Take a Break!

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Seizures
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What is it?

• Seizure episode of abnormal motor, sensory,
  autonomic or psychic activity (or a combination
  of these) resulting from sudden excessive
  discharge from cerebral neurons
• SS depend on which area of brain is affected
  twitching, convulsions, atony, mood swing,
  perception changes, loss of consciousness,
  irritability, etc

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What Causes Seizures?

• Cause is unknown?misfiring of brain cells!
• Primary (as the underlying disease)
• Secondary (to the underlying disease)
• Birth trauma
• Prenatal asphyxia
• Head injuries
• Infections-Fever
• Metabolic disease
• Hypoxia
• Tumors
• Drug/ETOH W/D
• Allergies
• CV disease ?1 in elderly

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Risk Factors

• Incidence decreases with age
• 1 per 1000 incidence in 1st yr of life
• Median age dev is 5-6 yrs of age
• Research 7 of aged 75yrs
• Complex partial seizure is most common type
• Other Risk Factors (see previous slide)
• SGA
• Neurological conditions
• Cerebral palsy
• Autism
• Family Hx
• etc

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Diagnostic Tests

• EEG
• CT, MRI, PET
• Angiography
• Surgery (rare)

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EEG sedation

• Sleep deprived
• Duration1-1 ½ hrs
• must be very still or asleep
• Age lt 5yo?chloral hydrate po or pr
• 25 mg/kg/day as single dose max 500 mg/day
• drowsiness occurs within 10-15 min
• sleep usually occurs within 30-60 min
• monitor POx sats
• fully awake within 2 hrs
• in some cases sleep can last 4 to 8 hours.

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Lab Tests

• To rule out metabolic disease or toxicity
• CBCD
• Blood chemistry
• Liver Renal studies
• Urine culture
• LP
• Serum drug levels (including Rx)
• Lead level
• Toxicology screening (drugs or poisons)

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Epilepsy Facts

• A group of syndromes characterized by recurring
  seizures
• 2-4 million ppl- 1 in 100 adults
• Does NOT affect intelligence
• Usual age of onset lt 20 yo
• Women? childbearing factors
• Meds?birth defects, BC pill effectiveness ? with
  some meds
• ? risk of seizure with menses
• ? risk of osteoporosis due to long term med tx
• ? folic acid absorption with meds

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Types of Seizure Activity

• Differentiated by how seizure manifests
• Partial (focal)?begin in only one part of
  cerebrum
• Simplemotor or sensory, confined to one area
  (face, contralateral part of body) then spreads
  to adjacent parts
• Complexusually temporal lobe aura, impaired LOC
  x hrs, automatisms (lip smacking, picking at
  clothes, aimless walking) followed by amnesia of
  the event
• Generalized?involves whole brain
• Absence (petit mal)?brief cessation of all motor
  activity blank stare unresponsive (common in
  children)may go unnoticed!
• Clonic (stiffening)/Tonic (alternating
  contraction relaxation jerking)?(grand mal)

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Phases of Tonic/Clonic Seizure

• Aurasensory alteration visual, smell, taste
• Tonic phaseunconscious muscle contraction?high
  metabolic demand?sugar!
• Clonic phasealternating contract-relax of
  muscles
• Postictal periodsleepy but arousable

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Status EpilepticusA FIGTx

• Cont seizures w/o recovery time between them
• Seizures lasting gt30 minutes
• Medical emergency!!
• high metabolic demand can cause brain damage or
  respiratory arrest!!!
• Do A FIG!!
• A - Airway?ET tube
• F - Find the cause
• VS, EKG, Accucheck, drug/toxin levels, ABGs
• I - IV access IV meds (slowly!)
• 50 Dextrose IV to prevent hypoglycemia
• Valium (diazepam) or Ativan (lorazepam) q 10 min
• Dilantin (phenytoin) F/U or longer effect
• G-General anesthesia
• Use of short-acting barbiturate-Pentothal,
  (thiopental) for anesthesia (or phenobarb)

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Nursing Responsibilities

• KNOW what to do!!!
• Recording sequence
• Dx may depend on description
• Preceding event, time of day, how long what
  occurred during each phase, both sides or one?
• Objectivewhich body part 1st, ANS signs (pupil
  dilation, salivation, altered breathing,
  cyanosis, etc), iteric?LOC, VS, sleep period, etc
• Subjective soreness, memory loss, weakness, etc
• Airway mngmt Safety
• Support protect head, turn on side, loosen
  clothing, ease to floor if seated, oxygen,
  suctioning, note any injurty F/U appropriately

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Antiseizure Medications p1536stabilize nerve
cell membranes

• Dilantin (phenytoin)
• Depakene (valproic acid)
• Depakote (divalproex)
• Tegretol (carbamazepine)
• No grapefruit juice!
• Klonopin (clonazepam)
• Luminal (phenobarb)
• Neurontin (gabapentin)
• CAM Fact Gingko may ? risk of seizure if Hx of
  seizure disorder

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Drug Therapy

• Begin with single drug
• Serum levels monitored
• Lowest dose is best dose
• Many have long half life (daily or bid doses)
• Do not DC abruptly!!

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Side Effects of Meds

• Idiosyncratic
• Skin rashes
• Hepatotoxicity
• Blood dyscrasias
• Renal disease
• Toxic effects
• Nystagmus
• Ataxia
• LOC changes
• Cognitive changes

• Drowsiness
• Diplopia
• Dizziness
• Lethargy
• Irritability
• Somnolence
• Anorexia
• NV

Gingival HyperplasiaDilantin gums!
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Client education Health Maintenance

• Oral hygiene
• Reducing fears
• Providing education
• Monitoring for complications
• Developmental considerations

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Public Education
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The End

• eheim productions ?

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