This document provides information on seizures and epilepsy. It defines seizures as uncontrolled electrical discharges in the brain that interrupt normal function. Epilepsy is defined as a recurrent seizure disorder caused by abnormal brain activity. Seizures can be caused by genetic, developmental, infectious, or environmental factors. The stages of a seizure are the prodromal, ictal, and postictal phases. Seizures are classified as partial or generalized and have different clinical manifestations depending on the affected brain region. Diagnosis involves a history, physical exam, EEG, and sometimes CT/MRI. Treatment includes anti-seizure medications, dietary therapies, surgery, and nursing care during and after seizures to prevent injury.

1. D E E P A K K R I S H N A
SEIZURES

2. DEFINITION
Seizure is a paroxysmal,
uncontrolled electrical discharge
of neurons in the brain that
interrupts normal function. It is
Often symptoms of underlying
illness.

3. Epilepsy
 Epilepsy is a recurrent seizure
disorder characterized by abnormal
electrical discharge from brain, often
in the cerebral cortex.”
Or
 Epilepsy is a chronic seizures
disorder with recurrent &
unprovoked seizures.

4. Etiology
Idiopathic
Agent factor:
 Exposure to toxins, e.g. lead,
infection &neurologic injury.
Fever

5. Cont…
Host factor:
• Age: Most common onset of epilepsy is before
the age of 20 years. It is higher during the first
year of life & at the onset of puberty.
• Genetic factor (inheritance)
• CVA
• Birth hypoxia
• Brain tumor & abscess
• Congenital abnormalities
• Trauma

6. • Environmental Factors:
• Air pollution ( carbon-mono-oxide & lead
poisoning).
• Some factors or events may precipitate the
seizures.
• Unskilled handling at the time of birth
causing brain injury & birth asphyxia.
• Intrauterine infections.
• Emotional disturbances & environmental
stressors.
• Drugs & alcohol intoxication.

7. Pathophysiology

8. Due to etiological factors
Disturbance of the neuronal
functions and activity
Brain turns epileptic
( Epileptogenesis)
Overactive neuronal
cells

9. Disruption of hyperpolarized
violent impulse in disorderly
manner
Electrical energy spreads to
adjacent areas of the brain
SEIZURES
jumps to distant areas
of CNS

10. Stages of seizure
• Prodromal phase: precedes seizure
with signs or activity
• Aural phase with sensory warning
• Ictal phase with full seizure
• Postictal phase with rest and
recovery

13. Clinical Manifestations
• Clinical manifestation in epilepsy
range from starting episodes to
prolonged convulsions with loss of
consciousness. The clinical
manifestations vary according to
the part of the brain involved.

14. Classification of seizures & related
clinical manifestations:
• Partial seizures:
•When seizures appears to
result from abnormal
activity in just one part of
the brain.

15. a. Simple partial seizures
• They have elementary or simple
symptoms & there is no loss of
consciousness in this. The patient may
experience only a finger or hand shake,
mouth may jerk uncontrollably he/she
may talk unintelligibly, may feel dizziness
or may experience unusual or unpleasant
sight, sound, odors or tastes.

16. b. Complex partial seizures
• The patient’s consciousness is altered
during the event. The seizures may
begin with an aura. Patient may have
no movement or moves automatically
but inappropriately for time & place;
may experience excessive emotions of
fear, anger, elation or irritability & does
not remember the episodes when it is
over.

17. Generalized seizures
• Generalized seizures involve both the
hemispheres of the brain. There is
intense rigidity of the entire body,
followed by alternate of muscles
relaxation & contraction.

18. TONIC-CLONIC SEIZURE(GRANDMAL)
• The most common generalized
seizure. It is characterized by loss of
consciousness and falling to the
ground if the patient is upright,
followed by stiffening of the body for
10 to 20 seconds and subsequent
jerking of the extremities for another
30 to 40 seconds.

19. • Cyanosis, excessive salivation, tongue
or cheek biting and incontinence may
accompany the seizure.
• In postictal phase the patient usually
has muscle soreness, is very tired and
may sleep for several hours. Some
patients may not feel normal for
several hours or days after seizure.
The patient has no memory of the
seizure.

22. TYPICAL ABSENCE SEIZURE (PETITMAL)
• It usually occurs in children. Typical
clinical manifestations is a brief
staring spell that last only a few
seconds, so it often occurs unnoticed.
there is a brief loss of consciousness.
Absence seizure can often be
precipitated by hyperventilation and
flashing lights.

24. ATYPICAL ABSENCE SEIZURE
• It is characterized by a staring
spell accompanied by other signs
and symptoms, including brief
warnings, peculiar behavior
during the seizure or confusion
after the seizure.

25. MYOCLONIC SEIZURE
• It is characterized by a sudden
,excessive jerk of the body or
extremities. The jerk may be
forceful enough to hurl the
person to the ground. These
seizure are very brief and may
occur in clusters.

26. MYOCLONIC

27. TONIC SEIZURE
• It involves a sudden onset of
maintained increased tone in the
extensor muscle . These patient
often fall and may cause injury.

28. CLONIC SEIZURE
• Seizure begin with loss of
consciousness and sudden loss
of muscle tone, followed by
limb jerking that may or may
not be symmetric.

29. ATONIC SEIZURE (DROP ATTACK)
• It involves either a tonic episode or a
paroxysmal loss of muscle tone and begins
suddenly with the person falling to the
ground. Consciousness usually return by the
time the person hits the ground, and normal
activity can be resumed immediately. The
patients with this type of seizure are at
greater risk of head injury often have to wear
protective helmets.

30. DIAGNOSTIC EVALUATION
• A complete seizure profile and history taking
• Physical examination including neurologic
examination & description of seizure activity.
• Major diagnostic tool is EEG
(electroencephalogram). This test assists in:
Locating the focus of abnormal electrical
discharges, if present.
Establishing a diagnosis of epilepsy.
Identifying the specific type of seizures.

31. • ECG.
• CT scan & MRI are used to rule out brain
lesions that can trigger seizures.
• PET (positron emission tomography) & SPECT
(single photon emission computed
tomography) may be helpful to measure
cerebral blood in clients undergoing surgery
for epilepsy.
• Lab studies may rule out other causes for the
seizures: RBS, CBC, KFT, LFT, Lumbar puncture,
etc.

32. MEDICAL MANAGEMENT
• carbamazepine (Tegretol)
• clonazepam (Klonopin)
• ethosuximide (Zarontin)
• phenobarbital (Luminal)
• phenytoin (Dilantin)

33. • oxacarbazepine (Trileptal)
• primidone (Mysoline)
• tiagabine (Gabitril)
• topiramate (Topamax)
• valproate (Depakote, Depakene)
• zonisamide (Zonegran, Excegran)

34. •felbamate (Felbatol)
•gabapentin (Neurotonin)
•lamotrigine (Lamictal)
•levetiracetam (Keppra)

35. OTHER TREATMENT
• A KETOGENIC OR MODIFIED
ATKINS DIET( LOW
CARBOHYDATE DIET)
• VAGAL NERVE STIMULATION
(VNS)

36. VAGAL NERVE STIMULATION
• VNS is a palliative technique that
involves surgical implantation of
a stimulating device. It is
currently indicated for patient
older than 12 years with
medically partial seizure that are
not treated surgically.

38. SURGICAL MANGEMENT
• LOBECTOMY
• LESIONECTOMY

39. NURSING
MANAGEMENT

40. Nursing Care During a Seizure
• Provide privacy and protect the patient from
curious on-lookers. (The patient who has an
aura [warning of an impending seizure] may
have time to seek a safe, private place.)
• Ease the patient to the floor, if possible.
• Protect the head with a pad to prevent injury
(from striking a hard surface).
• Loosen constrictive clothing.

41. • Push aside any furniture that may injure the
patient during the seizure.
• If the patient is in bed, remove pillows and raise
side rails.
• If an aura precedes the seizure, insert an oral
airway to reduce the possibility of the tongue or
cheek being bitten.
• Do not attempt to pry open jaws that are clenched
in a spasm to insert anything. Broken teeth and
injury to the lips and tongue may result from such
an action.
• No attempt should be made to restrain the patient
during the seizure because muscular contractions
are strong and restraint can produce injury.

42. CONT…
• If possible, place the patient on one side
with head flexed forward, which allows
the tongue to fall forward and facilitates
drainage of saliva and mucus. If suction is
available, use it if necessary to clear
secretions.

44. Nursing Care After the Seizure
• Keep the patient on one side to prevent
aspiration. Make sure the airway is patent.
• There is usually a period of confusion after a
grand mal seizure.
• A short apneic period may occur during or
immediately after a generalized seizure.
• The patient, on awakening, should be reoriented
to the environment.
• If the patient becomes agitated after a seizure
(postictal), use calm persuasion and gentle
restraint.

45. NURSING DIAGNOSES
1. Risk for injury related to seizure
activity
2. Fear related to the possibility of
seizures
3. Ineffective individual coping related
to stresses imposed by epilepsy
4. Deficient knowledge related to
epilepsy and its control

46. COMPLICATIONS
•STATUS EPILEPTICUS
• It is characterized by at least 30 min of
repetitive seizure activity with out return to
consciousness.
• In other words, it is state in which a person
has continuous seizures lasting at least 30
min.

47. Cont..
• This is medical emergency and
requires prompt intervention to
prevent irreversible neurological
damage.
• Abrupt cessation of
anticonvulsant therapy is the
usual cause of status epilepticus.