This document discusses epilepsy and seizures. It defines seizures and epilepsy, describes different types of seizures including partial and generalized seizures. Common causes of epilepsy including strokes, brain injuries, tumors are mentioned. Management of seizures focuses on preventing injuries, identifying and removing seizure triggers, and treating with anti-seizure medications to control seizures. Nursing care revolves around safety during seizures, airway management, education, and supporting patients' psychosocial needs.

1. BY:
Ekta S Patel
Assistant Professor

4. • Seizures are sudden, abnormal electrical
discharges from the brain that result in
changes in sensation, behavior,
movements, perception, or consciousness.
• Epilepsy is a chronic disorder of recurrent
seizures.
• An isolated , single seizure does not
constitute epilepsy.

5. • An epileptic syndrome consists of recurrent
episodes of one or more of the following
manifestations:
–Loss of consciousness.
–Convulsive movements or other motor
activity.
–Sensory phenomena .
–Behavioral abnormalities.

6. • Epilepsy occurs when
permanent changes in the
brain cause it to be too excitable or
irritable.
• As a result, the brain sends out
abnormal signals. This leads to
repeated unpredictable seizures.

7. • Epilepsy may be due to a medical
condition or injury that affects the
brain or the cause may be unknown.
• The common causes for epilepsy
include:
– Stroke or TIA.
– Dementia (like Alzheimer’s disease).

8. –Traumatic brain injury.
–Infections including brain abscess,
meningitis, encephalitis, and HIV/AIDS.
–Brain problems that are present at birth
(congenital birth defects).
–Brain injury that occurs during or near
birth.

9. –Metabolism disorders present at birth
(phenylketonuria).
–Brain tumor.
–Abnormal blood vessels in brain.
–Other illness that damages or destroys
brain tissue.

10. Ultimately resulting in a seizure.
When the intensity of the discharges reaches the
threshold the neuronal firing spreads to adjacent
neurons
The cell begins firing with increased frequency &
amplitude
The integrity of the neuronal cell membrane is altered.
Due to etiological factors

12. • Epilepsy may be classified according to
age of onset, cause, area of origin,
abnormalities on EEG, and clinical
manifestations of seizures.

13. • According to the International classification of
Epileptic seizures , based on clinical seizure type
and on EEG findings during seizures ( the ictal
period) and between seizures (the interictal
period).
• There are two major categories:
• PARTIAL SEIZURES: the neurologic abnormality
may be limited to a specific part or focus of
brain.
• GENERALIZED SEIZURES: additionally the
seizure may involve the entire cortical surface
(cerebral cortex).

16. 1. Partial seizures:
1) Simple Partial seizures.
2) Complex partial seizures.
2. Generalized seizures:
1) Absence seizure.
2) Myoclonic seizure.
3) Clonic seizure.
4) Tonic seizure.
5) Generalized tonic-clonic seizure.
6) Atonic seizure.

17. • Depending on the types, a seizure may
progress through several phases:
–The prodromal phase (with signs or
activity which precede a seizure).
–The aural phase, with a sensory warning
(aura is an unusual sensations of smell /
taste/ butterflies in stomach / feeling of
opposite or unfamiliar and intense feeling).
–The ictal phase (with full seizure).
–The postictal phase (period of recovery
after seizure).

18. •These are most common type of epilepsy.
•The first clinical & electroencephalographic
changes indicate initial activation of neurons
in one part of cerebral hemisphere.

19.  no impairment of consciousness
 It has 4 types that do not impair
consciousness.

20. – These arise from a focus in motor
cortex.

21. – Because the hand and fingers have
largest cortical representations , many
focal motor seizures begin with
convulsive movement in the upper
extremity.
– Involuntary movements may spread
centrally & involve the entire limb,
including one side of face & lower
extremity.
• This progression or spread is known as
the ‘’ Jacksonian march’’.
• The client also may exhibit changes in
posture or spoken utterances

22. – If the epileptogenic focus is in the parietal
region the client experiences sensory
phenomena such as numbness & tingling
in the affected area.
– If the focus is in the occipital region, the
client may experience bright, flashing
lights in the field of vision opposite the
side of focus.

23.  Likewise the client can have changes in
speech or taste with involvement of the
posterior temporal area of dominant
hemisphere.

24. Autonomic manifestations:
– Seizures of the autonomic system
produce epigastric sensations, pallor
sweating, flushing (being red face),
piloerection/goose flesh (involuntary
erection or bristling of hairs), pupillary
dilation, tachycardia, and tachypnea.

26. –However abnormality may be subtle
(tough in perceiving) and detected only by
a trained observer.
–This type usually last 2-3 minutes but can
last up to 15 minutes.
–The client is usually unaware
of any activity during the seizure and may
be confused or drowsy postictally.
–Attempts to restrain (control) the client
during a seizure may induce combative
and un-cooperative behavior.

27. – These seizures start from a particular focus ,
& then the electrical discharges spread
throughout the brain .
– Clinically , the client first shows focal
manifestations; for example : one side of
the face moves , and then the whole body
becomes involved .
– Consciousness is lost if the discharges
spread throughout
the brain.

28. These seizures lead to a loss of
consciousness .
They can be convulsive or non
convulsive.
Generalized seizures involve both
hemispheres.
About one third of seizures are
generalized.

29.  These are abrupt periods of
staring and lapses of
awareness lasting a few seconds to
a few minutes.

30. 2) Myoclonic seizures :
These types involves sudden uncontrolled
jerking movements of either a single muscle
group or multiple groups, sometimes
causing the client to fall.
The client loses consciousness for a
moment and then is confused postictally.
These seizures often occur in morning.
Clients often report that they spill their coffee
with their seizures.

31. 3) Clonic seizures:
The clinical manifestations of clonic
seizures include rhythmic muscular
contraction & relaxation lasting several
minutes.
Distinct phases of clonic seizures are not
easily observed.

32. 4) Tonic seizures:
These include an abrupt increase in
muscular tone & muscular contraction.
In addition with tonic seizures there is a
loss of consciousness and the presence
of autonomic manifestations.
Tonic seizures may last from 30 seconds
to several minutes.

33. 5)Generalized tonic clonic
seizures: (10%)
Formerly known as ‘’grandmal’’
seizures.
Tonic clonic seizures are the
type of seizures most closely associated
with epilepsy.

37. –The client is usually incontinent and may
bite the lips , tongue , or inside of the
mouth.
–Excessive saliva is blown from the
mouth, which creates frothing at lips.

38. An entire tonic clonic phase seizure may
last from 2-5 minutes, after which the
client enters the postictal phase, during
which the client relaxes & remains totally
unresponsive for a time.
The client may rouse (awake) briefly &
then go into a postictal sleep lasting 30
minutes to several hours.
This sleep may be followed by general
fatigue, depression , confusion , or
headache , all of which gradually
resolve.

39. The client has complete amnesia for the
seizure episode and may feel nauseated,
stiff, and sore.
 Bruising may occur as the result of falls.
Petechial hemorrhages may develop on the
face & chest due to vasovagal responses
(development of inappropriate cardiac
slowing and arteriolar dilatation).

40. The tonic clonic seizure vary in
frequency from many times daily to
once or twice a year.
Tonic only and clonic only seizure
may also occur.

41. 6) Atonic seizures :
These are associated with a total
loss of muscle tone.
They may be mild, with the client
briefly nodding the head (a
gesture in which the head is tilted
in alternating up and down arcs
), or the client may fall to the
floor.
Consciousness is impaired only
briefly.

44. • Fracture of bone.
• Impair intelligence.
• Socially stigmated.
• Reduced quality of life.
• A complication called ‘’sudden unexpected
death in epilepsy’’.

45. •Goals of management of
clientswith seizures and
epilepsy are
–To prevent injury during seizures,
–To eliminate factors that precipitate
seizure, and
–To control seizures to allow a desired
lifestyle.

46. • During the seizures the major goals
are :
–To maintain the airway.
–To prevent injury to client.
–To observe the seizure activity.
–To administer appropriate anticonvulsant
drugs.

47. • In a hospital setting, suction
equipment shouldbe readily available.
• The person experiencing a
seizure usually requires protection
from the environment.
• Objects should be moved out of the way
so that the client does not strike his/her
head or extremities.

48. • Any tight clothing around the person’s neck is
loosened.
• Put a pillow or folded blanket under the affected
person’s head, but not flex the neck sharply or
close the airway.
• Turning the client to his/her side displaces the
tongue and usually opens the airway once the
tonic phase has ceased.
• Do not attempt to open the airway with your
fingers.
• A jaw thrust maneuver (head tilt - chin lift) will
open the airway without the potential to harm
the client or the caregiver.

49. • The factors that precipitate seizure should be
eliminated , if possible.
• Eating a balanced diet, restricting excessive
cafeine and alcohol intake, sleeping well,
avoiding seizure triggers ( means initiations )
(ex.- flashing lights), and minimizing emotional
stress may be helpful in preventing seizures.
• Observer’s descriptions of a seizure can be
helpful in making a diagnosis.
• Instruct the family & unlicensed assistive
personnel to make the following observations:

50. – How long did the seizure last ?
– Where in the body did the seizures begin and
how did it progress?
– Did the client’s eyes or head deviate?
– Were the respirations labored or frothy?
– Was the client incontinent?
– Did the client lose consciousness?
– What were the types of movements and
what body parts moved ?

51. Currently available anti-epileptic drugs appear to
act primarily by blocking the initiation or spread of
seizures.
Ex. Phenytoin ,
Fosphenytoin sodium,
Carbamazepine, Valproic
acid , Lamotrigine.
(these inhibit sodium-dependent
action potentials, blocking the burst and
firing of neurons).

52. • Assessment.
• Nursing Diagnosis.
– Risk for trauma related to loss of large or small muscle
co-ordination as evidenced by abnormal body spasm.
– Risk for ineffective airway clearance related to tracheo-
bronchial obstruction as evidenced by oral secretions.
– Low self esteem or situational low self -esteem related
to stigma associated with condition as evidenced by
verbalization about changed lifestyles.
exposure and unfamiliarity with resources
– Knowledge deficient / deficit related to lack of
as
evidenced by questions & statement of concerns.

53. • Goals:
– Seizures activity control.
– Complications or injury prevented.
– Disease process or prognosis, therapeutic regimen,
and limitations understood.
– Plan in place to meet needs after discharge.
• Interventions:
Nurse has to set the action priorities:
– Prevent or control seizure activity.
– Protect patient from injury.
– Maintain airway or respiratory function.
– Promote positive self-esteem.
– Provide information about disease process, prognosis,
and treatment needs.

54. • Black JM, Hawks JH, A textbook of Medical Surgical Nursing , 8th
Edition, 2nd Volume, Published by Saunders Publication, Page No.
1811.
• Chintamani, A textbook of Lewis’s Medical Surgical Nursing :
Assessment & Management of Clinical Problems , Published by
Mosby publication, Page no. 1498.
• Research refrence:
http://journals.lww.com/cancernursingonline/Abstract/2005/07000
/Symptom_Clusters Concept_Analysis_and_Clinical.5.aspx
• https://nurseslabs.com/4-seizure-disorder-nursing-care-plans/
• https://medlineplus.gov/ency/article/000694.htm
• http://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve-
disorders/seizure-disorders/seizure-disorders