Seizure And Epilepsy Disorders

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Seizure And Epilepsy Disorders

• By
• Dr. Hanan Said Ali

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Objectives

• Define a Seizure and epilepsy.
• Identify the aetiology of a Seizure and
  epilepsy.
• Describe the Pathophysiology of a Seizure and
  epilepsy.
• Identify the Clinical Manifestations of a Seizure
  and epilepsy.
• Mention the treatment of a Seizure and epilepsy.
• Identify the Initial Nursing Interventions

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Seizure And Epilepsy Disorders

• A Seizure
• Is a paroxysmal, uncontrolled electrical
  discharge of neurons in the brain that interrupts
  normal functions.
• They may accompany a variety of disorders, or
  they may occurs spontaneously without any
  apparent cause.
• Epilepsy
• Is a condition in which a person has
  spontaneously recurring seizures caused by
  chronic underlying conditions.

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Seizure And Epilepsy Disorders Cont.

• Aetiology
• In first 6 months of life
• Severe birth injury , congenital defects ,
  involving the CNS infection and inborn errors of
  metabolism.
• In clients between 2 and 20 years of age
• Birth injury , infection, trauma, and genetic
  factors

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Seizure And Epilepsy Disorders Cont.

• Aetiology Cont.
• In individuals between 20- 30 years of age
• Structural lesions, such as trauma, brain tumours
  or vascular disorders
• After 50 years of age
• Cerebrovascular lesions and metastatic brain
  tumours

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Seizure And Epilepsy Disorders Cont.

• Pathophysiology
• A seizure can caused by any process that disrupts
  the cell membrane stability of a neuron.
• The point at which the cell membrane becomes
  destabilized and an uncontrolled electrical
  discharge discharge begins is known as seizures
  threshold.
• People have lower seizures threshold, more prone
  to seizure.

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Seizure And Epilepsy Disorders Cont.

• Pathophysiology Cont.
• The area of the brain from which the epileptic
  activity arises is found to have scar tissues
• The scaring is thought to interfere with the
  normal chemical and structural environment of the
  brain neurons, making them more likely to fire
  abnormally.

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Seizure And Epilepsy Disorders Cont.

• Clinical Manifestations
• The major categories are partial (focal)
  generalized and unclassified.
• Subdivisions based on the person's behaviour
• 1- Ictal refers to the time during the seizure
• 2- Interictal refers to the time between seizure
  activity.
• 3- Postictal refers to the time immediately after
  a seizure as the client recovers

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Seizure And Epilepsy Disorders Cont.

• Clinical Manifestations Cont.
• Partial seizures
• Simple partial seizures, no impairment of
  consciousness, twitching of extremity, speech
  arrest, speciral visual sensations (e.g. Seeing
  lights), feeling of fear or doom
• There is no postictal state.

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Seizure And Epilepsy Disorders Cont.

• Clinical Manifestations Cont.
• Partial seizures
• Complex partial, is a simple partial siezure with
  progression to impairment of consciousness.
• It begin as simple partial and progress to
  complex.
• It include lipsmacking, chewing, or picking at
  clothes

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Seizure And Epilepsy Disorders Cont.

• Clinical Manifestations Cont.
• Partial seizures
• Complex partial generalized to generalized tonic-
  clonic seizures .
• It begins as complex partial, then progress to
  tonic- clonic as in generalized seizures.
• Postictal state present.

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Seizure And Epilepsy Disorders Cont.

• Clinical Manifestations Cont.
• Generalized seizures
• Impair consciousness from the start.
• Absence seizures
• Do not include motor signs and may last less
  than 1- minute.
• There will be brief loss of consciousness,
  staring, unresponsive and no postictal state.

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Seizure And Epilepsy Disorders Cont.

• Clinical Manifestations Cont.
• Generalized seizures
• Tonic- clonic seizures
• It involves rhythmic jerking of muscles, possibly
  tongue biting and urinary and fecal incontinence.
• Atonic seizures, there will be impairment
  consciousness for only few seconds and brief loss
  of muscle tone, which may cause client to fall or
  drop

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Seizure And Epilepsy Disorders Cont.

• Clinical Manifestations Cont.
• Generalized seizures
• Myoclonic seizures, There will be impaired
  consciousness for few seconds or not at all and
  brief jerking of muscle group which may cause the
  client to fall.
• Status epileptical
• Is an episode of seizures activity lasting at
  least for 30 minutes or repeated seizures without
  full recovery between seizures

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Seizure And Epilepsy Disorders Cont.

• Diagnosis
• History including the risk factors.
• Physical examination
• Diagnostic tests (EEG, CT, MRI, PET)
• Treatment
• 1- Hydantoin (phenytoin- Dilantin)
• These blocks potentiation and propagation of
  electrical discharge
• It take as 10-20 mg/LN.saline at least 7-14 days

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Seizure And Epilepsy Disorders Cont.

• It is important to monitor side effects as
  ataxia, fatigue, drowsiness and GIT disturbance
  as, nausea, anorexia, vomiting.
• 2- Barbiturates (phenobarbitol- Luminal)
• Used to manage tonic- clonic, simple partial, and
  complex partial seizures and statuse epilepticus.
• The nurse has to monitor side effect as sedation,
  drowsiness and depression.

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Seizure And Epilepsy Disorders Cont.

• 3- Succinimides
• It raises threshold to stimuli used to manage
  absence seizures.
• 4- Others
• Carbamazepine (Tegretol)
• It blocks synaptic potentiation.
• Valpord acid (Depakene)
• Used to manage absence seizures.

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Seizure And Epilepsy Disorders Cont.

• Emergency Management of Tonic- Clonic S.
• Assessment Finding
• Aura- Peculiar sensation ( Symptoms) that
  precedes seizures.
• Loss of consciousness.
• Bowel and bladder incontinence.
• Tachycardia, Diaphoresis, Warm skin.
• Pallor, flushing or cyanosis.
• Tonic phase Continuous muscle contraction.

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Seizure And Epilepsy Disorders Cont.

• Hypertonic phase extreme muscular rigidity
  lasting 5 to 15 seconds.
• Clonic phase rigidity and relaxation alternate
  in rapid succession.
• Postical phase Lethargy, altered level of
  consciousness.
• Confusion and headache.
• Repeated tonic clonic seizure for several
  minutes.

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Seizure And Epilepsy Disorders Cont.

• Initial Nursing Interventions
• Ensure client airway.
• Assist ventilation if client does not breath.
• Suction as needed
• Stay with client until seizures have passed.
• Protect client from injury during seizures. Do
  not restrain . Bed side rails .
• Remove or loosen tight clothing.

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Seizure And Epilepsy Disorders Cont.

• Initial Nursing Interventions Cont.
• Monitor vital signs ( avoid using glass
  thermometer) , Loc, O2 saturation , GCS , pupil
  size and reactivity.
• Reassure and orient the client after seizures.
• Never force an airway between a patients
• Clenched teeth.
• Give dextrose for hypoglycaemia.

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Seizure And Epilepsy Disorders Cont.

• Guidelines to help nurse to care of status
  epilepticus.
• Protect airway and provide oxygen.
• Establish IV access for medication and fluids.
• Draw blood for electrolytes, ABG.

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Seizure And Epilepsy Disorders Cont.

• Guidelines to help nurse to care of status epi.
• Administer lorazepam (Ativan) 4 to 8 mg over 2 to
  4 minutes or diazepam (valium) 5 to 20 mg over 5
  to 10 minutes to stop seizures.
• Administer anticonvulsants usually phenytoin 15
  to 20 mg/ kg in normal saline at 50 mg/ min

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• Thank You