Neurological Seizures
description
Transcript of Neurological Seizures
Seizure Disorders
Seizures:Electrical Activity
Abrupt, uncontrolled electrical discharges of cerebral neurons that interrupts normal brain function
May be a symptom of an underlying illness or may be spontaneous
Epilepsy
Group of syndromes characterized by spontaneous reoccurring seizures
When seizures continue to occur for unknown reasons or because of an underlying problem that cannot be corrected, the condition is known as epilepsy.
Classification of Seizures
Generalized Seizures
Partial Seizures
Generalized Seizure
► Affects entire brain► No warning► Loss of
consciousness
Types of Generalized Seizures
Tonic –clonic (grand mal) Loss of consciousness
Fall to ground Tonic- muscles stiffness &
Clonic-extremity jerking Excessive salivation Cheek biting Incontinence may occur
Tonic – muscle stiffness Clonic-muscle contraction
and relaxation (jerking)
Absence seizures – disconnects from the world for a few seconds (staring, glaring)
Myoclonic seizures – involves jerking only for a few seconds
Partial Seizures (Simple or Complex)
Local onsetMay or may not
loose consciousness
Begin in a specific area of brain
May generalize and turn into tonic-clonic seizures
Causes of Seizure Disorder
Idiopathic (unknown)Birth injuryCNS defects or infectionHead traumaBrain tumorsCVA- cerebral vascular diseaseChronic disease Metabolic disorders
PRECIPITATING FACTORS
FatigueDecreased physical
healthAlcohol ingestionEmotional stressFlashing lightsMenstrual cycleHypoglycemia
Sleep deprivationStimulantsWithdrawal Substance abuseHigh FeverElectrolyte
imbalanceHypoxia
Diagnostic Studies
MOST USEFUL diagnostic tool is an accurate and comprehensive description of the seizures and health history
Electroencephalogram (EEG) Not completely reliable
CT/CAT, MRI, PET scansLabs (e.g. electrolytes/drug screen) to
R/O other medical causes
Electroencephalography: EEG
Clinical Manifestations
Determined by the site of the electrical disturbance
May involve Changes in
consciousness Motor Sensory/senses Emotional Combinations
Signs & Symptoms
May have a variety of presentations
Prodrome epileptic cry
Sensory changes Deja vue Aura- Smells, sights,
numbness, tingling, emotional changes
May have motor symptoms
Complications of Seizure
Greatest risk with loss of consciousness
Trauma from fallHead injuryDrowningAuto accident
Phases of Seizure
Pre-ictal-before the seizure May have warning
Ictal-during seizurePostictal-after the seizure
Usually lethargic, sleepy, memory loss
During a Seizure…
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Seizure Management
Monitor seizure activity and time eventMaintain patent airway
Support head or neck Turn patient on side to prevent aspiration
Prevent or minimize injury Do not restrain; stay with client Ease patient to floor Protect head Loosen restrictive clothing Do not place anything in mouth
video
Nursing Interventions: post seizure
Assess VS, LOC (GCS), pupilsMay require O2 or suctioningPatient will usually sleepReorient pt when arousesAllow to restDextrose if hypoglycemicAdminister prescribed meds
Seizure Precautions
Hospital at bedside: Oxygen Suction Oral Airway IV access Bed in low position Side rails up
• Padded side rails controversial
No padded tongue blades
Drug Therapy: Antiepileptic Drugs
Stabilize nerve cell membranesPrevent the spread of epileptic
discharges80% of patients controlled with
medication
Common Medications Phenytoin (Dilantin) Carbamazepine
(Tegretol)Valproic acid (Depakene)Barbiturates -
PhenobarbitalSuccinimides -ZarontinBenzodiazepines –
Valium, AtivanClonazepam –Klonopin
Newer Antiseizure DrugsNeurontinLamictalFelbatolTopamaxCerebyx
EducationMedication Therapeutic drug levels
Drug-drug and food-drug interactions
Stress compliance with medications
Do not stop abruptly
What to do if you miss a dose
Client and Family Education
Care of client during a seizure
When to call 911 Seizure precautions Keep seizure diary Rest; Manage stress Take medications as
prescribed
Status Epilepticus
State of continuous seizure activity Neurological emergency Uses up all brain energy stores May cause permanent brain damage Tonic-clonic Status Epilepticus can
lead to a respiratory or cardiac arrest and death
Emergency Care
Status Epilepticus Establish airway Administer oxygen IV antiseizure drugs
• Lorazepam (Ativan) or Diazepam (Valium): a short-acting benzodiazepine
• Phenytoin (Dilantin) long-acting
Stat labs
Surgical Management
Remove the epileptic focus Prevent spread of epileptic activityInvolves resection of brain tissue/ lobe
Brain Mapping
Video with EEG
Alternative Therapies: Do NOT REPLACE DRUGS
BiofeedbackKetogenic Diet-high fat low carb
Body burns fat instead of glucose for energy
Vagal nerve stimulation Implantation of a device to stimulate the
vagal nerve To abort the seizure
Psychosocial
Social stigmaUnable to driveFear of embarrassmentEffects of medications
Complications of Status Epilepticus
AspirationCerebral hypoxiaMusculoskeletal traumaDeath
Referrals and resources
Refer to community resourcesResources: Epilepsy Foundation Of
America, National Epilepsy League