seizures

• Episode of excessive & abnormal electrical activity of all or part of brain
• Abnormal activity is manifested by disturbances in skeletal motor activity, sensation,behavior, consciousness, autonomic dysfunction of viscera
• From acute febrile state, head injury, infection, metabolic/endocrine disorders, exposure to toxins
• Seizures recurring within min, days, yrs, diagnosis of epilepsy is given

• Initiating factor is unknown
• Metabolic needs, o2 requirements, metabolic by-products, cerebral blood flow increase dramatically
• AS long as cerebral blood flow can meet demands of seizure, brain is protected from cellular exhaustion and destruction
• Partial seizures: begin in one area of the cortex
• Generalized seizures: involve both hemispheres and deeper brain structures

• Limited to 1 hemisphere
• Manifestations- alterations in motor function, sensory signs, autonomic/psychic symptoms

• Originate in temporal lobe
• May be preceded by an aura
• Impaired LOC
• Repetitive nonpurposeful mvmnts noted
• Amnesia is common

Partial seizure that has spread to both hemispheres and deeper structures of brain

• Generalized seizure that lasts 5-30sec
• Sudden, brief cessation of motor activity and a blank stare
• Seizures may be occasional or up to 100/day
• May be accompanied by eyelid fluttering or automatisms
• More common in children than adults

• "Grand mal"
• May be preceded by aura but are often w/o warning
• Starts c loss of consciousness and sharp muscle contractions
• May have bowel/bladder incontinence
• Tonic phase: Breathing ceases and cyanosis develops- 15sec-1min
• Clonic phase: alternating muscle contraction/relaxation in all extremities, hyperventilation, eyes rolled back in head- 60-90sec
• Postictal period: relaxed c quiet breathing, unconcious/unresponsive, confusion and disorientation, head and muscle aches, fatigue, may sleep several hours
• Amnesia of seizure/events just prior to seizure

• Done to confirm diagnosis and determine treatable causes and precipitating factors
• Complete neurological exam
• Electroencephalogram (EEG)
• Computed Tomography (CT) scan
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomographt (PET) scan
• Lumbar puncture c CSF analysis
• Blood studies
• Electrocardiogram

• Pt on bed or recliner in very quiet room
• 16-24 electrodes attached to pt scalp
• Pt must lie still with eyes closed during initial recording
• Rest of test engages pt in activities such as hyperventilation, photic stimulation & sleep
• Test takes 40-60 min, pt closely watched, any mvmnt recorded

• Explain procedure/test not dangerous
• If to be sleep deprived, wake at 2 am
• Avoid CNS depressants or stimulants
• Withhold anticonvulsants only if ordered
• Avoid caffeine on day of test
• Wash hair/no sprays or oils
• Remove hairpins, accessories
• Wash hair p test to remove glue

• With the aid of a computer, pictures are taken in many diff "slices" of the brain
• Accurate, quick, easy, noninvasive, painless, least expensive way to diagnose neurologic problems.

• Assess for allergies to shellfish
• Assess for pre-existing renal disease, diabetic neuropathy, HF, dehydration
• Assess for drugs that interfere c renal perfusion
• Remove hairpins, accessories

• Use magnetic fields to produce images that are better than CT scan.
• Images may be enhanced using gadolinium, a noniodine-based contrast

• NO metal may enter the MRI room
• Contraindicated for pt c pacemakers, implanted pumps/devices and ion-containing metal aneurysm clips
• Contraindicated for confused/combative pts, unstabble VS, continuous life support, or have old tattoos (lead)

Provides info about the function of the brain, specifically glucose and oxygen metabolism and cerebral blood flow.

• Pt is injected c IV deoxyglucose, which is tagged to an isotope. The isotope emits activity in the form of positrons, which are scanned and converted into a color image by a computer. The more active a given part of the brain, the greater the glucose uptake.
• Pt may be asked to perform mental functions to activate diff areas of brain

• Withhold caffeine, alcohol, tobacco for 24 hours prior to test
• NPO 4-12 hrs prior to procedure
• No insulin given prior to test
• Do not give glucose solution AND anything else that alters glucose metabolism
• Insert 2 IV lines
• p procedure increase fluids to flush out radioisotopes

• Med therapy is mainstay of controlling seizure activity
• Then surgery for exicion of tissue involved in seizure activity
• Vagal Nerve Stimulation
• Electrodes surgically implanted into brain
• Partial Corpus Callostomy

• Controls partial seizures
• Device is implanted in L chest wall and electrode is attached to L vagus nerve and then to a generator
• Generator can be activated when experiencing an aura, and stop the seizure

• Close observation/continuous EEG recording to identify area of seizure
• Electrodes are surgically imlanted in brain
• Additional EEG, if vital areas of brain not involved, the area is surgical removed

• Treats tonic-clonic or atonic seizures
• Anterior two thirds of corpus callosom is sectioned, preventing neuronal discharges from passing btwn two hemispheres

• Maintain airway patency
• Reduce risk of injury during seizure
• Document seizure activity promptly & report as appropriate
• Maintain low stimulus environment during recovery