Neuro nursing: seizure
disorders
• Learning Objectives
• Define seizure & epilepsy
(seizure disorders)
• Seizure and Epilepsy:
Correcting Misconceptions
• List the types of seizure
disorders
• Aetiology of seizure disorders
• Brief pathophysiology of seizure
(how seizure happen)
• Clinical manifestations of
seizure disorders
• Radiologic and laboratory
investigations
• Medical and surgical
management for seizure
disorders
• Nursing management of seizure
disorders
Seizure defined….
• Sudden episode of abnormal
motor, sensory, autonomic or
psychic activity or a combination of
these resulting from the excessive
electrical discharges from cerebral
neurons
o (Hickey, 2003)
• Seizure = sudden attack, also
known as convulsion
• Also known as convulsion(comes
from convulse) = violent,
involuntary contraction/spasm of
muscles
• Epilepsy (seizure disorders)
defined…
• Greek word, comes from the word
‘epilambaneim’ meaning to seize/
attack
• Epilepsy is an adjective (descriptive
word), also known as seizure
disorder
• Defined as chronic disorder of
abnormal recurring, excessive, self-
terminating electrical discharges
from neurons.
• Characterized by recurring seizures
with changes in behaviour
Facts about Seizures & Epilepsy
• A common chronic disorder more
common than Parkinson’s disease,
Alzheimer’s disease, cancer.
• Epilepsy or seizure is NOT a
disease
• Seizures & epilepsy are not
infectious!
• History about Epilepsy…
• People have looked at epilepsy
differently than most other medical
problems.
• Epilepsy has been fraught with
social stigmas, even till today.
• Ancient Greeks knew about the
condition that led to a sudden
attack upon the unfortunate.
• Seizures manifest in unusual
behaviours mystified observers
who considered this illness as
coming from another world
(possessed / attacked by spirits /
demons).
• Hippocrates (400 B.C) referred
epilepsy as ‘sacred disease’, to
emphasize the general public’s
superstitious view of this condition.
• In 1873, English neurologist John
Hughlings Jackson explained
epilepsy as “a sudden, excessive,
 and rapid discharge of gray matter
of some part of the brain” that
would correspond to the patient’s
experience
• Correcting misconceptions about
seizure & epilepsy…
• Seizure & epilepsy affect people of
all ages, races & ethnic
backgrounds
• People who have had seizure
before does not mean they have
epilepsy
• Isolated seizure episodes can occur
in healthy people due to various
reasons
• Epilepsy is not a mental illness
• People with seizure or epilepsy can
lead a normal life.
• Epilepsy & seizures can be
controlled if patients are compliant
to their medication
• Types of Seizure Disorders
• Partial Seizures
• Result from firing of excessive
electrical discharges within a
particular brain region or focus &
will manifest focal symptoms e.g.
excessive electrical discharges in
frontal region cause involuntary
movements (movements that
cannot be controlled).
• E.g. finger / mouth / leg jerk
uncontrollably.
• Simple partial seizure; no LOC
• Complex partial seizure; with LOC /
impaired consciousness
• Partial Seizures
Simple Partial Seizure
• With motor symptoms
• With special sensory /
somatosensory symptoms
• With autonomic symptoms
• Compound symptoms (consist
of any 2 / more symptoms)
Refer additional notes provided for further
information on types of seizure disorders
& its clinical manifestations
• Partial Seizure
Complex Partial Seizure
• With impairment of
consciousness only
• With cognitive impairment
• With affective symptoms
• With psychosensory symptoms
• With psychomotor symptoms
(automatisms)
• Compound symptoms
• Generalized Seizures
• Generalized seizures probably
begin in the thalamus, other
subcortical structures, deeper
brain structures (basal ganglia,
thalamus, upper brainstem)
• Usually affect both brain
hemispheres – usually patient
have whole body jerks
uncontrollably (clonic) & go into
spasm (tonic).
• Too confused with all these
terms?
Let’s look at what do all these
terms mean…
• Aetiologic Factors for Epilepsy
(Seizure Disorders)
• Genetic / Hereditary
• Cerebrovascular disease
(e.g. stroke)
 • Hypoxemia including
vascular insufficiency
• Fever (during childhood-not
treated)
• Head injury
• Hypertension e.g.
preeclampsia, eclampsia
• CNS infection e.g.
meningitis, encephalitis
• Metabolic & toxic conditions
e.g. renal failure,
eletrolytes imbalance (Na+,
K+, Ca2+), hypoglycaemia,
pesticides poisoning
• Perinatal neurological injury
• Multiple sclerosis
• Brain tumour
• Drug & alcohol withdrawal
• Severe allergies
• Brief Pathophysiology to
Seizure
• Clinical Manifestations of
Seizure
• Depends on the location of the
discharging neurons
• Initial part of seizure (the start
of seizure) tells about the part
of brain where seizure originate
• Simple partial seizure;
• No loss of consciousness (o
LOC)
• Finger / hand may jerk, mouth
jerk uncontrollably.
 Talk unintelligibly, dizzy,
experience unusual sights,
odours, tastes.
Complex partial seizures;
 Remains motionless / moves
automatically but
inappropriate to time / place
 Experience excessive
emotions of fear, anger,
elation / irritability
 Sometimes will have the
‘blank stare’ & unable to
provide appropriate
response to questions when
asked during seizure attack
 Post- seizure / post-ictally;
does not remember the
seizure experience
 Generalized seizures(also
known as grand mal);
 Involve both side of brain
hemispheres – both sides of
body to react
 Intense rigidity of body
occur alternate with muscle
relaxation (tonic =
contraction & relaxation)
 Epileptic cry
 Chewing of tongue / injure
oral mucosa
 Urinary & fecal incontinence
 After 1-2 minutes post-ictal,
patient relaxes & lies in
deep coma, breathing
noisily using abdominal
muscle.
 Post-ictal; confused, hard to
arouse, sleep for hours, may
complain of headache, sore
muscles, fatigue &
depression
 Some with uncontrolled
seizures & poor family
support can be depressive &
suicidal.
Diagnostic Tools for Diagnosing
Seizure / Epilepsy
  History taking & physical
examination
 Neurophysiologic Tools
 Electroencephalography /
Electroencephalogram
(EEG)
 Video telemetry EEG
 Radiologic Tool
 Magnetic Resonance
Imaging (MRI) & Magnetic
Resonance
Angiography/Angiogram
(MRA) brain
 Single photon emission
computer tomography
(SPECT scan)
 Positron electron
tomography (PET scan)
 Diagnostic Tools for Diagnosing
Seizure / Epilepsy
 Laboratory Ix
 Sr. electrolytes, urea,
glucose
 Complete blood count
(CDC) / Full blood count
 Lumbar puncture to assess for
CNS infections / tumours
 CNS infections - WBCs
 Tumours – protein level
 Management for Seizure
Very individualized to meet the medical
needs of the patients as some seizures /
epilepsy is caused by brain damage &
some by altered brain chemistry.
Aim of Management
 Manage & prevent seizure attacks
 To be seizure-free
 Minimize side effects of
medications
 Be able to follow an easy regime so
that compliance is high
 Medical Management
Symptomatic Management (controls
symptoms, does not cure)
1) Pharmacologic Therapy
 Choice of medication is
based on the aim to control
of seizure with minimal side
effects
 Selected based on the type
of seizure, effectiveness &
safety of medications
 Periodic assessment of
medication & compliance is
important to ensure seizure
is controlled & patient can
tolerate side effects
Pharmacologic Therapy (anti-epileptic
medications)
Refer to the notes provided by lecturers
2) Ketogenic Diet (prescribed as
pharmacologic Rx)
 Diet of high fat, low carbohydrate,
low protein
 Named so because the production
of ketones by the breakdown of
fatty acids
 Diet must be consulted by a
dietician / nutritionist
2) Ketogenic Diet
 Diet will be supplemented with
sugar-free vitamins & supplements.
 Potential side effects; hair thinning,
lethargy, weight loss, kidney
stones, possible cardiac problems
  Diet is contraindicated for
children / individuals with
metabolic disease (e.g. DM)
 Surgical Management
Objectives:
 Eradicate / cure seizure
 Reduce the severity of seizure
attacks
1. Surgical intervention is the last
resort due to possible
complications e.g. injury to other
brain parts
2. Choice of surgery depends on
nature of seizure most common is
localized to a particular brain part
e.g temporal lobectomy
Types of surgery
 Lobectomy
 Lesionectomy
 Corpus Collosotomy
 Multiple subpial transection
 Hernispherectomy
 Nursing Management
 Nursing Management
Objectives:
1) Patient Safety
 Prevention of injury
 Control of seizures
 Absence of complication
2) Psychosocial Needs
 Reducing fear of seizures
 Achieving satisfactory psychosocial
adjustment, coping mechanisms
3) Health Education
 Providing patient & family
education -understanding about
condition
 Nursing Management
Patient Safety: Prevention of Injury
 For patient with seizure, set up the
side rails with pads/cushions
 During seizure, lower patient on
the floor (if patient not on the bed),
guiding the head to the floor.
 Remove potential harmful items
nearby
 Never restrain / force patient into 1
position
 Do not attempt to put anything into
patient’s mouth once seizure begin
Psychosocial Needs: Reducing Fear of
Seizures
 Reassure & emphasis on
compliance to medication(s) to
control seizure
 Teach patient on how to write
seizure diary (outpatient), fit chart
(if in-patient)
 Family support is vital
 Compliance to medical review is
important – to monitor treatment
regime, side effects, drug toxicity,
drug resistance
 Health education; explain factors
that can trigger seizure e.g. photic
stimulation from TV, high lights
from cars, video games; stress;
lack of sleep & rest.
Psychosocial Needs: Improving
Coping Mechanism
 Refer to counselor for counselling
 Include family member &
significant others in health
education on this medical problem
Health Education for patient & family
 To modify the perceptions &
attitudes towards the disorder
 Patient may perceive that every
attack is a humiliation & shame to
self – cause anxiety, depression,
hostility & secrecy on patient &
family.
 Ongoing assessment &
encouragement need to be given.
 Encourage patient to carry
emergency medical identification
card / band
 Educate on medications &
management during seizure attack.
 Patient is not encouraged to drive
alone –seizures can happen when
driving – dangers self / others.
Patient Safety: Monitoring &
Managing Potential Complications
 Potential complications; status
epilepticus & medication toxicity
 Educate on medication, side
effects, to report if there are signs
of medication overdose
 Monitor serum level of drug to
prevent drug toxicity – periodic
blood check-up
 Need to review the complete
medication profile of patient to
avoid interaction with other
medications.
 Nursing Management during
Seizure (Ictal)
Nursing Care during Ictal
 Provide privacy & protect patient
from curious onlookers
 Ease the patient to the floor (guide
the head to the floor)
 Protect head with pad to prevent
injury
 Loosen constrictive clothing
 Push aside any items on the floor
that may injure patient
 If patient is on bed, remove pillows
& raise side rails
Nursing Care during Ictal…con’t...
 If an aura precedes seizure, insert
an oral airway to reduce possibility
of patient biting tongue / cheek
 Do not attempt to force open
clenched jaws in spasm / insert
anything. There will be a risk of
broken teeth & injury to lips &
tongue.
 Do not attempt to restrain patient
during seizure. Muscular
contractions is strong & restraint
can cause injury / fracture.
 Place patient on lateral position to
facilitate tongue to fall forward &
drainage of saliva & mucus.
 Set up O2 & do oral suction.
Nursing Care Post-Ictal
 Keep patient on lateral position to
prevent aspiration.
 Make sure airway is patent – no
obstruction.
 There may be a period of confusion
after grand mal seizure
 On awakening, re-orientate patient
on the place
 Short apneic period may occur
during / immediately after grand
mal seizure
 If patient is agitated post-ictally,
use gentle persuasion & gentle
restraint
  Status Epilepticus
 Defined as continuous / repetitive
seizures with no / very short
remission period (resting period)
between seizures.
 Considered a possible complication
for epileptic patient.
 Risk of hypoxia, acidosis,
hypoglycaemia, hyperthermia &
exhaustion
 Medical Management
Objectives:
 Stop seizures as soon as possible
 Ensure adequate cerebral
oxygenation
 To be seizure-free as soon as
possible
Most patients will be transferred /
admitted straight to Intensive Care
Unit (ICU) for close monitoring &
observation
 Medical Management
Adequate Oxygenation
 Insert airway during resting
period/post-ictally (patient may
have continuous seizures with
short resting period in between)
 If unconscious, endotracheal tube
needs to be inserted for
oxygenation
 Assessment of vital signs including
SPO2
Parenteral Support
 Set IV lines for IV antiepileptic
drugs (AED)
 IV Mannitol – decrease cerebral
edema due to recurrent seizures
 Infusion dextrose if seizures due to
hypoglycaemia
Pharmacologic Therapy
 Refer to notes provided in Microsoft
Word
Neurologic monitoring
 Continuos EEG monitoring in ICU
 To monitor seizure progress
- whether decreasing /
increasing / status quo
 Monitor the effectiveness of
IV anti-epileptic drugs (AED)
that has been started to
control the status
epilepticus
 Nursing Management
 Intensive Care
 Seizure / Fit Chart
 Document time of seizure,
description of seizure,
duration of seizure
 Vital signs including SPO2
monitoring
 Set up oxygen apparatus
 Prevention of injury
 Set up pads & side rails
 IV lines care – can be dislodge
during seizure
 Positioning – supine / semi-
recumbent
 Standby suction apparatus
 Nursing Management
 Psychosocial support
  Important to notify
caregiver / family members
of what is going on with
patient, patient’s progress.

 Reassurance is important
especially on anxious family
members / caregivers

 Conclusion

 Seizure / epilepsy is a disorder that

can be controlled with medications,
stress management, family &
caregiver support & lifestyle
modification.

 Compliance to medications is vital

for seizure control

 Nurses & doctors must

continuously provide support, not
just on in-patient basis, but also in
outpatient clinic especially in giving
psychosocial support.

 Health education is very important

in educating patient & caregiver
about this disorder.

 Exam Tips…

 Questions are Multiple Choice

Questions (MCQs)

 Emphasis is given on definitions of

disorders, nursing management &
pharmacologic therapy (including
nursing responsibilities & health
teaching on medications & side
effects of medications).

 But you will still need read all the

notes about seizure & seizure
disorders