SEIZURE

DISORDER
Presented by
S.DOUGLAS
S.HIBBERT
S.LEWIS
M.MCINTOSH
D.SMITH
S.SMITH
OBJECTIVES ★ TO DEFINE SEIZURE
★ To EXPLAIN THE PATHOPHYSIOLOGY
OF SEIZURE
★ TO CLASSIFY THE TYPES OF
SEIZURES
★ TO IDENTIFY THE CLINICAL
MANIFESTATIONS OF SEIZURE
DISORDERS
★ FACTORS CONTRIBUTING TO
SEIZURES
★ TO INVESTIGATE THE DIAGNOSTIC
TESTS
★ TO DETERMINE MEDICAL,NURSING
MANAGEMENT AND INTERVENTIONS
Overview
Typically seizures are derived from a defect in the CNS . When
people think of seizures, they often think of convulsions in which
a person's body shakes rapidly and uncontrollably. Not all
seizures cause convulsions. There are many types of seizures
and some have mild symptoms. Seizures fall into two main
groups. Focal seizures, also called partial seizures, happen in
just one part of the brain. Generalized seizures are a result of
abnormal activity on both sides of the brain.
 What is Seizure??
This is a disorder that involves a
sudden episode of abnormal,
uncontrolled discharge of the
electrical activity of the neurons
within the brain.
PATHOPHYSIOLOGY
OF SEIZURE DISORDER
Pathophysiology
•Seizures are a result of a shift in the
normal balance of excitation and inhibition
within the CNS.

•i.e. Abnormal discharges of neurons that

may be caused by any pathological
process affecting the brain
Classification of
seizures
There are two main classification OF Seizures

● Partial (Focal) seizures These start in a

particular part of your brain, and their names
are based on the part where they happen.
● Generalized seizures These happen when
nerve cells on both sides of your brain misfire.
They can make you have muscle spasms,
black out, or fall. There are five main types:
 Partial Seizure
★ Simple Partial Seizure -Begins with aura; may have
unilateral unusual sensation or movement of extremity,
autonomic (heart rate, flushing), or psychic changes; no
loss of consciousness

★ Complex Partial Seizure - involves loss of

consciousness; automatisms (lip smacking,
picking, patting)
 Generalized Seizure
★ Tonic clonic (Grand Mal): Begins with tonic (stiffening/rigidity of muscles of
limbs), loss of consciousness, then clonic (rhythmic jerking)

★ Tonic: Stiffening or rigidity of muscles; loss of consciousness.

★ Clonic :Rhythmic jerking of muscle contraction and relaxation.

★ Absence (Peti Mal):Brief loss of conscious awareness and staring into space;
appears to be daydreaming
 Generalized Seizure
Myoclonic : Brief stiffening or jerking of extremity, either single
or in groups.

Atonic: Loss of muscle tone

Generalized seizures
Clinical Manifestations
● Temporary confusion
● A staring spell
● Uncontrollable jerking movements of the
arms and legs
● Loss of consciousness or awareness
● Cognitive or emotional symptoms, such as
fear, anxiety or deja vu
Factors that
contribute to
seizures

•Fever in children caused by

underlying endogenous factors
may result in seizures.

•Head trauma, stroke, infections,

as a result of abnormalities of
CNS development.
Psychological or physical
•

stress, sleep deprivation, or

hormonal changes,
exposure to toxic
substances and certain
medications.
MEDICAL MANAGEMENT
Complication Of Seizure
Status epilepticus is a medical emergency in which seizures recur without the patient
regaining consciousness between events. This condition can develop in any type of
seizure but is most common in tonic-clonic seizures. Status epilepticus may cause brain
damage or cognitive dysfunction and may be fatal. Usually last greater than >5minuites
Complications may include:

● Aspiration
● Cardiac arrhythmias
● Dehydration
● Fractures
● Myocardial infarction (heart attack)
DIAGNOSTIC TEST
For seizure disorders
Main Diagnostic Test for Seizure
1. Electroencephalogram
2. Computerized tomography (CT) scan
3. Magnetic resonance imaging (MRI)
4. Positron emission tomography (PET)
5. Single-photon emission computerized tomography
(SPECT)
 ELECTROENCEPHALOGRAM (EEG)

Electroencephalogram is
used to identify areas of
abnormal electrical activity
within the brain.
Computerized tomography (CT) scan .

A CT scan uses X-rays to obtain cross-sectional images of the

brain. CT scans can reveal abnormalities in your brain that
might be causing your seizures, such as tumors, bleeding and
cysts.
 Magnetic resonance imaging (MRI).

An MRI uses powerful magnets and

radio waves to create a detailed view
of your brain that detect lesions or
abnormalities in the brain that could
be causing your seizures.
Positron emission tomography (PET)

PET scans use a small amount of

low-dose radioactive material that's
injected into a vein to help visualize
active areas of the brain and detect
abnormalities.
Single-photon emission computerized tomography (SPECT)

This type of test is used primarily if an MRI and EEG

that didn't pinpoint the location in your brain where the
seizures are originating.

A SPECT test uses a small amount of low-dose

radioactive material that's injected into a vein to create
a detailed, 3-D map of the blood flow activity in your
brain during seizures.
 NURSING
DIAGNOSIS &
INTERVENTIONS
Risk for Injury related to: loss of
consciousness during seizure activity and
postictal physical weakness.
•Outcomes:
At the end of one hour following collaborative care
safety practices will be implemented in the
environment .
Interventions
–Remove potentially harmful objects from the
environment.
–Keep suction, Ambu bag, oral or nasopharyngeal
airway at bedside to maintain airway and oxygenation if
needed.
–Use padded side rails to prevent injury during a seizure.
–Remain with patient during seizure to protect patient
from injury.
Ineffective airway clearance related to:
blockage of the tongue, endotracheal,
increased secretion of saliva
Outcome
–Maintain a patent airway at all times.
Interventions
–Auscultate breath sounds every 1 to 4 hours
–Monitor respiratory patterns, including rate, depth,
and effort. Monitor blood gas values and pulse
oxygen saturation levels as available.
–Position person to optimize respirations: head of
bed elevated 30-45 degrees
 Spinal Cord Injury (SCI)
According to Shepherd Center (2019) a spinal
cord injury (SCI) is damage to the spinal cord
that results in a loss of function, such as
mobility and/or feeling. The leading causes of
spinal cord injury (SCI) include motor vehicle
crashes, falls, acts of violence, and sporting
injuries. The mechanism of injury influences the
type of SCI and the degree of neurological
deficit.
 Anatomy and Physiology
The spinal cord is the major bundle of
nerves that carries nerve impulses to
and from the brain to the rest of the
body.The spinal cord extends as a
continuous structure from the medulla at
the base of the skull to the first lumbar
vertebra (L1), where it tapers into a
fibrous band called the conus medullaris.
At L2 the nerve roots (cauda equina)
extend beyond the conus.
The vertebral column comprises 7
cervical, 12 thoracic, 5 lumbar, and 5
fused sacral vertebrae that protect the
spinal cord. Intervertebral discs and facet
joints cushion and allow movement. Nerve
roots exit from the vertebral column
through the intervertebral foramina
(openings). The spinal cord is
approximately 18 inches (45 cm) long in
an adult and about finger width.
Anatomy and Physiology
 General Classification
● C-1 to C-3: Tetraplegia with total loss of muscular/respiratory function.

● C-4 to C-5: Tetraplegia with impairment, poor pulmonary capacity, complete dependency

for ADLs.

● C-6 to C-7: Tetraplegia with some arm/hand movement allowing some independence in

ADLs.

● C-7 to T-1: Tetraplegia with limited use of thumb/fingers, increasing independence.

● T-2 to L-1: Paraplegia with intact arm function and varying function of intercostal and

abdominal muscles.
 Classification of SCI
Complete SCI: complete loss of
sensory and motor functions
below the level of the injury. The
brain is unable to send signals
down spinal cord below the level
of injury.
Incomplete SCI
Sensory or motor fibres or both
are preserved below the level of
primary injury. A person may
have more function in one limb
more than the other.
 Types of Incomplete SCI
● Central Cord Syndrome: the most frequent
type of incomplete lesion, primarily of the
cervical spine, most often occurring in elderly
patients with pre-existing cervical spondylosis.
In younger patients, CCS may occur with high
force trauma. CCS results from
hyperextension that compresses the spinal
cord anteriorly, resulting in bleeding and/or
edema and injuring the central gray matter.
 Anterior Cord Syndrome
The most severe of the cord syndromes, with the
worst prognosis for recovery, with improvement rare
(10-15%) if there is no evidence of progressive
reduction of symptoms within 24 hours. ACS is
characterized by loss of pain, temperature, and motor
function below the level of injury but with retention of
light touch, proprioception, and vibration sensation.
May occur as the result of acute disc herniation or
hyperflexion injuries associated with fracture
dislocation of vertebra or compression of and injury to
the anterior spinal artery,
 Posterior Cord Syndrome
Very rare and usually results from
cervical hyperextension injuries that
damage the dorsal areas of the cord.
PCS is characterized by loss of deep
pressure, deep pain, and proprioception
below the level of the lesion but with
normal motor function and other pain and
temperature sensations intact. Prognosis
is good.
 Brown-Sequard Syndrome
Also known as lateral cord syndrome is rare but has
a better prognosis than the other syndromes. The
lesion on one side of the spine is caused by
transverse hemisection of the spinal cord (most
often from a stabbing or missile injury),
fracture-dislocation of a unilateral articular process,
or acute ruptured disc. BSS is most common in the
cervical region. BSS is characterized by paresis
with ipsilateral loss of touch, pressure, and vibration
sensation below the level of the lesion and
contralateral loss of pain and temperature 2 to 3
levels below the level of the lesion.
 Pathophysiology
❖ Spinal cord injuries may range from contusion, laceration, and
compression to complete transection, and impairment may be
temporary or permanent.
❖ May be categorized as Primary from the initial trauma and
Secondary from a chain of events that results in destruction of
myelin and axons.
 Pathophysiology Cont’d
❖ Immediately: after injury, axonal transmission is interrupted and
decreased spinal blood flow can result in ischemia. Initially, injury
is more severe to gray matter than to white.
❖ Within a few minutes: hemorrhages can begin to occur in the
gray matter and within 30 minutes, central neuronal necrosis is
evident and nerve fibers are edematous.
❖ By 4 hours: the gray matter shows marked necrosis and
increasing necrosis in the white matter as well. By 8 hours, the
axons have become maximally edematous and axonal necrosis is
occurring along with vesicular degeneration. By =/< 24 hours,
permanent damage can occur.
Complications
1. Decubitus ulcers
2. Osteoporosis and Fracture
3. Pneumonia atelectasis aspiration
4. Heterotopic Ossification
5. Spascity
6. Autonomic Dysreflexia
7. DVT
8. Cardiovascular disease
9. Neuropathic/Spinal cord pain
10. Respiratory Dysfunction
Acute Complications
Spinal shock

Spinal shock is a sudden and transient loss of motor, sensory and reflex function
below the level of damage.

Spinal shock is caused by a direct force applied to the spinal cord resulting in
physiological block to conduction areflexia, loss of sensation, flaccid paralysis
below level of of lesion with retention of urine, lax anal sphincter, bowel distention
and paralytic ileus.

NB THERE IS NO TREATMENT
Acute complications
Neurogenic Shock

This develops as a result as a result of loss of ANS function below level of the
lesion.

Distributive type- occurs in injuries above T6 (T1 - T4) mid thoracic. This results in
the loss of vasomotor tone (vascular dilatation) and loss of sympathetic
innervation to the heart.

Clinical findings- triad hypotension, severe bradycardia, peripheral vasodilation,

loss of the ability to sweat below the level of injury.
 Diagnostic Test
Spinal x-rays: Locates level and type of bony injury (fracture, dislocation);
determines alignment and reduction after traction or surgery.

CT scan: Locates injury, evaluates structural alterations. Useful for rapid screening
and providing additional information if

x-rays questionable for fracture/cord status.

MRI: Identifies spinal cord lesions, edema, and compression.

Myelogram: May be done to visualize spinal column if pathology is unclear or if

occlusion of spinal subarachnoid space is suspected (not usually done after
penetrating injuries).
Somatosensory evoked potentials (SEP): Elicited by presenting a peripheral
stimulus and measuring degree of latency in cortical response to evaluate spinal cord
functioning/potential for recovery.

Chest x-ray: Demonstrates pulmonary status (e.g., changes in level of diaphragm,

atelectasis).

Pulmonary function studies (vital capacity, tidal volume): Measures maximum

volume of inspiration and expiration; especially important in patients with low cervical
lesions or thoracic lesions with possible phrenic nerve and intercostal muscle
involvement.

ABGs: Indicates effectiveness of gas exchange and ventilatory effort.