Tonic Clonic Seizures

Marco, Carmela Dawn M. BSN II - 3

Tonic Clonic Seizures

Also known as Grand mal Seizure Generalized seizures consisting of four stages:
1.

2.
3. 4.

Prodromal Period Aura Tonic- Clonic Stage Postictal Stage

Not all four stages occur with every seizure

Tonic Clonic Seizures

Four Stages: I. Prodromal Period

1. Prodromal Period

Manifestations:
Drowsiness Dizziness Malaise Lack of coordination Tension

Parents may observe simply that the child is not himself School- Age Children May able to predict from vague preliminary feelings when they are going to have seizure

Four Stages: II. Aura

2. Aura May reflect the portion of the brain in which seizure originates Manifestations:

Smelling unpleasant odors Denotes activity in medial portion of the temporal lobe Seeing flashing lights Suggests occipital area Repeated hallucinations Arise from the temporal lobe Numbness of the an extremity Relates to the opposite parietal lobe

Four Stages: II. Aura

Cheshire- cat grin Relates to the frontal lobe

Young Children

Unable to describe or understand an aura

Expected Actions During Onset:

May scream in fright Run to their parents

Note exactly what symptoms the child experiences during the onset

It may help to localize the involvement of brain portion

Four Stages: III. Tonic Clonic Stage

3. Tonic Clonic Stage

Tonic Stage

It lasts only about 20 seconds

Manifestations:
All muscles of the body contract Child falls on the ground Extremities stiffen Face distorts May experience hypoxia and become cyanotic Due to contraction of respiratory muscles

Four Stages: III. Tonic Clonic Stage

Collection of saliva in the mouth Due to contraction of the throat and prevent swallowing Child might bite the tongue Due to contraction of the jaw Guttural Cry Due to initially contraction of the chest muscle and air pushed through the glottis

Clonic Stage

It usually lasts about 20-30 seconds Manifestations:

Quick, Jerky Motions

Muscles of the body rapidly contract and relax

Four Stages: III. Tonic Clonic Stage

May blow bubbles or foamy saliva Incontinent of stool and urine If the child bite his tongue when his jaw spasmed shut

Presence of blood in the mouth

Four Stages: IV. Postictal Period

4. Postictal Period
The child falls into a sound sleep He will sleep soundly for 1 to 4 hours and will rouse only to painful stimuli When the child awakens, expect:

Severe headache No memory of the occurring seizure

Tonic Clonic Seizures

Seizures may occur at night When the child wake up in the morning expect:

Blood on the pillow

Due to bitten tongue

Bed wet with urine Considered possibility of nocturnal seizures

Persistent Bedwetting

Abnormal EEG patterns

Therapeutic Management:

Daily administration of Anticonvulsant

Valproic Acid (Depakene)

Care should be taken when giving this medication to very young children and clients with liver disorders Due to hepatoxicity for possible adverse reaction

Carbamazepine (Tergetol)

Used to control this type of seizure that have not responded to other anticonvulsant therapy Avoid drinking grapefruit juice May cause toxicity

Therapeutic Management:

Phenobarbital

Inexpensive anticonvulsant that lowers the seizure threshold Drowsiness and Sleepiness
To prevent this type of seizure Non-toxic side effects Painless Hypertrophy of the gums

Phenytoin Sodium (Dilantin)

Unless the gum hypertrophy is extensive, it is not sufficient reason to discontinue the medication.

Prescription of Ketogenic Diet

High in fat and low in protein and carbohydrate To causes an increased level of ketones Decrease tonic- clonic seizure activity

References:

Maternal and Child Health Nursing Volume 2; Adele Pillitteri Pharmacology www.youtube.com