This study examined the incidence of epilepsy-related injuries and accidents in 292 patients seen at an outpatient epilepsy clinic in Germany over a period of one year. The study found that 14% of patients experienced injuries related to seizures in the past 3 months, with the most common being lacerations, abrasions, bruises, and fractures. Risk factors associated with higher rates of injury included having generalized seizures, a family history of epilepsy, lower quality of life scores, and depression. The results indicate epilepsy poses a risk of injury that clinicians should seek to prevent or minimize through optimized treatment and safety precautions.

1. SEIZURE
PREPARED BY
Ms.Mahalakshmi.L
M.Sc Nursing 2nd Year

2. INTRODUCTION
• Seizure is a common neurological
condition . A seizure occurs when the
function of electrical system of brain
disturb. Seizures occurs at any time or
any place like during rest or work.

3. DEFINITION
• SEIZURE
A sudden involuntary, time limited alteration
in behavior , motor activity , autonomic
function, consciousness, or sensation,
accompanied by an abnormal electrical
discharge in the brain.

4. • Epilepsy
A neurological disorder marked by sudden
recurrent episodes of sensory disturbance, loss
of consciousness, or convulsion , associated
with abnormal electrical activity in the brain.

5. EPIDEMIOLOGY
• It is estimated that 1 is 26 people will develop
epilepsy during his or her lifetime. The
incidence of single unprovoked seizures 23-62
cases per 1,00,000 persons-years, while the
incidences of acute symptomatic seizure is 29-
39 cases per 1,00,000 population per year.

6. CAUSES
• NEONATE
Hypoxic ischemic encephalopathy
Brain bleeds
Infection
Hypoglycemia
Ischemic stroke

7. • CHILDREN
Febrile seizure
Other reason
Infections metabolic disorder
Drugs
Poisons
Bleeding inside the brain

8. • Adult
Abnormal level of sodium or glucose in the blood
Brain infection, including meningitis and
encephalitis
Brain injury
Electric shock
Vascular disease
• Idiopathic

9. RISK FACTOR
• A family history of seizure disorders
• Any injury to the brain from trauma, a stroke,
previous infection and other causes
• Sleep deprivation
• Medical problems that affect electrolyte balance
• Heavy alcohol abuse
• Vascular disease
• Seizure in childhood

10. Types

11. Types of seizure
Partial seizure
• Begins with an electrical discharge in one
limited area of the brain
• Related to head injury , brain infection , stroke
or tumor

12. SIMPLE PARTIAL SEIZURE
• Affect only asmall region of the brain, often
the temporal lobes and/or hippocampi.
People who have simple partial seizures
retain consciousness.
• Usually last for less then 2 mins.

13. Signs and symptoms
• MOTOR SEIZURE
• brief muscle contractions (twitching, jerking, or
stiffening), often beginning in the face,finger, or
toe on one sideof the body.
• twitching or jerking spreadsto other parts of the body
on the same sidenear the initial site.
• other motor seizuresmayinvolve movement of the eye
and head.
• the seizurebeginsthe samewayeachtime.
• the patient remainsconscious.

14. • SENSORYSEIZURES
• seeingsomething that is not there, suchasshapes
or flashing lights, or seeingsomething aslarger or
smaller than usual
• hearing or smelling something that is notthere
• feeling of pins and needles or numbness in part of
the body
• the patient remainsconscious.

15. • PSYCHICSEIZURES
• problems with memory
• garbled speech
• sudden emotions for no apparent
reason such as fear,depression, rage,or
happiness.

16. 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.

17. Signs and symptoms of complex
seizure
• warning signsuchasafeeling of fear or nausea
• lossof awareness
• confusion after theseizure
• lossof memory about events just before or after the
seizure.
• Screaming or thrashing, either from sleep or while
awake
• Automatisms such as mouth movements,
picking clothing, repeating words orphrases

18. GENERALIZED SEIZURE
• Begins with a widespread electrical discharge.
• Involves both side of the brain at once.
• Hereditary factor are important

19. 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.

20. Signs and symptoms
• staring
• The patient suddenly stops what sheisdoing
• afew secondsof unresponsiveness (usually less
than 10 seconds, but it canbe up to 20 seconds)
that can be confused with daydreaming
• no response when you touch your child
• The patient is alert immediately afterthe
seizure
• The patient may have many seizures per day

21. • Lesscommon featuresinclude:
 repetitive blinking
 eyesrolling up
 head bobbing
 automatisms such aslicking, swallowing, and hand
movements
 autonomicsymptoms such as dilated pupils,
flushing, pallor, rapid heartbeat, or salivation

22. MYOCLONIC SEIZURES
• involve an extremely brief (< 0.1 second)
muscle contraction and can result in jerky
movements of muscles or muscle groups.

23. Signs and symptoms
• one or many brief jerks, which may involve
the whole body or asingle arm or leg
• in juvenile myoclonic epilepsy, these jerks
often occur uponwaking
• the patient remainsconscious

24. Clonic seizure
• Myoclonus that are regularly repeating at a
rate typically of 2-3 second.in some cases , the
length varies.

25. ATONIC SEIZURES
• involve the loss of muscle tone, causing the
person to fall to the ground. Theseare
sometimes called 'drop attacks' but should
be distinguished from similar looking attacks
that may occur in cataplexy.

26. Signs and symptoms
• sudden lossof muscletone
• the patient goeslimp and falls straight to theground
• The patient remains consciousor hasabrief lossof
consciousness
• eyelids droop, headnods
• jerking
• the seizure usually lasts lessthan 15 seconds, although
somemaylast several minutes
• the patient quickly becomesconsciousand alert
againafter theseizure

27. Tonic seizure
• Usually last for less than 20 sec.
• In such seizure the tonic is greatly . Increase
and the body , arms or legs marken sudden
stiffening movements. Increase muscle on of
extensor muscles.
• Conscious is usually preserved.
• Seizure must often occur during sleep usually
involves all or most of the brain , affecting
both side of the body

28. TONIC–CLONIC SEIZURES
• involve an initial contraction of the muscles (tonic
phase) which mayinvolve tongue biting, urinary
incontinence and the absenceof breathing. Thisis
followed by rhythmic muscle contractions (clonic
phase). Thistype of seizure is usually what is
referred to when the term 'epileptic fit' is used
colloquially

30. Signs and symptoms
• the patient cries out or groansloudly
• the patient losesconsciousnessand fallsdown
• 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 pressurerise
• sweating
• tremor

31. • in the clonic phase, the patient resumes shallow
breathing; her arms and legs jerk quickly and
rhythmically; her pupils contract anddilate
• at the end of the clonic phase, the child relaxes
and maylose control of her bowel or bladder
• following the seizure, the child regains
consciousness slowly and may appear drowsy,
confused, anxious, or depressed

32. PATHOPHYSIOLOGY
• Seizure producing
stimuli(trauma,highfever,brain injury)
• a small group of abnormal neurons undergo
prolonged depolarizations associated with
the rapid firing of repeated action potentials.

33. • These abnormally discharging epileptic
neurons recruit adjacent neurons or neurons
with which they are connected into the
process
• the electrical discharges of a large number of
cells become abnormally linked together
• creating a storm of electrical activity in the
brain

34. • Seizures may spread to involve adjacent
areas of the brain or through established
anatomic pathways to other distant areas

35. COMPLICATION
• Status epilepticus
• Social challenges
• anxiety

37. DIAGNOSTIC EVALUATION
1. HISTORY
2. PHYSICAL EXAMINATION
3. NEUROLOGICAL EXAMINATION
4.BLOOD TESTS
5.ELECTROENCEPHALOGRAM

38. 6.CT SCAN
7.MAGNETIC RESONANCE IMAGING
8.FUNCTIONAL MRI (FMRI)
9.POSITRON EMISSION TOMOGRAPHY
10.SINGLE-PHOTON EMISSION COMPUTERIZED
TOMOGRAPHY
11.NEUROPSYCHOLOGICAL TESTS

39. MANAGEMENT OF SEIZURE

40. NON-PHARMACOLOGICAL
MANAGEMENT

41. KETOGENIC / LOW CARBOHYDATE
DIET
 VAGAL NERVE STIMULATION (VNS)

42. SURGICAL MANGEMENT

43. • Temporal lobe resection
• Lesionectomy
• Functional Hemispherectomy
• Corpus Callosotomy
• Extratemporal Cortical Resection

46. NURSING DIAGNOSIS
• Ineffective airway clearance related to
obstruction of airway by secretions as evidenced
by dyspnea
• Ineffective tissue perfusion related to seizure
activity as evidenced by decreased oxygen
saturation
• Risk for injury related to seizure activity
• Ineffective coping related to psychosocial &
economic consequences of epilepsy as evidenced
by patient is uncooperating

47. JOURNAL
• Incidence , Risk Factors and Consequences of
Epilepsy-Related Injuries and Accidents: A
Retrospective, Single Center Study
• Introduction: This study was designed to evaluate
risk factors and incidence of epilepsy-related
injuries and accidents (ERIA) at an outpatient
clinic of a German epilepsy center providing
healthcare to a mixed urban and rural population
of over one million inhabitants.

48. • Methods: Data acquisition was performed
between 10/2013 and 09/2014 using a validated
patient questionnaire on socioeconomic status,
course of epilepsy, quality of life (QoL),
depression, injuries and accidents associated with
seizures or inadequate periictal patterns of
behavior concerning a period of 3 months.
Univariate analysis, multiple testing and
regression analysis were performed to identify
possible variables associated with ERIA.

49. • Results: A total of 292 patients (mean age 40.8 years, range 18–86;
55% female) were enrolled and analyzed. Focal epilepsy was
diagnosed in 75% of the patients. The majority was on an
antiepileptic drug (AEDs) polytherapy (mean number of AEDs:
1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related
injuries and accidents in a 3-month period. Besides lacerations (n =
18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6,
2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were
reported. In 20 (6.8% of the total cohort) cases, urgent medical
treatment with hospitalization was necessary. Epilepsy-related
injuries and accidents were related to active epilepsy, occurrence of
generalized tonic-clonic seizures (GTCS) and drug-refractory course
as well as reported ictal falls, ictal loss of consciousness and
abnormal peri-ictal behavior in the medical history. In addition,
patients with ERIA had significantly higher depression rates and
lower QoL.
• Conclusion: ERIA and their consequences should be given more
attention and standardized assessment for ERIA should be
performed in every outpatient visit.