SEIZURES are episodes of abnormal motor, sensory, autonomic, or psychic activity (or combination of these) that result from

m sudden excessive discharge from cerebral neurons. (Hickey, 2009) A part or all of the brain may be involved. Frequently, it is manifested by involuntary repetitive movements or abnormal sensations. Etiology The specific causes of seizure are varied and can be categorized as Idiopathic (genetic, developmental defects) and Acquired. Acquired seizures can be caused by cerebrovascular disease, head injury, brain tumor, CNS infections, hypoxemia, hypertension, fever (childhood), allergies, drug and alcohol withdrawal, and metabolic and toxic conditions (e.g. hypoglycemia, renal failure, etc.) Classifications 1. Generalized Seizures begin in one area of the brain and rapidly spread throughout both hemispheres of the brain (Karch,2008) Patients who have a generalized seizure usually experience a loss of consciousness resulting from this massive electrical activity throughout the brain. They can be convulsive or nonconvulsive

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Atonic Seizures - are associated with a total loss of muscle tone. - They may be mild, with the client briefly nodding the head, or the client may fall to the floor - Consciousness is impaired only briefly

2. Partial Seizures also called focal seizures involve one area of the brain and do not spread throughout the entire organ Types of Partial Seizures a. Simple Partial Seizures - occur in a single area of the brain and may involve a single muscle movement or sensory alteration Complex Partial Seizures - Involve complex sensory changes such as hallucinations, mental distortion, and changes in personality, loss of consciousness, and loss of social inhibitions. - Motor changes include involuntary urination, chewing motions, diarrhea and so on.

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EPILEPSY > a group of syndromes characterized by unprovoked, recurring seizures Status Epilepticus > a state in which a client has continuous seizures or seizures in rapid succession, without regaining unconsciousness, lasting at least 30 minutes. Diagnostic Tests EEG (Electroencephalogram) - This test assists in (1) Locating the focus of abnormal electrical discharges (2) Establishing a diagnosis of epilepsy (3) Identifying the specific type of seizures CT Scan MRI PET SPECT

Types of Generalized Seizures: a. Absence Seizures - formerly known as petit mal seizures - abrupt periods of staring and lapses of awareness lasting a few seconds to a few minutes - Occur commonly in childhood and early adolescence - Tonic-clonic or partial seizures may develop at any time in clients who have had absence seizures Myoclonic Seizures - Involve sudden, uncontrollable, jerking movements of either a single muscle group or multiple groups, sometimes causing the client to fall - The client loses consciousness for a moment and then is confused postically - Often occur in the morning Clonic Seizures - Include rhythmic muscular contraction and relaxation lasting several minutes - Distinct phases of clonic seizures are not easily observed Tonic Seizures - Include an abrupt increase in muscular tone and muscular contraction - There is a loss of consciousness and may last from 30 seconds to several minutes Tonic-clonic Seizures - formerly known as grand mal seizures - they are most closely associated with epilepsy - it may last from 2-5 minutes - sudden loss of consciousness may occur

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Nursing Diagnosis Risk for Injury related to uncontrolled movement and/or loss of airway patency during a seizure Interventions: Seizure precautions should be implemented in all clients with a history of seizures and epilepsy No oral temperatures should be taken, use axillary or rectal routes The bedrails should be padded and up when the client is in bed and the bed is in a low position. Seizure precautions also include inserting an IV needle for medication administration, keeping oxygen with a nasal cannula, and suction equipment

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Risk for Impaired Adjustment related to complex and long-term health management needs

Interventions: 1. 2. Five types of seizure precautions should be discussed with clients and their families: Driving motorized vehicles: Generally no driving is allowed for 6 to 12 months following a seizure. Water precautions: Ensure that the clients are in the presence of an adult lifeguard who can pull them out of the water if needed. Wearing a life jacket in a boat is important. Heights: Clients should not work at heights because they could fall and sustain injuries Fire: Teach clients to cook with other people present and to avoid using the front burners Power tools: Caution with the use of power tools is required.

Ethosuximide Partial Seizures Carbamazepine Lamotrigine

3. 4. 5.

Ineffective Health Maintenance

Interventions: Provide the client with verbal information about how AEDs prevent seizures, the importance of taking prescribed medications regularly, and care during seizures. Consult with the client to plan ways to make taking medication part of daily activities. Help the client to identify factors that precipitate seizures and ways of avoiding these factors.

Management The goals of management of clients with seizures and epilepsy are: To prevent injury to the client during seizures Objects should be moved out of the way so that the client doesnt strike his/her head or extremities Any tight clothing around the persons neck is loosened Put a pillow or folded blanket under the affected persons head, but do not flex the neck sharply or close the airway To eliminate factors that precipitate seizures Eating a balanced diet Restricting excessive caffeine and alcohol intake Sleeping well Avoiding seizure triggers Minimizing emotional stress To diagnose and treat the cause of the seizure Observers descriptions of a seizure can be helpful in making a diagnosis. To control seizures to allow a desired lifestyle Medications are used to control seizures. Currently available antiepileptic drugs appear to act primarily by blocking the initiation or spread of seizures

Tonic-Clonic Seizures: Phenytoin Barbiturates Benzodiazepine Absence Seizures Valproic acid