introduction, definition, types, classification, indepth information.

1. By Suryakant Satpute
M.Sc (N)
College of Nursing
Seminar on Seizure Disorders

2. Introduction
 Normal brain function requires an orderly,
organized, coordinated discharge of electrical
impulses.
 Electrical impulses enable the brain to
communicate with the spinal cord, nerves, and
muscles as well as within itself.
 Seizures may result when the brain's electrical
activity is disrupted.

3. Seizure Disorders (Epilepsy)
 Epilepsy is a disorder of brain in which a fit occurs
because of abnormal electrical discharge between
certain brain cells.
 A sudden loss of consciousness which is often
accompanied by repeated jerky movements called
convulsions.
 These attacks are sometimes called fits or seizures.
 Epilepsy is due to disturbance in the electrical activity
of the brain. Is caused by a transient, excessive and
abnormal discharge of nerve cells.
 The abnormal discharge may involve a small part of
brain only ( partial or focal seizure) or much more
extensive area in both hemispheres (generalized
seizures).
 It can start at any age. In majority of the cases, it
starts in childhood and adolescence

6. Causes
1. Primary( idiopathic)
epilepsy:-
 Unknown genetic or
biochemical
 predisposition
2. Secondary epilepsy:-
 a. Intracranial
 Tumor
 Cerebro -vascular disease
 Arteriovenous malformation
 Trauma ( birth injury,
depressed
 fracture, penetrating wound)
 Infection ( meningitis,
 encephalitis)
 b. Extra cranial
 Metabolic
 Electrolyte
 Biochemical
 Inborn errors of
metabolism
 Hypoglycemia
 Drugs
 Drug withdrawal
 Alcohol withdrawal

7. Classification of Seizures

8. Partial seizures
 Initially affect one
specific area in one
hemisphere of the brain
 May or may not cause
an alteration
of consciousness
 Symptoms can include
muscle twitching,
repetitive motions, and
the appearance of
“daydreaming”
 Can become
generalized seizures
Generalized seizures
 Affect both
hemispheres of the
brain
 Loss of
consciousness
 Symptoms can
include blank stares,
falling to the floor,
sudden muscle jerks,
and repetitive
stiffening and relaxing
of muscles

9. 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.
 This is medical emergency and requires prompt
intervention to prevent irreversible neurological
damage.

10. Partial Seizures
Simple partial seizures
 Affect one specific part of the brain only,
and do not cause a change in consciousness
Complex partial seizures
 Affect a larger area of the brain and result
in alteration or loss of consciousness
Secondarily generalized seizures
 Begin as a partial seizure in one area of
the brain and spread to affect the whole brain

11. Simple Partial Seizures

12. Complex Partial Seizures

13. Generalised Seizures
Absence seizures:
 Brief episodes of staring
 Absence seizures are considered complex absence seizures
 Include a change in muscle activity
 Most common movement are eye blinks
 Complex absence seizures are often more than 10 seconds long
 Usually begin between ages 4 and 14
 no warning before a seizure, and the person is completely alert
immediately afterward.
 Other movements include slight tasting movements of the mouth,
hand movements such as rubbing the fingers together ,etc
 Children who get them usually have normal development and
intelligence
 70%of cases, absence seizures stop by age 18.

15. Monoclonic seizures:
 Very brief jerks, last only for 2 to 3 sec
 Seizures usually cause abnormal movements on both
sides of the body at the same time
 Myo" means muscle and "clonus" (KLOH-nus) means
rapidly alternating contraction and relaxation
 Seizures usually begin in childhood, but the seizures
can occur at any age
 Seizures occur in reflex epilepsies, triggered by
flashing lights or other things in the environment
 Syndromes usually can be diagnosed on the basis of
the medical history and often EEG patterns

17. Atonic Seizures:
 Atonic means without tone
 In an atonic seizure, muscles suddenly lose strength
 Eyelids may droop, the head may nod, and the person may drop
things and often falls to the ground
 Also known as "drop attacks" or "drop seizures”
 The person usually remains conscious
 Another name for this type of seizure is “akinetic” which means
"without movement“
 Seizures often begin in childhood often last into adulthood
 People with atonic seizures are injured when they fall Seizures
may cause people to fall when they're standing often have tonic
seizures rather than atonic seizures
 Syndromes usually can be diagnosed on the basis of the medical
history and often EEG patterns

19. Tonic Seizures:
 Usually last less than 20 sec
 In such seizures, the tone is greatly increased
and the body, arms, or legs make sudden
stiffening movements
 Consciousness is usually preserved
 Seizures most often occur during sleep
 Usually involve all or most of the brain, affecting
both sides of the body

20. Clonic seizures:
 Seizures consist of rhythmic jerking movements of the
arms and legs
 Length vary according to the case
 Clonus means rapidly alternating contraction and
relaxation of a muscle.
 Movements cannot be stopped by restraining or
repositioning the arms or legs
 These seizures are rarely found
 Common are tonic-clonic seizures, in which the jerking is
preceded by stiffening (the "tonic" part)
 Sometimes tonic-clonic seizures start with jerking alone
These are called clonic-tonic-clonic seizures
 Occur at various ages, including in newborns
 Brief and infrequent clonic seizures in infants usually
disappear within very short period

21. Tonic-clonic seizures:
 Normally last for 2 to 3 min
 More than 5 min calls for immediate medical help
 Seizure that lasts more than 30 minutes indicate
convulsion
 Person loses consciousness and falls to the floor.
 Tongue or cheek may be bitten, so bloody saliva
may come from the mouth. Person may turn a bit
blue in the face
 After the tonic phase comes the clonic phase.
Arms and usually the legs begin to jerk rapidly
and rhythmically.
 Bladder or bowel control sometimes is lost as the

22.  Consciousness returns slowly, and the person
may be drowsy, confused, agitated, or depressed.
 Tonic-clonic seizures can be controlled by seizure
medicines
 Patients who are seizure-free for a year or two
while taking seizure medicine will stay seizure-
free
 Medicine can be stopped gradually
 Patients with no epilepsy wave in EEG can stay
free with any medication
 People who faint sometimes may develop tonic or
clonic seizure

24. Percentage of various types of
seizures all over the world.

25. Common Symptoms
 Change in consciousness, so that you can't
remember some period of time.
 Change in emotion, like unexplainable fear, panic, joy,
or laughter.
 Change in sensation of the skin, usually spreading
over the arm, leg, or trunk
 Changes in vision, including flashing lights, or (rarely)
hallucinations.
 Loss of muscle control and falling, often very
suddenly Muscle movement such as twitching that
might spread up an armor leg
 Muscle tension/tightening that causes twisting of the
body, head, arms or leg.
 Tasting a bitter or metallic flavor.

27. Composition of Seizures
Beginning State:
 This stage can be said as warning or aura
 Sometimes an individual may not be aware of
such aura
 In middle stage this aura is followed by other
symptoms
 It may be considered as simple partial seizure
Middle State:
 People have aura in beginning, the aura may
convert into convulsion
 For those who don’t have aura, the seizure may
continue as complex partial seizure

28. End state:
 This state represents a transition from seizure
back to normal state.
 Also referred as the “Post-ictal period” Signifies
recovery period of brain
 May last from a second to minutes to hours.
 If a person has a convulsion, the level of
awareness gradually improves during the post-
ictal period, much like a person waking up from
anesthesia after an operation

29. Diagnostic Evaluation
 Detailed history taking.
 An electroencephalogram (EEG) to measure the
electrical activity of the brain
 A spinal tap to collect spinal fluid for analysis
 Imaging tests, like an MRI or CT scan, of the
head
 Complete blood count and chemistry of the blood

30. Management of Seizures
 The goal of treatment in patients with epileptic
seizures is to achieve a seizures free status
without adverse effects. This goal is
accomplished by in more than 60% of patients
who require treatment with anticonvulsants.
 Medical Management:
 Anti Epileptic drugs
 Oxygen administration
 Diazepam / Lorazepam
 Maintaining Airway
 50% dextrose solution to administration

31.  Surgical Management:
 Vegal Nerve stimulation therapy
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.

32. Nursing Management
 History, including prenatal,birth, and
developmental history, family history, age at
seizure onset, history of all illness and traumas.
 Determine whether the patient has an aura before
an epileptic seizure, which may indicate the origin
of seizure.
 Observe and assess neurological condition.

33. Nursing Diagnosis
 Risk for injury related to seizure activity.
 Fear related to possibility of having seizures.
 Inafective coping related to stress imposed by
epilepsy.
 Deficit knowledge about epilepsy and its control.

34. First Aid in Seizures

35. Bibliography
Centers for Disease Control and Prevention:
http://www.cdc.gov/Epilepsy/
Epilepsy Foundation:
http://www.epilepsyfoundation.org/
Epilepsy Foundation of Eastern PA:
http://www.efepa.org/
National Institute of Health:
http://search.nih.gov/search?utf8=%E2%9C%9
3&affiliate=nih&query=epilepsy