SEIZURE DISORDER POWERPOINT PRESENTATION

2. SEIZURE DISORDER
PREPARED BY – SUHEL KHAN,
M.Sc. NURSING
MEDICAL AND SURGICAL
NURSING

3. INTRODUCTION
 The word epilepsy derived from the Greek
word epilepsia, meaning “seizure”.
 In early times, epilepsy was viewed as
being of divine origin and was called the
“sacred disease”. Because someone with
epilepsy was thought to be “seized” or
struck down by the gods.

4. CONT....
 Seizures are fairly common medical
emergency; typically stopping on their own
in less than two minutes, and they present a
low risk of harm of the patient.

5. Definitions
 Seizure:- A hyper excitation of neurons in the
brain that can result in involuntary motor activity,
sensory disturbance, abnormal behavior, loss of
consciousness or all of these.

6.  Epilepsy:- A group of neurologic disorders
characterized by recurrent seizures.
 Convulsion:- convulsion is a medical
condition where body muscle contract and relax
rapidly and repeatedly, resulting in an
uncontrolled shaking of the body.

8.  Abnormal level of sodium or glucose in the
blood.
 Brain infection, including meninges.
 Brain injury that occurs to the baby during labor
or childbirth.
 Congenital brain defects.
 Brain tumor(rare)
 Drug abuse

9.  Electric shock
 Metabolic disorders, hypoglycaemia,
hypocalcaemia, anoxia
 Very high blood pressure(malignant
hypertension)
 Venomous bites and stings(snake bite)
 Withdrawal from alcohol after drinking a lot on
most days

10. OTHER CAUSES
 Congenital brain abnormalities
 Tumors
 Strokes
 Head trauma
 Previous infection of the nervous system

11. RISK FACTORS
 Cerebral palsy
 Perinatal problem
 Mental retardation
 CNS tumours
 Family history of epilepsy

12. CONT...
 Excessive mental works
 Reading for long time
 Hearing music for long time
 Loss of sleep

13. Classifications of seizure
1. Partial seizure:- Partial seizures arise from a
localized region of the brain and have clinical
manifestations that reflect the area of brain.
TYPES:-
 Simple partial seizures:- consciousness is not
impaired.
 Complex partial seizures:- consciousness is
impaired.

14. 2. Generalized seizures:- Generalized seizure
involve the whole of both hemispheres. The term
secondary generalization may be used to describe a
partial seizure that later spread to the whole of the
cortex and becomes generalized. Primary
generalized seizures can be sub-classified into a
number of categories, depending on their
behavioural effects.

15.  Absence seizures:- This type of seizure is a brief (usually less than
15 seconds) disturbance of brain function due to abnormal electrical
activity in the brain.
 Myoclonic seizure:- It involve an extremely brief (<0.1 second)
muscle contraction and can result in jerky movements of muscle.
 Clonic seizures:- They are myoclonus that are regularly repeating at
a rate typically of 2-3 per second.
 Tonic clonic seizures:- It involves an initial contraction of the
muscle (tonic phase) which may involve tongue biting, urinary
incontinence and the absence of breathing. This is followed by
rhythmic muscle contractions (clonic phase).

16. PATHOPHYSIOLOGY
Due to precipitating factors
Altered integrity of neuron in the epileptogenic focus
Hyper-excitability of the neurons in the focus

17. Partial depolarization of neurotransmitters
Imbalanced release in excitatory and inhibitory
neurotransmitters
Abnormal spontaneous spread of electrical discharges
seizures

19.  Aura
 loss of alertness.
 Temporary confusion.
 Uncontrollable jerking movements of the arms
and legs.
 Loss of consciousness or awareness.
 Psychic symptoms such as fear and anxiety.

21. The diagnostic assessment is aimed at determining the type of
seizures, their frequency and severity and precipitate factors.
 History collection and physical examination.
 Electroencephalogram (EEG)- locates epileptic focus, spread,
intensity and duration; helps classify seizures type.
 CT and MRI-To identify lesion that may be cause of seizures.
 Single photon emission computed tomography (SPECT) & PET –
helpful to measure cerebral blood flow in clients undergoing surgery
for epilepsy.
 Complete blood count-To evaluate for infections, hormonal or
metabolic etiology.

22. Management
 The mainstay treatment of epilepsy is
anticonvulsant medications, possible for the
person’s entire life such as:-
 Effective termination of a seizures requires
early administration of
benzodiazepines(diazepam, lorazepam, and
midazolam.)

23.  1. Acetazolamide
 This drug is indicated for refractory absence
seizures.
 Dosage -
 Adults: 4 to 15 mg/kg po bid
 Children: 4 to 15 mg/kg po bid
 Adverse effects- include renal calculi,
dehydration, and metabolic acidosis.

24.  2. Carbamazepine
 This drug is indicated for partial, generalized, and mixed
seizures but not absence, Myoclonic, or Atonic seizures.
 Dosage -
 Adults: 200 to 600 mg po bid (starting dose is the same for
regular and extended-release tablets)
 Children < 6 yr: 5 to 10 mg/kg po bid (tablets) or 2.5 to 5 mg/kg
po qid (suspension)
 Children 6 to 12 yr: 100 mg po bid (tablets) or 2.5 mL (50 mg)
po qid (suspension)
 Children > 12 yr: 200 mg po bid (tablets) or 5 mL (100 mg) po
qid (suspension)
 Adverse effects -include diplopia, dizziness, nystagmus, GI
upset, dysarthria, lethargy, a low WBC count (3000 to 4000/μL

25.  3. Clobazam
 This drug is indicated for absence seizures; it is indicated as
adjunctive therapy for tonic or Atonic seizures in Lennox-Gastaut
syndrome and for refractory partial seizures with or without secondary
generalization.
 Dosage -
 Adults: 5 mg to 20 mg po bid
 Children: 5 to 10 mg po bid (up to 20 mg po bid in children > 30 kg)
 Adverse effects- include somnolence, sedation, constipation, ataxia,
suicidal thoughts, drug dependency, irritability, and dysphasia.

26.  4. Clonazepam
 This drug is indicated for atypical absence seizures in Lennox-
Gas taut syndrome, Atonic and Myoclonic seizures, infantile
spasms, and possibly absence seizures refractor
to ethosuximide.
 Dosage -
 Adults: Initially, 0.5 mg po tid, up to 5 to 7 mg po tid for
maintenance (maximum: 20 mg/day)
 Children: Initially, 0.01 mg/kg po bid to tid (maximum: 0.05
mg/kg/day), increased by 0.25 to 0.5 mg every 3 days until
seizures are controlled or adverse effects occur (usual
maintenance dose: 0.03 to 0.06 mg/kg po tid)
 Adverse effects- include drowsiness, ataxia, behavioural
abnormalities, and partial or complete tolerance to beneficial
effects (usually in 1 to 6 mo); serious reactions rare.

27.  5. Levetiracetam
 This drug is indicated as adjunctive therapy for the following: partial
seizures in patients ≥ 4 yr, primarily generalized tonic-Clonic
seizures in patients > 6 yr, Myoclonic seizures in patients > 12 yr,
and juvenile Myoclonic epilepsy.
 Dosage is
 Adults: 500 mg po bid (maximum: 2000 mg bid)
 Children: 250 mg po bid (maximum: 1500 mg bid)
 No significant relationship between blood levels and pharmacologic
effect has been observed.
 Adverse effects- include fatigue, weakness, ataxia, and mood and
behavioral changes.

28.  6. Oxcarbazepine
 This drug is indicated for partial seizures in patients aged 4 to
16 yr as adjunctive therapy and for partial seizures in adults.
 Dosage -
 Adults: 300 mg po bid, increased by 300 mg bid at weekly
intervals as needed to 1200 mg po bid
 Children: Initially, 4 to 15 mg/kg po bid, then increased over 2
wk to 15 mg/kg po bid (the usual maintenance dose)
 Adverse effects- include fatigue, nausea, abdominal pain,
headache, dizziness, somnolence, leukopenia, diplopia, and
hyponatremia (in 2.5%)

29. Surgical management
 Surgical interventions include limbic resection,
primary anterior temporal lobe resection.
 Corpus colostomy.
 Functional hemispherectomy.
 Vegas nerve stimulation (In partial seizure).
 Responsive neurostimulation device.(RNS)

30. Nursing management
 Maintaining a patient airway to ensure adequate
ventilation.
 suctioning as necessary to prevent obstruction of airway
and possible aspiration.
 Providing oxygen by nasal cannula as ordered.
 Protecting the IV site to allow for continuous access for
medication.
 Protecting the patient from injury.
 Providing the information to the family.

31. Nursing diagnosis
1. Risk for injury related to seizure activity.
2. Ineffective breathing pattern related to neuromuscular
impairment.
3. Fear related to possibility of seizure.
4. Ineffective individual coping related to stresses imposed
by epilepsy.
5. knowledge deficit related to epilepsy and its control.

32. Nursing interventions
 Injury prevention for the patient with seizures is a
priority.
 Remove potentially harmful object from the
environment.
 Keep suction Ambu bag, oral or nasopharyngeal
airway at bedside to maintain airway and
oxygenation if needed.
 Avoid seizures triggers/risk factors.

33.  Seeks medical attention immediately if seizures
frequency increases.
 Implements safety practices in home/work
environment.
 Record seizure characteristics: body parts
involved, motor activity, and seizures
progression.
 Monitor respiratory and oxygenation status to
determine presence and extend of problem and to
initiate appropriate interventions.
 Position patient (side lying) to maximize
ventilation potential.

34.  Identify patient requiring actual/potential airway
insertion to facilitate intubation as necessary.
 Perform endotracheal or nasotracheal suctioning
to maintain airway as needed.
 Loosen clothing to prevent restricted breathing.
 Apply oxygen as appropriate to maintain
oxygenation and prevent hypoxia.

35. COMPLICATIONS
 Cognitive and behavioral changes
 Memory loss .
 Injuries.
 Tongue bite, lips or the inside of cheeks.
 Accidents.

36. PROGNOSIS
There are 50 million people living with epilepsy
worldwide, and most of them reside in developing
countries. About 10 million persons with epilepsy are
there in India. Many people with active epilepsy do not
receive appropriate treatment for their condition,
leading to large treatment gap. The lack of knowledge
of antiepileptic drugs, poverty, cultural beliefs. stigma,
poor health infrastructure, and shortage of trained
professionals contribute for the treatment gap.

37. CONCLUSION:-
 Epilepsy is a chronic condition with a profound effect on
the quality of life. Dorothea Orem defines nursing with
emphasis on client’s self-care needs. Self-care
management techniques for epilepsy should include
interventions that enhance seizure control, minimize side
effects. And risks promote adaptations and enhance quality
of life involving assessment of a variety factors.

38. BIBLIOGRAPHY
 . Black m. joyce; hawks hokansonjane (2015) , medical
surgical nursing(8th edition),st.louis Missouri.
 2. Phipps j. Wilma; Monahan d. Frnches (1999), medical
surgical nursing (7th edition) Philadelphia pa, Mosby
 3. Gopper d Paula; Linda s. Williams (2o12), medical
surgical nursing (4th edition), F.a.davis
 4. Brunner and Siddhartha (2012), medical surgical
nursing(12th edition), Philadelphia pa, usa
NET CONTENT
 https://www.medicinenet.com/script/main/art.asp?articlek
ey=11198.
 http://www.merckmanuals.com/professional/neurologic-
disorders/seizure-disorders/seizure-disorders.