3. INTRODUCTION
• Seizure disorders include disturbance of brain’s
electrical activity periodically, resulting in some
degree of temporary brain dysfunction.
• Our normal brain function requires an orderly ,
organized , co-ordinated discharge of electrical
impulses.
• Electrical impulses enable the brain to communicate
with spinal cord, nerves, and muscles as well as
within itself.
4. DEFINITION
• Seizures are sudden, abnormal electrical discharges
from the brain that result in changes in sensation,
behavior, movements, perception, or consciousness.
• Epilepsy is a chronic disorder of recurrent seizures.
• An isolated , single seizure does not constitute
epilepsy.
5. • An epileptic syndrome consists of recurrent episodes
of one or more of the following manifestations:
– Loss of consciousness.
– Convulsive movements or other motor activity.
– Sensory phenomena .
– Behavioral abnormalities.
6. INCIDENCE
• About 2.5 to 11.9 per 1000 population in different
parts of India have epilepsy.
• India is home to 10 million epileptics, accounting for
one to fifth of global burden.
• The incidence rates are high in during the first year of
life , decline through childhood and and
adolescence, plateau in middle age, and rise sharply
again among the elderly.
• The population with highest prevalence of new-onset
epilepsy is those over the age of 60.
7. ETIOLOGY
• Epilepsy occurs when permanent changes in the
brain cause it to be too excitable or irritable.
• As a result, the brain sends out abnormal signals.
This leads to repeated unpredictable seizures.
• Epilepsy may be due to a medical condition or injury
that affects the brain or the cause may be unknown.
• The common causes for epilepsy include:
– Stroke or TIA.
– Dementia (like Alzheimer’s disease).
8. – Traumatic brain injury.
– Infections including brain abscess, meningitis, encephalitis,
and HIV/AIDS.
– Brain problems that are present at birth (congenital birth
defects).
– Brain injury that occurs during or near birth.
– Metabolism disorders present at birth (phenylketonuria).
– Brain tumor.
– Abnormal blood vessels in brain.
– Other illness that damages or destroys brain tissue.
9. PATHOPHYSIOLOGY
Due to etiological factors
The integrity of the neuronal cell membrane is altered
The cell begins firing with increased frequency & amplitude
When the intensity of the discharges reaches the threshold the
neuronal firing spreads to adjacent neurons
Ultimately resulting in a seizure.
10. • Seizure activity increases cerebral oxygen
consumption and the need for ATP.
• Supplies of oxygen and glucose are rapidly
consumed.
• To meet these demands , cerebral blood flow
increases during a seizure.
• If the seizure is ongoing (as in status epilepticus),
severe hypoxia and lactic acidosis occur and may
result in brain tissue destruction.
11. CLINICAL MANIFESTATIONS
• Epilepsy may be classified according to age of onset,
cause, area of origin, abnormalities on EEG, and
clinical manifestations of seizures.
• According to the International classification of
Epileptic seizures , based on clinical seizure type and
on EEG findings during seizures ( the ictal period) and
between seizures (the interictal period). There are
two major categories:
• PARTIAL SEIZURES: the neurologic abnormality may
be limited to a specific part or focus of brain.
• GENERALIZED SEIZURES: additionally the seizure may
involve the entire cortical surface (cerebral cortex).
13. • Depending on the types, a seizure may progress
through several phases:
– The prodromal phase (with signs or activity which
precede a seizure).
– The aural phase, with a sensory warning (aura is
an unusual sensations of smell / taste/ butterflies
in stomach / feeling of opposite or unfamiliar and
intense feeling).
– The ictal phase (with full seizure).
– The postictal phase (period of recovery after
seizure).
14. 1. Partial seizures (focal origin):
These are most common type of epilepsy.
The first clinical & electroencephalographic changes
indicate initial activation of neurons in one part of
cerebral hemisphere.
1) Simple partial seizures (no impairment of
consciousness) :
It has 4 types that do not impair consciousness.
15. I. Motor manifestations:
– These arise from a focus in motor cortex.
– The resulting seizures occur in part of body innervated
by motor neurons originating in the affected region of
cortex.
– Because the hand and fingers have largest cortical
representations , many focal motor seizures begin with
convulsive movement in the upper extremity.
– Involuntary movements may spread centrally & involve
the entire limb, including one side of face & lower
extremity.
• This progression or spread is known as the ‘’ Jacksonian march’’.
• The client also may exhibit changes in posture or spoken
utterances
16. II. Somato-sensory manifestations:
– If the epileptogenic focus is in the parietal region the
client experiences sensory phenomena such as
numbness & tingling in the affected area.
– If the focus is in the occipital region, the client may
experience bright, flashing lights in the field of vision
opposite the side of focus.
– Likewise the client can have changes in speech or taste
with involvement of the posterior temporal area of
dominant hemisphere.
17. III. Autonomic manifestations:
– Seizures of the autonomic system produce epigastric
sensations, pallor sweating, flushing (being red face),
piloerection/goose flesh (involuntary erection or bristling
of hairs), pupillary dilation, tachycardia, and tachypnea.
IV. Psychic manifestations:
– Seizures arising in the anterior temporal lobe can begin
with psychic manifestations.
– These seizures frequently begin with an aura, a
subjective sensations that helps localize the focus.
18. 2) Complex partial seizures: (impairment of
consciousness):
I. Complex partial seizures with automatisms:
– The most characteristics features of a complex partial
seizures are accompanying automatisms (an action
performed unconsciously or involuntarily.)
– These automatic behaviors include purposeless
repetitive activities such as lip-smacking (expressing
pleasure of taste), chewing , patting a part of the body
(touching someone to tell something), or picking at
clothes while in a dreamy state.
– Inappropriate or antisocial behavior may also occur
during the seizure.
– This unusual behavior may cause the client to be viewed
as psychotic or otherwise mentally disturbed .
19. – However abnormality may be subtle (tough in perceiving)
and detected only by a trained observer.
– This type usually last 2-3 minutes but can last up to 15
minutes.
– The client is usually unaware of any activity during the
seizure and may be confused or drowsy postictally.
– Attempts to restrain (control) the client during a seizure
may induce combative and un-cooperative behavior.
20. II. Partial seizures evolving to secondary generalized
seizures:
– These seizures start from a particular focus , & then the
electrical discharges spread throughout the brain .
– Clinically , the client first shows focal manifestations; for
example : one side of the face moves , and then the
whole body becomes involved .
– Consciousness is lost if the discharges spread throughout
the brain.
21. 2. Generalized Seizures:
These seizures lead to a loss of consciousness .
They can be convulsive or non convulsive.
Generalized seizures involve both hemispheres.
About one third of seizures are generalized.
1) Absence seizures:
These are abrupt periods of staring and lapses of
awareness lasting a few seconds to a few minutes.
22. 2) Myoclonic seizures :
These types involves sudden uncontrolled 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 postictally.
These seizures often occur in morning.
Clients often report that they spill their coffee with
their seizures.
23. 3) Clonic seizures:
The clinical manifestations of clonic seizures include
rhythmic muscular contraction & relaxation lasting
several minutes.
Distinct phases of clonic seizures are not easily
observed.
24. 4) Tonic seizures:
These include an abrupt increase in muscular tone
& muscular contraction.
In addition with tonic seizures there is a loss of
consciousness and the presence of autonomic
manifestations.
Tonic seizures may last from 30 seconds to several
minutes.
25. 5) Generalized tonic clonic seizures: (10%)
Formerly known as ‘’grandmal’’ seizures.
Tonic clonic seizures are the type of seizures most
closely associated with epilepsy.
These seizures typically proceeds as follows:
An aura may or may not be present.
Sudden loss of consciousness may occur.
In tonic phase:
– The entire body becomes rigid.
– If standing or sitting, the client falls (accidently)
to the floor.
26. – A cry may be uttered (expressed).
– Respirations are interrupted temporarily, and the
client may become cyanotic.
– The jaw is fixed and the hands are clenched .
– The eyes may be opened wide; the pupils are
dilated & fixed.
– The tonic phase lasts 30-60 seconds.
– At the end of this phase the client breathes
deeply.
In clonic phase:
– This phase begins next with rhythmic, jerky
contraction and relaxation of all body muscles ,
especially those of extremities.
27. – The client is usually incontinent and may bite the lips ,
tongue , or inside of the mouth.
– Excessive saliva is blown from the mouth, which
creates frothing at lips.
An entire tonic clonic phase seizure may last from 2-5
minutes, after which the client enters the postictal
phase, during which the client relaxes & remains
totally unresponsive for a time.
The client may rouse (awake) briefly & then go into a
postictal sleep lasting 30 minutes to several hours.
This sleep may be followed by general fatigue,
depression , confusion , or headache , all of which
gradually resolve.
28. The client has complete amnesia for the seizure
episode and may feel nauseated, stiff, and sore.
Bruising may occur as the result of falls. Petechial
hemorrhages may develop on the face & chest
due to vasovagal responses (development of
inappropriate cardiac slowing and arteriolar
dilatation).
The tonic clonic seizure vary in frequency from
many times daily to once or twice a year.
Tonic only and clonic only seizure may also occur.
29. 6) Atonic seizures :
These are associated with a total loss of muscle
tone.
They may be mild, with the client briefly nodding
the head (a gesture in which the head is tilted in
alternating up and down arcs ), or the client may fall
to the floor.
Consciousness is impaired only briefly.
30. DIAGNOSTIC EVALUATION
• A complete seizure profile and history taking.
• Physical examination including neurologic
examination & description of seizure activity.
• Major diagnostic tool i.e. EEG
(electroencephalogram). This test assists in:
– Locating the focus of abnormal electrical
discharges, if present.
– Establishing a diagnosis of epilepsy.
– Identifying the specific type of seizures.
• ECG.
31. • CT scan & MRI are used to rule out brain lesions that
can trigger seizures.
• PET (positron emission tomography) & SPECT (single
photon emission computed tomography) may be
helpful to measure cerebral blood in clients
undergoing surgery for epilepsy.
• Lab studies may rule out other causes for the
seizures: RBS, CBC, KFT, LFT, Lumbar puncture, etc.
32. COMPLICATIONS
• Fracture of bone.
• Impair intelligence.
• Unable to get job, driver’s license, life insurance.
• Socially stigmated.
• Reduced quality of life.
• A complication called ‘’sudden unexpected death in
epilepsy’’.
33. MANAGEMENT
MEDICAL MANAGEMENT:
• Goals of management of clients with seizures and
epilepsy are
– To prevent injury during seizures,
– To eliminate factors that precipitate seizure, and
– To control seizures to allow a desired lifestyle.
34. • During the seizures the major goals are :
– To maintain the airway.
– To prevent injury to client.
– To observe the seizure activity.
– To administer appropriate anticonvulsant drugs.
• In a hospital setting, suction equipment should be
readily available.
• The person experiencing a seizure usually requires
protection from the environment.
• Objects should be moved out of the way so that the
client does not strike his/her head or extremities.
35. • Any tight clothing around the person’s neck is
loosened.
• Put a pillow or folded blanket under the affected
person’s head, but not flex the neck sharply or close
the airway.
• Turning the client to his/her side displaces the
tongue and usually opens the airway once the tonic
phase has ceased.
• Do not attempt to open the airway with your fingers.
• A jaw thrust maneuver (head tilt - chin lift) will open
the airway without the potential to harm the client
or the caregiver.
36. • The factors that precipitate seizure should be
eliminated , if possible.
• Eating a balanced diet, restricting excessive cafeine
and alcohol intake, sleeping well, avoiding seizure
triggers ( means initiations ) (ex.- flashing lights), and
minimizing emotional stress may be helpful in
preventing seizures.
• Observer’s descriptions of a seizure can be helpful in
making a diagnosis.
• Instruct the family & unlicensed assistive personnel
to make the following observations:
37. – How long did the seizure last ?
– Where in the body did the seizures begin and how
did it progress?
– Did the client’s eyes or head deviate?
– Were the respirations labored or frothy?
– Was the client incontinent?
– Did the client lose consciousness?
– What were the types of movements and what
body parts moved ?
38. Medications are used to control seizures :
Currently available anti-epileptic drugs appear to act
primarily by blocking the initiation or spread of
seizures.
Ex. Phenytoin ,
Fosphenytoin sodium ,
Carbamazepine,
Valproic acid ,
Lamotrigine.
(these inhibit sodium-dependent action potentials,
blocking the burst and firing of neurons).
39. NURSING MANAGEMENT:
• Assessment.
• Nursing Diagnosis.
– Risk for trauma related to loss of large or small muscle
co-ordination as evidenced by abnormal body spasm.
– Risk for ineffective airway clearance related to
tracheo-bronchial obstruction as evidenced by oral
secretions.
– Low self esteem or situational low self -esteem related
to stigma associated with condition as evidenced by
verbalization about changed lifestyles.
– Knowledge deficient / deficit related to lack of
exposure and unfamiliarity with resources as
evidenced by questions & statement of concerns.
40. • Goals:
– Seizures activity control.
– Complications or injury prevented.
– Disease process or prognosis, therapeutic regimen,
and limitations understood.
– Plan in place to meet needs after discharge.
• Interventions:
Nurse has to set the action priorities:
– Prevent or control seizure activity.
– Protect patient from injury.
– Maintain airway or respiratory function.
– Promote positive self-esteem.
– Provide information about disease process, prognosis,
and treatment needs.
41. REFRENCES
• Black JM, Hawks JH, A textbook of Medical Surgical Nursing , 8th
Edition, 2nd Volume, Published by Saunders Publication, Page No.
1811.
• Chintamani, A textbook of Lewis’s Medical Surgical Nursing :
Assessment & Management of Clinical Problems , Published by
Mosby publication, Page no. 1498.
• Research refrence:
http://journals.lww.com/cancernursingonline/Abstract/2005/07000
/Symptom_Clusters__Concept_Analysis_and_Clinical.5.aspx
• https://nurseslabs.com/4-seizure-disorder-nursing-care-plans/
• https://medlineplus.gov/ency/article/000694.htm
• http://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve-
disorders/seizure-disorders/seizure-disorders
