system infections, metabolic and
toxic conditions (e.g, renal failure, hyponatremia,
hypocalcaemia, hypoglycemia, pesticides), brain tumor, drug
and alcohol withdrawal, and allergies]
• Cerebrovascular disease is the leading cause of seizures in the
elderly.

7. Uncontrolled electrical discharges lead to seizures.
Associated symptoms
• loss of consciousness
• excess movement
• or loss of muscle tone or movement
• disturbances of behavior, mood, sensation, and
perception.

9. Phases of seizures

10. Nursing Management During a Seizure
• A major responsibility of the nurse is to observe and record the sequence of symptoms.
Before and during a seizure, the following are assessed and documented:
 The circumstances before the seizure (visual, auditory, or olfactory stimuli, tactile
stimuli, emotional or psychological disturbances, sleep, hyperventilation)
 The occurrence of an aura (visual, auditory, or olfactory)
• The first thing the patient does in a seizure—where the movements or the stiffness
starts, conjugate gaze position, and the position of the head at the beginning of the
seizure.
• This information gives clues to the location of the seizure origin in the brain. (In
recording, it is important to state whether the beginning of the seizure was observed.)

11. Pharmacological therapy
• For partial seizures, common first-line medications include
carbamazepine (Tegretol), phenytoin (Dilantin), Oxcarbazepine
(Trileptal) and, especially in children, ethosuximide (Zarontin).
Additionally, phenobarbital is often the medication of choice for
seizures in very young children.

12. Nursing Management During a Seizure
• The type of movements in the part of the body involved
• The areas of the body involved (turn back bedding to expose patient)
• The size of both pupils. Are the eyes open? Did the eyes or head turn to one side?
• The presence or absence of automatisms (involuntary motor activity, such as lip smacking or
repeated swallowing)
• Incontinence of urine or stool
• Duration of each phase of the seizure
• Unconsciousness, if present, and its duration
• Any obvious paralysis or weakness of arms or legs after the seizure
• Inability to speak after the seizure
• Movements at the end of the seizure
• Whether or not the patient sleeps afterward
• Cognitive status (confused or not confused) after the seizure

13. Nursing Management After a Seizure
• Prevent from injury
• Supporting the patient not only physically but also
psychologically.
• Document the events before, during and after the seizure
• To prevent complications (eg, aspiration, injury)
• patient is placed in the side-lying position to facilitate drainage
of oral secretions and is suctioned.
• low position of bed with side rails up and padded.

14. THE EPILEPSIES
• Epilepsy is a group of syndromes characterized by recurring seizures.
• Epilepsy is not synonymous with mental retardation or illness.
• Many who are developmentally disabled because of serious neurologic
damage, however, have epilepsy as well.
• An estimated 2 to 4 million people in the United States have
• epilepsy (1 in 100 adults is affected), and onset occurs before the
• age of 20 years in greater than 75% of patients.
• the elderly must be monitored closely for adverse and toxic effects of
antiseizure medications and for osteoporosis

15. Etiology of Epilepsy
• Inherited
• birth trauma, asphyxia neonatorum, head injuries, some
infectious diseases, circulatory problems, fever, metabolic and
nutritional disorders, and drug or alcohol intoxication.
• brain tumors, abscesses, and congenital malformations.

16. Pathophysiology
• During the period of unwanted dischargesparts of the body
controlled by the errant cells may perform erratically. Resultant
dysfunction ranges from mild to incapacitating and often
causes unconsciousness
• When these uncontrolled, abnormal discharges occur
repeatedly a person is said to have an epileptic syndrome.

17. Clinical Manifestations
• Depending on the location of the discharging neurons.
• In simple partial seizures, only a finger or hand may shake, or the mouth
may jerk uncontrollably. The person may talk unintelligibly, may be dizzy,
and may experience unusual or unpleasant sights, sounds, odors, or
tastes,
 but without loss of consciousness.
• In complex partial seizures, the person either remains motionless or
moves automatically but inappropriately for time and place, or may
experience excessive emotions of fear, anger, elation,or irritability.
 Whatever the manifestations, the person does not remember the
episode when it is over.

18. Generalized seizures(grand mal seizures)
involve both hemispheres of the brain, causing both sides of the body
to react.
intense rigidity of the entire body followed by alternating muscle
relaxation and contraction (generalized tonic–clonic contraction).
• The simultaneous contractions of the diaphragm and chest muscles
may produce a characteristic epileptic cry.
• Tongue biting and the patient is incontinent of urine and stool.
• After 1 or 2 minutes, the convulsive movements begin to subside;
the patient relaxes and lies in deep coma, breathing noisily.

21. Generalized seizures(grand mal seizures)
• The respirations at this point are chiefly abdominal.
• In the postictal state (after the seizure), the patient is often
confused and hard to arouse and may sleep for hours.
• Many patients complain of headache, sore muscles, fatigue,
and depression

22. Assessment and Diagnostic Findings
• Patient history
• MRI
• EEG
• Blood test
• SPECT( single-photon emission computerized tomography)

23. Women With Epilepsy
• Women with epilepsy often note an increase in seizure
frequency during menses; this has been linked to the increase
in sex hormones.
• Fetal malformation has been linked to the use of multiple anti
seizure medications.
• The effectiveness of contraceptives is decreased by antiseizure
medications.
• Anti seizure medication increased risks for osteoporosis.

24. Prevention
• Society-wide efforts
• Closely monitoring of epileptic mothers & High-risk mothers
• Reduced Head injury  Through highway safety programs and
occupational safety precautions decreased risk of epilepsy

25. Medical Management
• Medication therapy controls rather than cures seizures.
• Side effects of anti seizure agents may be divided into three groups:
(1) idiosyncratic or allergic disorders, which present primarily
as skin reactions
(2) acute toxicity, which may occur initially when medication started.
(3) chronic toxicity, which occurs late in the course of therapy.
Manifestations of drug toxicity are variable
• Gingival hyperplasia (swollen and tender gums) can be associated
with long-term use of phenytoin

26. • Nurses must take care when administering lamotrigine which is
resemble to many other drugs. It cause adverse effects called
Severe rash (Stevens-Johnson syndrome).
SURGICAL MANAGEMENT
• Surgery is indicated for patients whose epilepsy results from
intracranial tumors, abscess, cysts, or vascular anomalies .

27. • Nursing Process ???????????

28. Status epilepticus
• Major potential complication of patients with epilepsy is as follows:
• Status epilepticus (acute prolonged seizure activity) is a series of generalized
seizures that occur without full recovery of consciousness between attacks.
• The term has been broadened to include continuous clinical or electrical seizures
lasting at least 30 minutes, even without impairment of consciousness.
• It is considered a medical emergency.
• respiratory arrest at the height of each
• seizure that produces venous congestion and hypoxia of the brain

30. Medical Management
• The goals of treatment are to stop the seizures as quickly as possible,
to ensure adequate cerebral oxygenation, and to maintain
the patient in a seizure-free state.
 An airway and adequate oxygenation are established.
 If the patient remains unconscious and unresponsive, a cuffed endotracheal
tube is inserted.
• Intravenous diazepam/lorazepam given .
• An intravenous line is established, and blood samples are obtained to monitor
serum electrolytes, glucose, and phenytoin levels
• Vital signs and neurologic signs are monitored.
• An intravenous infusion of dextrose is given if the seizure is due to
hypoglycemia

31. Nursing management?????

32. Thank you