Slides For Seizure

Seizure Disorders by: Bryan Mae H Degorio, RN csllfi

Seizure disorders - the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. -some seizures cause uncontrollable shaking and loss of consciousness, but more often, people simply stop moving or become unaware of what is happening. -normal brain function requires an orderly, organized, coordinated discharge of electrical impulses. Electrical impulses enable the brain to communicate with the spinal cord, nerves, and muscles as well as within itself. Seizures may result when the brain's electrical activity is disrupted.

Two basic types of seizures 1. Epileptic (idiopathic) - These seizures have no apparent cause (or trigger) and occur repeatedly. These seizures are called a “seizure disorder” or “epilepsy.” -It often begins at the age of 20 and rarele begin ot the age of 30 2. Nonepileptic (secondary epilepsy) -These seizures are triggered (provoked) by a disorder or another condition that irritates the brain. In children, a fever can trigger a nonepileptic seizure. -Psychogenic nonepileptic seizures -Certain mental disorders can cause symptoms that resemble seizures.

Causes: 1. High fever 2. Brain infections 3. Metabolic disorders 4. Inadequate oxygen supply to the brain 5. Structural damage to the brain 6. Fluid accumulation in the brain (cerebral edema) 7.Prescription drugs

Pathophysiology alteration in the neural cell integrity

increase in firing of electrical impulses (reaching threshold)

Neural firing spread to the adjacent normal neurons

Clinical manifestations 1. AuraAbnormal – smells or tastes Butterflies in the stomach feeling of déjà vu. An intense feeling that a seizure is about to begin

Base on the Classification:

1.Partial Seizures: - Only one side of the brain is affected. Partial seizures may be simple or complex. A. simple partial seizures- abnormal electrical discharges begin a small area of the brain and remain confined to that area. -no loss of consciousness And the most common type of seizure

B. complex partial seizures-abnormal electrical discharges begin in a small area of the temporal lobe or frontal lobe and quickly spread to other nearby areas. -The seizures usually begin with an aura that lasts 1 to 2 minutes. During the aura, people start to lose touch with the surroundings. During the seizure, consciousness is impaired but not completely lost. 2 types of complex seizure 1. complex partial with automatism Stare Chew or smack the lips involuntarily Move the hands, arms, and legs in strange, purposeless ways are

Utter meaningless sounds Not understand what other people saying Resist help

2.Partial seizure evolving into generalized seizure 2.a Grand mal (tonic-clonic) -he most common type of seizure that is associated with epilepsy - tonic phase- characterized by contraction and the body becomes rigid - the client may fall, “cry may be uttered” and it may last for 30-60 seconds -clonic phase- characterized by jerky, rhythmic contraction and relaxation of all body muscles -accompanied by drooling, dyspnea and urinary incotinence - during the post-ictal phase there 1. cessation of of tonic-clonic phase 2. characterized by exhaustion,headache and drowsiness, deep sleep of 1-2 hours and disorientation.

2.b. Absence seizures may be typical (petit mal) or atypical - not preceded by an aura - has little or no tonic-clonic movement - Instead, they have episodes of staring with fluttering eyelids and sometimes twitching facial muscles. -They are completely unaware of their surroundings. These episodes last 10 to 30 seconds. People abruptly stop what they are doing and resume it just as abruptly. 2.c.Febrile seizure - common among children less than 5yo whem temp is rising

2.d. Psychomotor seizure -has a psychomotor component characterized by mental clauding (out of touch with the environment) -aura is present such as hallucination and illusion 2.e. Status epilepticus - is the most serious seizure disorder and a medical emergency because the seizure does not stop. -Status epilepticus is diagnosed when a seizure lasts more than 5 minutes or when people do not completely regain consciousness between seizures. -People have convulsions with intense muscl contractions and cannot breathe adequately. Body temperature increases. Without rapid treatment, the heart and brain can become overtaxed and permanently damaged, sometimes resulting in death.

Diagnostic procedures: 1. Doctors diagnose a seizure disorder when people have at least two unprovoked seizures that occur at different times. 2. Computed tomography (CT) -is usually done promptly to check for bleeding, tumors, and other structural damage to brain t issue (for example, by a stroke). If results are negative, magnetic resonance imaging (MRI) is usually done later. It provides detailed images of abnormalities and can detect most neurologic disorders. 3. Electroencephalography (EEG) can help confirm the diagnosis.

MANAGEMENT: 1. Prevention of injury during seizure a. maintaining a patent airway and observe seizure activity -present of oral airways and suctioning -turning to the side to displace the tongue that results in airway opening -loosen tight clothing -provide safe environment for seizure activity b. do not leave the client alone an do not apply restraints c. do not insert tongue blade during the attack d. pad the side rail.

e. Client education -take the medication on aregular basis -avoid alcohol and have adequate rest -avoid driving, operate machines, swimming until seizure is well controlled 2. Pharmacologic management -use of AED’s (phenytoin, phenobarb and carbamazipine and benzodiazipine)