movement disorders

1. Movement
disorders

2. CHOREA

3. Chorea is a symptom that causes
involuntary, irregular or
unpredictable muscle
movements. It affects your arms,
legs and facial muscles. Chorea
comes from the Greek word that
means “to dance.” It can make
you look like you're dancing,
restless or fidgety.

4. SEIZURES/EPILEPSY/CONVULSIONS

5. INRODUCTION
 The brain is the center that controls and regulates all
voluntary and involuntary responses in the body.
 It consists of nerve cells that normally communicate
with each other through electrical activity.

6.  A seizure is a sudden, uncontrolled electrical disturbance
in the brain, results in changes in behaviour, movements,
feelings, and in levels of consciousness.
 If the person has two or more seizures or a tendency to
have recurrent seizures, than it is called as epilepsy.
 Most seizures last from 30 seconds to 2 minutes. A
seizure that lasts longer than 5 minutes is a medical
emergency.

7. DEFINITION
 A Seizure is a paroxysmal, uncontrolled electrical discharges
of neurons in the brain that interrupts normal function results
in episodes of abnormal motor, sensory, autonomic or
psychic activity (or a combination of these).
 Seizure are sudden, abnormal electrical discharges from the
brain that results changes in sensation, behaviour,
movements, perceptions or consciousness.

8. CONVULSION
 Seizure associated with motor component results in
sudden, abnormal, irregular, involuntary contraction
of the muscles of the body and thus results in
uncontrolled shaking of the body. The term
convulsion is sometimes used as a synonym for
seizure.

9. EPILEPSY
The word epilepsy derived from Greek Word ‘Epilepsia’.
Epilepsy is a group of syndromes characterized by
unprovoked, recurring seizure/convulsions, over time.
 Epilepsy is a 2 or more unprovoked seizures and
convulsions in more than 24 hours apart.

10. INCIDENCE AND PREVALENCE
 It is estimated that there are more than 10 million persons with
epilepsy in India.
 The prevalence is higher in the rural compared to urban population.
 Approximately 50 million people worldwide have epilepsy, making it
one of the most common neurological diseases globally.
 Epilepsy is the 4th most common neurological problem.
 Affects people of all ages.
 People with epilepsy respond to treatment approximately 70% of the
time.

11. TYPES OF SEIZURES

12. CLASSIFICATION
FOCAL CONCIOUSNESS
ALERT
SIMPLE FOCAL
SEIZURES
ALTERED
COMPLEX FOCAL
SEIZURES
GENERALIZED
PROBABLE ALTERED
CONCIOUSNESS
GENERALIZED
TONIC-CLOIC
ABSENCE
BRIEF OR POSSIBLE
ALTERED
CONCIOUSNESS
MYOCLONIC
TONIC
CLONIC
ATONIC

13. PARTIAL / FOCAL SEIZURE

14. 1. Partial seizures takes place when abnormal electrical
brain function occurs in one or more areas of one
side of the brain.
2. One third of the person with partial seizures may
experience an aura before seizure occurs. An aura is
a strange feeling either consisting of visual changes,
hearing abnormalities or changes in the sense of
smell.

15.  Partial seizure is divided into 2 categories.
1. Simple Partial Seizure
2. Complex Partial Seizure

16. 1. SIMPLE PARTIAL SEIZURE
 The seizure typically last less than 1 minute.
 These seizure do not result in loss of
consciousness.

17. 2. COMPLEX PARTIAL SEIZURE
 In this type of seizure the person has a change
in or loss of consciousness for a period of time.

18. GENERALIZED SEIZURE

19.  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.
 There is loss of consciousness.
 There is no warning or aura.

20. Types of generalized seizures include the following:
1. Absence or petit mal seizure.
2. Tonic clonic seizure or Grandmal seizure.
3. Myoclonic Seizure.
4. Tonic seizure.
5. Clonic seizure.
6. Atonic seizure.

21. 1. ABSENCE OR PETIT MAL SEIZURE
 These seizures are characterized by an altered state of
consciousness and staring episodes.
 Typically, the person's posture is maintained during the
seizure.
 The mouth or face may move or the eyes may blink.
 The seizure usually lasts no longer than 30 seconds.
 When the seizure is over, the person may not recall what just
occurred and acting as though nothing happened.

22. 2. TONIC-CLONIC SEIZURES
 Also called as Grand Mal Seizures.
 This seizure is characterized by 5 distinct phases that occur.
1. The body, arms, and legs will flex (contract) for 30-40
seconds.
2. Extend (straighten out)
3. Tremor (shake)
4. Clonic period (contraction and relaxation of the muscles).
Cyanosis, excessive salivation, tongue or cheek biting,
and incontinence may occur.

23. 5. Post ictal period- The patient usually has muscle
soreness.
During the post ictal period, the person may be
sleepy, have problems with vision or speech, and
may have a bad headache, fatigue, or body aches.

24. 3. MYOCLONIC SEIZURE
 This type of seizure refers to quick movements or
sudden jerking of a group of muscles or twitches of
the upper body, arms or legs.
 These seizures tend to occur in clusters, meaning that
they may occur several times a day, or for several
days in a row.

25. 4. TONIC SEIZURE
Tonic seizures causes stiffening of the muscles,
generally those in back, arms, legs, and may
cause the person to fall to the ground.

26. 5. CLONIC SEIZURE
 These type of seizures are begins with loss of
consciousness and sudden loss of muscle tone
followed by limb jerking that may or may not be
symmetric.
 Symptoms include rhythmic, jerking muscle
contractions usually affecting the arms, neck and face.

27. 6. ATONIC SEIZURE
 Also known as ‘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.
 Conscious usually returns once the person hits in the
ground and they have the great risk of head injury.

31. ETIOLOGY
The exact cause of the seizure may not be known, the more
common seizures are caused by the following:
In newborns and infants:
 Birth trauma
 Congenital (present at birth) problems
 Fever
 Metabolic or chemical imbalances in the body
 Genetic influence.

32. In children, adolescents, and adults:
 Alcohol or drugs
 Head trauma
 Infection
 Developmental disorder such as autism, down
syndrome.
 Unknown reasons

33. Other possible causes of seizures may include the following:
 Brain tumor
 Neurological problems
 Drug withdrawal
 Overdose of antidepressants and other medications
 Stroke or transient ischemic attack.
 Dementia such as alzheimers diseases.
 Traumatic brain injury.
 Infections including brain abscess, meningitis, encephalitis, aids.
 Abnormal blood vessels in the brain.
 Exposure to led, carbon monoxide, and many other poison.

34. CLINICAL FEAURES
 The person may have varying degrees of symptoms depending upon
the type of seizure.
 Symptoms or warning signs may include:
 Staring
 Jerking movements of the arms and legs
 Stiffening of the body
 Loss of consciousness
 Breathing problems or breathing stops
 Loss of bowel or bladder control
 Falling suddenly for no apparent reason

35.  Not responding to noise or words for brief periods
 Appearing confused or in a haze
 Sleepiness and irritable upon waking in the morning
 Nodding the head
 Periods of rapid eye blinking and staring
 During the seizure, the person's lips may become bluish and
breathing may not be normal.
 The movements are often followed by a period of sleep or
disorientation.

36. DIAGNOSTIC EVALUATION
 History collection AND Physical examination.
Birth and developmental history
Significant illness and injuries
Family history
Febrile seizures
 Neurological examination.

37. Seizure History
 Precipitating factors
 Antecedent events
 Seizures description (including onset, duration,
frequency, postictal state)

38.  CBC, urinalysis, electrolytes, creatinine, fasting blood
glucose
 Lumber puncture for CSF
 CT, MRI, MRA, MRS, PET SCAN
 Electroencephalography (EEG)
CONT.
MRI detected right insular tumour in an old patient
with history of epilepsy

39.  Electroencephalogram
(EEG)- A procedure that
records the brain's
continuous, electrical
activity by means of
electrodes attached to the
scalp.

40. INITIAL INTERVENTION
 Ensure patent airway
 Protect patient from injury during seizures
 Do not restrains, bed side rails.
 Remove or loosen tight clothes.
 Establish IV access.
 Stay with patient until seizures has passed.
 Anticipate administration of medications to control seizures.
 Suction if needed.
 Assist ventilation if patient does not breath spontaneously after seizure.
 Anticipate need for intubation if gag reflex is absent.

41. MANAGEMENT
 Surgical management
 Antiseizures drugs
 Vagal Nerve stimulation
 Psychosocial Counseling

42. • Complex focal seizures of temporal lobe origin:
Resectioning of epileptogenic tissues.
 A surgical procedure to remove the
part of the brain that is causing
seizures
• Focal seizures of frontal lobe
origin:
Resectioning of epileptogenic tissue (if
in resectable area)

43. • Generalized seizures (lennox- gastaut syndrome or drop attacks):
Sectioning of corpus callosum
 It involves cutting the major pathway
connecting the two cerebral hemispheres, which
is the corpus callosum. This procedure is
primarily used in epilepsy cases where seizures
are not controlled by other methods.

44. • Intactable unilateral multifocal epilepsy associated with infantile
hemiplegia :
Hemispherectomy or callosotomy
 Hemispherectomy involves either removing or disconnecting a
whole cerebral hemisphere, while callosotomy involves cutting the
corpus callosum, the nerve fibers connecting the two brain
hemispheres

45. VAGUS NERVE STIMULATION (VNS)

46.  There are some side effects that may occur with
the use of VNS. These may include.
Hoarseness
Pain or discomfort in the throat
Changes in the voice.

47. PSYCHOLOGICAL TREATMENT: It include-
 Psychosocial counseling.
 Relaxation therapy.
 Cognitive behavior therapy.

48. COMPLICATION
 STATUS EPILEPTICUS- It is a acute
prolonged seizure activity that
occur full recovery of
consciousness between attacks.
 Last 30 minutes without
impairment of consciousness.
 Vigorous muscular contraction
may interfere with respiration
and may cause hypoxia to the
brain and leads to brain damage.

49. Treatment
 Adequate oxygenation.
 IV Diazepam, Lorazepam
 Phenytoin and phenobarbital are administered later to
maintain a seizure free state.

50. NURSING MANAGEMENT
 Move harmful object out of the way.
 Cushion the head
 Protect the person from falling.
 Side rails of bed should be padded to prevent injury , if the patient’s
extremity hits against them.
 Loosen ties and tight fitting clothing.
 Do not put anything in the patient’s mouth.
 The individual should not be restrained because they may increase the risk
of injury.
 If the person started to vomiting turn the person on his /her left side to
protect the airway and to help drain away any mouth secretions.

51.  Suction the airway and make it clear and patent. But do not force
an airway in once the seizure has begun.
 If the person is not breathing start the rescue breathing and seek
immediate medical attention.
 Observe the length of seizure, the movements involved, direction
of head and eye movements and the time it takes to return to full
consciousness and alertness. And the information should be
reported to the medical profession.

52. THANK YOU