AMYOTROPHIC LATERAL
SCLEROSIS produced by cyanobacteria
Amyotrophic lateral sclerosis (ALS)
is a nervous system disease that
attacks nerve cells called neurons
in your brain and spinal cord.
These neurons transmit messages
from your brain and spinal cord to
your voluntary muscles - the ones
you can control, like in your arms
and legs. At first, this causes mild
muscle problems. Some people
notice
• Trouble walking or running
• Trouble writing
• Speech problems
Eventually, you lose your strength
and cannot move. When muscles in
your chest fail, you cannot breathe.
A ventilator can help, but most
people with ALS die from
respiratory failure.
The disease usually strikes
between age 40 and 70. More men
than women get it. No one knows
what causes ALS. It can run in
families, but usually it strikes at
random. There is no cure.
Medicines can relieve symptoms
and, sometimes, prolong survival
General Information
• Progressive motor
neuron disease, which leads
to death in 2-6 years
• Onset usually between
ages 40 and 70
• Cause is unknown
• Some environmental
causative factors have been
suggested for the increased
incidence in the western
Pacific. Prolonged exposure
to a dietary neurotoxin
called BMAA is one
suspected risk factor
in Guam; this neurotoxin
is one of several possible
neurotoxic compounds
found in the seed of
the cycad Cycas circinalis, a
tropical plant found in
Guam, which was used in
the human food supply
during the 1950s and early
1960s.
• No cure or specific
treatment; death usually
occurs as a result of
respiratory infection
secondary to respiratory
insufficiency
Assessment findings
• Progressive weakness
and atrophy of the muscles
of arms, trunk or legs
• Dysarthia, dysphagia
• Fasciculations
• Respiratory
insufficiency
Diagnostic Tests:
• EMG
• & Muscle biopsy can
rule out other diseases
Nursing Interventions
• Provide nursing
measures for weakness
and dysphagia
• Promote adequate
ventilator function
• Prevent complications
of immobility
• Encourage diversional
activities; spent time with
the patient
• Provide compassion
and intensive support to
client or significant others
 • Provide or refer for
physical therapy as
indicated
• Promote independence
for as long as possible
___________MYASTHENIA
GRAVIS_________
- chronic
- characterized by fatigue and
severe weakness of skeletal
muscles
- autoimmune disorder
- 3x more common to women
- onset: 20-30 years old
Pathophysiology:
1. Antibodies destroy or block
the neuromuscular junction,
especially disrupting the
transmission of acetylcholine.
There is now decreased number
of acetylcholine receptors. Due
to diminished acetylcholine
uptake, structural changes
occur in the neuromuscular
junction.
2. In 75% patients with MG, the
thymus gland, which is usually
inactive after puberty, continues
to produce antibodies as
brought by tumor in the gland or
hyperplasia of the gland.
3. It is sometimes associated
with thyroxicosis
(hyperthyroidism), rheumatoid
arthritis and lupus
erythematosus.
Manifestation:
 Onset: eye muscles are
affected
- Diplopia or ptosis
 Follows the facial, speech
and mastication muscles’
weakness
- Dysarthria and dysphagia
 Fatigue
 Posture: head juts forward
due to neck muscle
weakness
 Decreased in diaphragm
movement
Complications:
- Related to involved muscle
and degree of weakness
 Myasthenic Crisis – Caused
by insufficient medication or
exacerbated by infection
- aspiration and
respiratory failure (also
pneumonia)
s/s:
Severe respi distress
Tachycardia and -pnea
Dysphagia
 Cholinergic crisis – from
overdose of
anticholinesterase
medications.
s/s:
Severe muscle
weakness
GI symptoms
Vertigo
Respiratory distress
Diagnostics:
 Serum assay of circulating
acetylcholine receptor
antibody -confirmatory
 Tensilon test – injection with
anticholonergic,
edrophonium chloride
(Tensilon) lasting approx 5
min.
Result: (+) myasthenic
crisis
(-) cholinergic crisis
 CT scan of chest – for thymus
involvement
 Single-fiber
electromyography –detects
 delayed or failes
neuromuscular transmission
Medications:
 Primary: Anticholinesterase
such as Pyridostigmine
(Mestinon)
 Prednisone –glucocorticoid,
aiming for muscle strength
NOTE: if irresponsive to
prednisone, combine
with cyclosporine or
azathioprine (Imuran)
Surgical Intervention:
 Thymectomy for clients
under 60 y.o.
Medical Interventions:
 Plasmapheresis –done only
when respiratory muscles are
involved. Used to remove
antiacetylcholinesterase
receptor antibodies, thus
alleviating symptoms. Used
in conjuction with other
therapies
Nursing Interventions:
 Administering
anticholinesterase
medications
-give parenterally if with
dysphagia
-note for excessive
stimulation of muscarinic
receptors: excess
salivation, diaphoresis, GI
hypermotility, bradycardia,
and urinary urgency. Give
Atropine to combat these
manifestations
-ready mechanical
ventilation when
respiratory depression and
failure occur.
 For thymectomy
-Pre-op: assist in
administering chest
tubes and tracheostomy
-Post-op: pulmonary
hygiene, manage pain,
and observe
complication of
pneumothorax if with
chest tube.
 For Plasmapheresis
-Pre-procedure: check blood
type and crossmatch,
CBC, platelet count and
clotting studies
-Intra and post procedure:
check for hypovolemia
(dizziness and
hypotension), apply
pressure dressing to
access site, assess for
infection and bruises at
IV port site, monitor fluid
and electrolytes
 For fatigue
-Schedule activities and
rest
-Avoid cigarette, alcohol
and beverages with
quinine
-Avoid extremes of
temperature
-Avoid people with URTI
 For Ineffective Airway
Clearance
-Place in semi-fowler’s
position
-Assist with turning, DBE,
and coughing every 2
hours
-Monitor for dehydration
-Monitor hydration, use of
humidifier
 For Impaired swallowing
 -Have the patient eat -occur at any age, but typically in
slowly, using small bites of young adults (20-40 yrs); affects
food women more frequently
-Plan meals to promote Types:
medication effectiveness
-Teach caregivers the
Heimlich maneuver and
how to suction

Manifestations:
Pathologic triad:
o CNS inflammation
o Demyelination
o Gliosis (scarring)
Muscle symptoms:
• Loss of balance
• Muscle spasms
_________MULTIPLE • Numbness or abnormal
SCLEROSIS__________ sensation in any area
-also known as disseminated • Problems moving arms or
sclerosis or encephalomyelitis legs
disseminate • Problems walking
- is an inflammatory disease in • Problems
which the fatty myelin sheaths with coordination and making
around the axons of small movements
the brain and spinal cord are • Tremor in one or more arms
damaged, leading or legs
to demyelination and scarring as • Weakness in one or more
well as a broad spectrum of signs arms or legs
and symptoms
Bowel and bladder symptoms:
• Constipation and stool
leakage
• Difficulty beginning to urinate
• Frequent need to urinate
• Strong urge to urinate
• Urine leakage (incontinence)
Eye symptoms:
• Double vision
• Eye discomfort
• Uncontrollable rapid eye
movements
• Vision loss (usually affects
one eye at a time)
Numbness, tingling, or pain
• Facial pain
• Painful muscle spasms
• Tingling, crawling, or burning
feeling in the arms and legs
Other brain and nerve symptoms:
• Decreased attention span,
poor judgment, and memory
loss
• Diffulty reasoning and solving
problems
• Depression or feelings of
sadness
• Dizziness and balance
problems
• Hearing loss
Sexual symptoms:
• Problems with erections
• Problems with vaginal
lubrication
Speech and swallowing symptoms:
• Slurred or difficult-to-
understand speech
• Trouble chewing and
swallowing
Fatigue is a common and
bothersome symptom as MS
progresses. It is often worse in the
late afternoon
Diagnostics:
Tests to diagnose multiple sclerosis
include:
• Lumbar puncture (spinal tap)
for cerebrospinal fluid tests,
including CSF oligoclonal
banding
• MRI scan of the brain and MRI
scan of the spine are important
to help diagnose and follow MS
• Nerve function study (evoked
potential test)
Medical Management
Main pharmacologic therapy:
- inhibits T-cell proliferation
and antigen–specific T-cell
activation
a. Avonex (beta-1a)
b. Bteaseron (beta-1b)
c. Copaxone (Glatiramer
acetate)
d. Rebif
Immunosuppressive Medications
-to treat chronic progressive
multiple sclerosis
a. Mitoxantrone
(Novantrone)
Corticosteroids
-reduce edema and
inflammatory process
a. Corticotropin (Acthar)
b. Methyl Prednisolone
Sodium Succinate
Treatment of spasms
a. Baclofen (Lioseral)
b. Diazepam (Valium)
c. Trizanidine (Zanaflex)
d. Dantrolene (Dantrium)
For fatigue
a. Amantadine
(Symmetrel)
b. Pemoline (Cylent)
c. Fluoxetine (Prozac)
For ataxia
a. Propanolol (Inderal)
b. Clonazepam (Klonopin)
For bowel and bladder control
 a. anticholinergics
b. alpha-adrenergics
c. antispasmodic
Ascorbic Acid – prevent
UTI
For pain: NSAIDS
Nursing Diagnosis:
1. Impaired Physical
Mobility r/t weakness, muscle
spasm and paresis
2. Risk for injury r/t
sensory and visual
impairment
3. Impaired urinary and
bowel elimination r/t nervous
system dysfunction
4. Impaired speech and
swallowing r/t cranial nerve
involvement
5. Disturbed thought
process r/t cerebral
dysfunction
Nursing Interventions:
6. Promote relaxation and
coordination exercises
especially progressive
resistive exercises to
strengthen muscle weakness.
7. Apply warm packs but not
hot baths for muscle spasm.
8. Provide bed rest during
exacerbation.
9. Protect client from injury
by providing safety
measures.
10. Place an eye patch on the
eyes for diplopia.
11. Promote regular
elimination by bowel and
bladder training.
12. Encourage independence.
13. Assess the need for and
provide assistive devices.
14. Initiate physical and
speech therapy.
15. Instruct client to avoid
fatigue, stress, infection,
overheating and chilling.
16. Instruct to increase fluid
intake and eat a balance diet
including low fiat, high fiber
and foods rich in potassium.
17. Assist with self-care
activities.
________________EPILEPSY_________
_____
Definition: a common chronic
neurological disorder characterized
by seizures. These seizures are
transient signs and/or symptoms of
abnormal, excessive or
synchronous neuronal activity in
the brain. About 50 million people
worldwide have epilepsy, with
almost 90% of these people being
in developing countries. Epilepsy is
more likely to occur in young
children or people over the age of
65 years; however, it can occur at
any time.
Causes:
• a brain injury, such as from a
car crash or bike accident
• an infection or illness that
affected the developing brain of
a fetus during pregnancy
• lack of oxygen to an infant's
brain during childbirth
• meningitis, encephalitis, or
any other type of infection that
affects the brain
• brain tumors or strokes
• poisoning, such as lead
or alcohol poisoning
Predisposing Factors:
Certain things can sometimes
trigger seizures in people with
epilepsy. They include:
• flashing or bright lights
• a lack of sleep
 • stress
• overstimulation (like staring at
a computer screen or playing
video games for too long)
• fever
• certain medications
• hyperventilation (breathing too
fast or too deeply)
Types:
 Partial seizures start in one
part of the brain. The electrical
disturbances may then move to
other parts of the brain or they
may stay in one area until the
seizure is over.
 Generalized seizures involve
electrical disturbances that occur
all over the brain at the same
time.
There are over 40 different
types of epilepsy,
including: Absence
seizures, atonic seizures,
benign Rolandic
epilepsy, childhood
absence,clonic
seizures, complex partial
seizures, frontal lobe
epilepsy, febrile
seizures, infantile
spasms, juvenile myoclonic
epilepsy, juvenile absence
epilepsy, hot water
epilepsy, Lennox-Gastaut
syndrome, Landau-Kleffner
syndrome , myoclonic
seizures, mitochondrial
disorders,progressive
myoclonic
epilepsy, psychogenic
seizures, reflex
epilepsy, Rasmussen's
syndrome, simple partial
seizures, secondarily
generalized
seizures, temporal lobe
epilepsy, tonic-clonic
seizures, tonic seizures,
psychomotor
seizures, limbic epilepsy,
partial-onset seizures, Rett
syndrome, generalized-onset
seizures, status
epilepticus, abdominal
epilepsy, akinetic seizures, a
utonomic seizures, massive
bilateral myoclonus, catamen
ial epilepsy, drop
seizures, emotional seizures,
focal seizures, gelastic
seizures, Jacksonian seizure
disorder, Lafora
disease, motor
seizures, multifocal
seizures, neonatal
seizures, nocturnal
seizures, photosensitive
epilepsy,pseudoseizures, sen
sory seizures, subtle
seizures, Sylvan
seizures, withdrawal
seizures and visual reflex
seizures, among others.[
 Epilepsy syndromes are
further divided by presumptive
cause: idiopathic, symptomatic,
and cryptogenic.
Idiopathic epilepsies are
thought to arise from genetic
abnormalities that lead to
alteration of basic neuronal
regulation.
Symptomatic epilepsies arise
from the effects of an
epileptic lesion, whether that
lesion is focal, such as a
tumor, or a defect in
metabolism causing
widespread injury to the
brain.
Cryptogenic epilepsies
involve a presumptive lesion
 that is otherwise difficult or
impossible to uncover during
evaluation.
A. Grand Mal Seizure.
(Characterized by three phases.)
(1) Preictal phase.
(a) Consists of vague emotional
changes (depression, anxiety,
nervousness).
(b) Lasts for minutes to hours.
Followed by an "aura."
(c) Aura is usually a sensory
"cue" (odor or sound) or
sensation "cue" (weakness,
numbness). It is related to the
anatomical origin of the seizure,
and warns the patient that a
seizure is imminent.
(d) Preictal phase may or may
not be present in all patients.
(2) Tonic-clonic phase.
(a) Loss of consciousness.
(b) Skin may become cyanotic,
breathing is spasmodic, jaws are
tightly clenched, and tongue
and inner teeth may be bitten.
(c) Urinary and fecal
incontinence usually occur.
(d) Phase may last one or more
minutes.
(e) Tonic activity is
characterized by rigid
contraction of the muscles.
(f) Clonic activity is
characterized by alternate
contraction and relaxation of
muscles, causing jerking
movements of the arms and
legs.
(3) Postictal phase.
(a) Phase will vary in symptoms.
(b) Many patients fall into a
deep sleep which may last for
several hours.
(c) Patient may experience
headache, fatigue, confusion,
and nausea.
B. Petit Mal Seizure.
(1) Characterized by brief loss of
consciousness, or "blank spells."
(2) Individual stares blankly,
eyelids may flutter, and there is
slight movement of head and
extremities.
(3) More common in children.
(4) May occur dozens of times
per day.
C. Psychomotor Seizure.
(1) Different forms of seizure
activity often appearing as
irrational or odd behavior, such
as removing one's clothing or
purposeless behaviors such as
smacking one's lips.
(2) Last only a few moments
and individual has no recall of
behavior.
(3) Auditory, visual, or olfactory
hallucinations may also occur.
D. Jacksonian Seizure. (Also called
focal or marching seizures.)
(1) Seizures may start in one
part of the body and move to
another. Consciousness may not
be lost.
(2) May be followed by a grand
mal seizure.
F. Status Epilipticus.
(1) Series of grand mal seizures
experienced by the patient
without regaining
consciousness.
(2) Extreme neurological
emergency.
(3) May occur spontaneously or
if anticonvulsant medications
are suddenly stopped.
Diagnostic exam:
o EEG
o Brain scan
 o Skull x-ray
o Brain CAT scan
o Brain MRI scan
o Blood tests
o Brain blood circulation tests
Medical and Nursing Management.
(1) Objectives of care:
(a) Determine and treat
underlying cause of seizures if
possible.
(b) Prevent recurrence of seizures
and therefore allow patient to live
a normal life.
(2) Institute and reinforce the
importance of anticonvulsant drug
therapy:
(a) Drug therapy is a means of
controlling the condition; it is not
a cure.
(b) Initially, dosage will have to
be monitored and altered to
provide maximum control with
minimum side effects.
(3) Instruct patient to keep record
of events surrounding his/her
seizures (number, duration, time,
sleep/eating patterns).
(4) Use of multidisciplinary
approach to cope with social,
emotional, and vocational
pressures of the person with
epilepsy.
(5) Place a padded tongue blade
and oral airway at the patient's
bedside. Tape them to the
headboard or wall above the bed.
This provides easy emergency
access.
(6) Take the seizure prone patient's
temperature with a rectal
thermometer; prevents possibility
of patient biting an oral
thermometer if a seizure should
occur.
(7) Set up suction equipment at the
patient's bedside.
(a) Check the equipment daily to
be sure it is working properly.
(b) Use during or after a seizure
to clear the patient's airway.
(8) Essential steps necessary to
protect the patient during a
seizure.
(a) Turn patient on his side to
provide for drainage of oral
secretions.
(b) Do not forcibly restrain patient
during seizure.
(c) Remove objects that may
obstruct breathing or cause injury
to patient.
(d) Protect patient's head from
injury with pillow, blanket, etc.
(9) Essential steps necessary to
ensure safety of the patient
following a seizure.
(a) Keep bed flat and patient
turned on his side until he is alert.
(b) Room lighting should be dim
and noise kept to a minimum.
(c) Loosen restrictive clothing (if
not done during seizure).
(d) Check vital signs immediately
following seizure and every 30
minutes (or as ordered) until
patient is alert.
(e) Check lips, tongue, and inside
of mouth for injuries.
(f) If patient is incontinent,
change clothing and bedding with
as little disturbance as possible.
(10) Documentation.
(a) Document all precautions
taken.
(b) Document all activity
observed during a seizure, to
include the time, location,
circumstances, length of seizure
activity, and vital signs.
(c) Document any injury
sustained during a seizure.

_______________SEIZURES__________
_____
Causes:
In general, seizures may be
caused by many conditions,
diseases, injuries, and other
factors. These may include
conditions such as the following
abnormalities in the blood vessels
of the brain, atherosclerosis, or
hardening of the arteries supplying
the brain, bleeding into the brain,
such as a subarachnoid
hemorrhage , brain tumors,
chromosomal abnormalities,
congenital diseases or conditions,
high blood pressure, pregnancy
and problems associated with
pregnancy, stroke, transient
ischemic attack, which is also
called a mini-stroke.
Diseases also can be a factor
in seizures, they include advanced
liver disease, Alzheimer's disease
and other types of dementia,
epilepsy, or a disease of the
nervous system, hereditary
diseases, infections involving the
brain, including encephalitis, brain
abscess, and bacterial meningitis,
kidney failure, such as chronic
renal failure.
Injuries that may cause
seizures include choking, head
injury such as a motor vehicle
accident or sports injury, electrical
injuries, injury during birth or in the
uterus, poisonous insect bites or
stings
Additional factors that may
cause seizures include alcohol
withdrawal • craniotomy, which is
brain surgery, high fever,
especially in young children, illegal
drugs such as cocaine, lead
poisoning, overheating, withdrawal
from some medicines, including
those used to treat seizures.
Types:
Primary generalized seizures
Primary generalized seizures
begin with a widespread electrical
discharge that involves both sides
of the brain at once. Hereditary
factors are important in many of
these seizures.
ABSENCE SEIZURES
Absence seizure — also known as
petit mal seizure — involves a
brief, sudden lapse of conscious
activity. Occurring most often in
children, an absence seizure may
look like the person is merely
staring into space for a few
seconds.
ATYPICAL ABSENCE SEIZURES
Usually 5 to 30 seconds (commonly
more than 10), with a gradual
beginning and ending.
Atypical means unusual or not
typical. The person will stare (as
they would in any absence seizure)
but often is somewhat responsive.
Eye blinking or slight jerking
movements of the lips may occur.
This behavior can be hard to
distinguish from the person's usual
behavior, especially in those with
cognitive impairment. Unlike other
absence seizures, these seizures
usually cannot be produced by
rapid breathing.
MYOCLONIC SEIZURES
They're very brief jerks. Usually
they don't last more than a second
or two. There can be just one, but
sometimes many will occur within a
short time. Myoclonic seizures are
brief, shock-like jerks of a muscle
or a group of muscles. "Myo"
means muscle and "clonus" means
rapidly alternating contraction and
relaxation—jerking or twitching—of
a muscle.
ATONIC SEIZURES
Less than 15 seconds. Muscle
"tone" is the muscle's normal
tension. "Atonic" means "without
tone," so in an atonic seizure,
muscles suddenly lose strength.
The eyelids may droop, the head
may nod, and the person may drop
things and often falls to the
ground. These seizures are also
called "drop attacks" or "drop
seizures." The person usually
remains conscious. Another name
for this type of seizure is "akinetic",
which means "without movement."
TONIC SEIZURES
Usually less than 20 seconds.
Muscle "tone" is the muscle's
normal tension at rest. In a "tonic"
seizure, the tone is greatly
increased and the body, arms, or
legs make sudden stiffening
movements. Consciousness is
usually preserved. Tonic seizures
most often occur during sleep and
usually involve all or most of the
brain, affecting both sides of the
body. If the person is standing
when the seizure starts, he or she
often will fall.
CLONIC SEIZURES
The length varies. "Clonus" means
rapidly alternating contraction and
relaxation of a muscle -- in other
words, repeated jerking. The
movements cannot be stopped by
restraining or repositioning the
arms or legs. Clonic seizures are
rare, however. Much more 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!
TONIC-CLONIC SEIZURES
Generally, 1 to 3 minutes. A tonic-
clonic seizure that lasts longer than
5 minutes probably calls for
medical help. A seizure that lasts
more than 30 minutes, or three
seizures without a normal period in
between, indicates a dangerous
condition called convulsive status
epilepticus. This requires
emergency treatment. This type is
what most people think of when
they hear the word "seizure." An
older term for them is "grand mal."
As implied by the name, they
combine the characteristics of tonic
seizures and clonic seizures. The
tonic phase comes first: All the
muscles stiffen. Air being forced
past the vocal cords causes a cry
or groan. The person loses
consciousness and falls to the floor.
The tongue or cheek may be
bitten, so bloody saliva may come
from the mouth. The person may
turn a bit blue in the face. After the
tonic phase comes the clonic
phase: The arms and usually the
legs begin to jerk rapidly and
rhythmically, bending and relaxing
at the elbows, hips, and knees.
After a few minutes, the jerking
slows and stops. Bladder or bowel
control sometimes is lost as the
body relaxes. Consciousness
returns slowly, and the person may
be drowsy, confused, agitated, or
depressed.
Partial seizures
Partial seizures begin with an
electrical discharge in one limited
area of the brain. Some are related
to head injury, brain infection,
stroke, or tumor, but in most cases
the cause is unknown.
One question that is used to
further classify partial seizures is
whether consciousness (the ability
to respond and remember) is
"impaired" or "preserved." The
difference may seem obvious, but
really there are many degrees of
impairment or preservation of
consciousness.
SIMPLE PARTIAL SEIZURES
Only a short time, usually less than
2 minutes. Doctors often divide
simple partial seizures into
categories depending on the type
of symptoms the person
experiences:
Motor seizures:
These cause a change in muscle
activity. For example, a person
may have abnormal movements
such as jerking of a finger or
stiffening of part of the body.
These movements may spread,
either staying on one side of the
body (opposite the affected area of
the brain) or extending to both
sides. Other examples are
weakness, which can even affect
speech, and coordinated actions
such as laughter or automatic hand
movements. The person may or
may not be aware of these
movements
Sensory seizures:
These cause changes in any one of
the senses. People with sensory
seizures may smell or taste things
that aren't there; hear clicking,
ringing, or a person's voice when
there is no actual sound; or feel a
sensation of "pins and needles" or
numbness. Seizures may even be
painful for some patients. They
may feel as if they are floating or
spinning in space. They may have
visual hallucinations, seeing things
that aren't there (a spot of light, a
scene with people). They also may
experience illusions—distortions of
true sensations. For instance, they
may believe that a parked car is
moving farther away, or that a
person's voice is muffled when it's
actually clear.
Autonomic seizures:
These cause changes in the part of
the nervous system that
automatically controls bodily
functions. These common seizures
may include strange or unpleasant
sensations in the stomach, chest,
or head; changes in the heart rate
or breathing; sweating; or goose
bumps.
Psychic seizures:
These seizures change how people
think, feel, or experience things.
They may have problems with
memory, garbled speech, an
inability to find the right word, or
trouble understanding spoken or
written language. They may
suddenly feel emotions like fear,
depression, or happiness with no
outside reason. Some may feel as
though they are outside their body
or may have feelings of déja vu
("I've been through this before") or
jamais vu ("This is new to me"—
even though the setting is really
familiar).
COMPLEX PARTIAL SEIZURES
They usually last between 30
seconds and 2 minutes. Afterward,
the person may be tired or
confused for about 15 minutes and
may not be fully normal for hours.
These seizures usually start in a
small area of the temporal lobe or
frontal lobe of the brain. They
quickly involve other areas of the
brain that affect alertness and
awareness. If the symptoms are
subtle, other people may think the
person is just daydreaming.
Some people can have seizures of
this kind without realizing that
anything has happened. Because
the seizure can wipe out memories
of events just before or after it,
however, memory lapses can be a
problem.
Some of these seizures (usually
ones beginning in the temporal
lobe) start with a simple partial
seizure. Also called an aura, this
warning seizure often includes an
odd feeling in the stomach. Then
the person loses awareness and
stares blankly. Most people move
their mouth, pick at the air or their
clothing, or perform other
purposeless actions. These
movements are called
"automatisms". Less often, people
may repeat words or phrases,
laugh, scream, or cry. Some people
do things during these seizures
that can be dangerous or
embarrassing, such as walking into
traffic or taking their clothes off.
These people need to take
precautions in advance.
Complex partial seizures starting in
the frontal lobe tend to be shorter
than the ones from the temporal
lobe. The seizures that start in the
frontal lobe are also more likely to
include automatisms like bicycling
movements of the legs or pelvic
thrusting. Some complex partial
seizures turn into secondarily
generalized seizures.
SECONDARILY GENERALIZED
SEIZURES
The generalized, convulsive phase
of these seizures usually lasts no
more than a few minutes, the same
as primary generalized seizures.
The preceding partial seizure is
usually not very long. Sometimes
this part is so brief that it is hard to
detect.
These seizures are called
"secondarily generalized" because
they only become generalized
(spread to both sides of the brain)
after the initial or "primary" event,
a partial seizure, has already
begun. They happen when a burst
of electrical activity in a limited
area (the partial seizure) spreads
throughout the brain. Sometimes
the person does not recall the first
part of the seizure. These seizures
occur in more than 30% of people
with partial epilepsy.
Diagnostic tests
1. Blood studies to rule out lead
poisoning, hypoglycemia,
infection, or electrolyte
imbalance
2. Lumbar puncture to rule out
infection or trauma
3. Skull X-rays, CT scan, or
ultrasound of the head, brain
scan, arteriogram, or
pneumoencephalogram to
detect any pathologic defects
 4. EEG may detect abnormal
wave patterns characteristic
of different types of seizures
Medical management
1. Drug therapy
A. Phenytoin (Dilantin)
1) Often used with
phenobarbital for its potentiating
effect
2) Inhibits spread of electrical
discharge
3) Side effects include gum
hyperplasia, hirsutism, ataxia,
gastric distress,
nystagmus, anemia, sedation
B. Phenobarbital: elevates
the seizure threshold and
inhibits the spread of
electrical discharge
2. Surgery: to remove the
tumor, hematoma, or epileptic
focus
Nursing interventions
1. During Seizure activity
A. Protect from injury
1) Prevent falling, gently
support head
2) Decrease external
stimuli: do not restraib.
3) Do not use tongue
blades (they add
additional stimuli)
4) Loosen tight clothing
B. Keep airway open.
1) Place in side lying
position.
2) Suction excess mucous
C. Observe and record seizure.
1. Note any preictal aura.
a) Affective signs:
fear, anxiety
b) Psychosensory
signs:
hallucinations
c) Cognitive signs:
“deja-vu”
symptoms
2. Note nature of the ictal phase
a) Symmetry of
movement
b) Response to
stimuli; LOC
c) respiratory
pattern
3. Note postictal response:
amount of time it takes child to
orient to time and place;
sleepiness.
2. Provide client teaching and
discharge planning concerning
a. Care during a seizure
b. Need to continue drug
therapy
c. Safety precautions/
activity limitations
d. Need to wear Medic-Alert
identification bracelet or
carry identification card
e. Potential behavioral
changes and school
problems
f. Availability of support
groups/community
agencies
g. How to assist the child in
explaining disorders to
peers
______GUILLAIN-BARRE
SYNDROME_______
 is an autoimmune attack on
the peripheral nerve myelin
that results to acute, rapid
segmental demyelination of
peripheral nerves and some
cranial nerves producing
ascending weakness with
 dyskinesia, hyporeflexia, and
paresthesias.
 An antecedent event most
often a viral infection
precipitates
clinicalpresentation such as
Campylobacter jejuni,
Haemophilus influenzae, and
Human Immunodeficiency
virus (HIV).
 It is the result of a cell
mediated and humoral
immune attack on the
peripheral nerve myelin
proteins that causes
inflammatory demyelination.
 It does not affect cognitive
function or level of
cosciousness
Clinical Manifestations:
 Areflexia and ascending
weakness (classic clinical
features)
 hyporeflexia and muscle
weakness may progress to
tetraplegia
 neuromuscular respiratory
failure and bulbar weakness
 Sensory symptoms:
paresthesias of the hands
and feet and pain
 Optic nerve demyelination:
blindness
 Glossopharyngeal
demyelination: inability to
swallow or clear secretions
 Vagus nerve demyelination:
instability of the
cardiovascular system
(tachycardia, bradycardia,
hypertension, or orthostatic
hypotension)
Assessment and Diagnostic
Findings:
 Patient presents with
symmetric weakness,
diminished reflexes, and
upward progression of motor
weakness.
 A history of a viral illness in
the previous few weeks
suggests the diagnosis.
 Changes in vital capacity and
negative inspiratory force are
assessed to identify
impending neuromuscular
respiratory failure.
 Elevated protein levels are
detected in CSF evaluation,
without an increase in other
cells.
Medical Management:
 requires management in an
intensive unit care
 assessment of changes in
muscle strength and
respiratory function alert the
clinician to the physical
respiratory needs of the
patient.
 Respiratory therapy or
mechanical ventilation may
be necessary to support
pulmonary function and
adequate oxygenation.
 Mechanical ventilation may
be required for an extended
period.
 Patient is weaned after
mechanical ventilation.
 Elective intubation before
onset of extreme respiratory
muscle fatigue
 Prevent the complications of
immobility such as using
anticoagulant stockings or
 thigh-high elastic
compression stockings or
sequential compression boots
to prevent thrombosis and
pulmonary emboli.
 Plasmaparesis and IVIG are
used to affect directly the
peripheral nerve myelin
antibody level.
 IVIG is currently the therapy
of choice because it is
associated with fewer side
effects.
 Continuous
electrocardiographic
monitoring.
 Short-acting medications
such as alpha-adrenergic
blocking agents are used to
treat tachycardia and
hypertension.
 Hypotension is treated by
increasing the aount of IV
fluid administered.
Assessment:
 Ongoing assessment for
disease progression is critical
 Monitored for life-threatening
complications such as
respiratory failure, cardiac
dysrhythmias, DVT.
 Assess the patient’s and
family’s ability to cope and
their use of coping strategy.
Nursing diagnoses:
 Ineffective breathing pattern
and impaired gas exchange
r/t rapidly progressive
weakness and impending
respiratory failure
 Impaired bed and physical
mobility r/t paralysis
 Imbalanced nutrition, less
than body requirements r/t
inability to swallow
 Impaired verbal
communication r/t cranial
nerve dysfunction
 Fear and anxiety r/t loss of
control and paralysis
Planning and goals:
The major goals for the
patient may include improved
respiratory function, increased
mobility, improved nutritional
status, effective communication,
decreased fear and anxiety, and
absence of complications.
Nursing interventions:
 Maintaining respiratory
function.
o Incentive spirometry
and chest
physiotherapy
o Monitor for changes in
the vital capacity and
negative inspiratory
force
o Mechanical ventilation
o Suctioning may be
needed to maintain a
clear airway.
o Assess the blood
pressure and heart rate
o Medications are
administered as
indicated or a
temporary pacemaker
is placed for clinically
significant bradycardia.
 Enhancing physical mobility
o Passive-range of
motions exercises are
performed twice daily
 o Position changes every and distraction
2 hours techniques.
o Use of thigh-high  Monitoring and Managing
elastic compression Potential Complications
stockings or sequential o Thorough assessment
compression boots and of respiratory function
adequate hydration at regular intervals is
decrease risk of DVT essential.
o Padding may be placed o ECG monitoring
over bony
prominences. Evaluation:
 Providing adequate nutrition  Maintains effective
o Administer IV fluids and respirations and airway
parenteral nutrition as clearance
prescribed and monitor  Shows increasing mobility
for the return of bowel  Receives adequate nutrition
sounds. and hydration
o Gastrotomy tube may  Demonstrates recovery of
be placed of the speech
patient cant swallow to  Shows lessening fear and
administer nutrients. anxiety
o Assess the gag reflex  Absence of complications
and bowel sounds
before resuming oral
nutrition.
 Improving Communicaiton
o Establishing some form
of communication with
picture cards or an eye
blink system provides a
means of
communication.
o Collaborate woth a
speech therapist may
be helpful.
 Decreasing fear and anxiety
o Referral to a support
group
o Provide information
about the condition,
emphasizing a positive
appraisal of coping
resources and teaching
relaxation exercises