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define seizure
- an abnormal, sudden, excessive discharge of electrical activity within the brain.
- -may be caused by metabolic disorders, acute ETOH withdraw, electrolyte disturbances (hyperkalemia, water intoxication, hypoglycemia), heart disease (causing brain anoxia) or tumor or a single seizure may occur for no known reason
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define epilepsy
- a chronic disorder characterized by recurrent, unprovoked seizure activity and my be inherited.
- -caused by abnormal electrical activity of neurons, imbalance in neurotransmitters (GABA) or both
-typical triggers: incr. physical activity, excessive fatigue, alcohol or caffeine, some foods or chemicals
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tonic-clonic aka grand-mal
- -a generalized epileptic seizure
- -typically lasts 2-5 min
- -tonic phase: (stiffening or rigidity of the muscles)and immediate loss of consciousness followed by clonic phase (rhythmic jerking of all extremities), you may hear an epileptic cry before start of seizure
- -post ictal fatigue, confusion, and lethargy may last for an hour- safety risk high
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Tonic
- -a generalized epileptic seizure
- -pt stiff
- -abrupt incr. in muscle tone, loss of consciouslness and loss of autonomic signs lasting from 30 sec to several min.
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clonic
- -a generalized epileptic seizure
- -pt. shaking
- -muscle contraction and relaxation lasting several min.
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Abscence, (Petit mal)
- -a generalized epileptic seizure
- -more common in children
- -few sec. of loss of consciousness and blank staring, "daydreaming appearance"
- -often manifested by automatisms- involuntary (often repetative) behaviors such as blinking, staring straight forward
- -pt. returns to baseline immediately after seizure (no post-ictal period)
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Myoclonic
- -a generalized epileptic seizure
- -brief jerking or stiffening of the extremities
- -may occur singly or in groups, may be symmetric or asymmetric lasting just a few sec.
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Atonic (akinetic, "drop attack")
- -a generalized epileptic seizure
- -sudden loss of muscle tone, lasting seconds, followed by post-ictal confusion
- -in most cases this seizure causes pt. to fall
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Partial seizures
- -begin in one part of the cerebral hemisphere, there are 2 classes: complete and simple
- -more diff. to control w/ meds (than general), and seen more commonly in the elderly
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complete partial seizure
- -loss of consciousness for 1-3 min
- -characterized by automatisms
- -may be amnesic afterwards
- -knwon as "psychomotor" or "temoporal lobe" seizures bc of the area of the brain often involved
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simple partial seizure
- -No loss of consciousness
- -client reports aura before seizure
- -during the seizure,may have unilateral movement of an extremity, experinece unusual sensations or have autonomic sx (e.g. change in HR, skin flushing, epigastric discomfort)
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Unclassified seizures (idiopathic)
- -account for 1/2 of all seizure activity!
- -occur for no known reason and do not fit onto the generalized or partial classifications
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Status Epilepticus
- -a medical emergency!-prolonged seizure lasting longer than 5 min, or repeated seizures over the course of 30 min, potential complication for ALL TYPES OF SEIZURES....seizures lasting longer than 10 min can cause death
- common causes of staus epilepticus:-sudden withdrawl from antiepileptic drugs
- -infections
- -acute ETOH or drug withdrawl
- -head trauma
- -cerebral edema
- -metabolic disturbances
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Discuss emergency tx for a seizure
- -911
- -abc's
- -remove objects that might injure pt., loosen clothing if poss
- -don't insert tongue blade!
- -ensure IV access- large bore needle and saline infusion preferred
- -usually Lorzepam (Ativan) or Diazepam (Valium) preferred to treat Status Epilepticus, possible followed by Phenytoin (Dilantin) or Fosphenytoin (Cerebyx)
- -suction PRN, assess for resp. distress, have ET equipment available, collab w/ RT
- -after seizure take VS w/ neuro checks, facilitate rest, document details of seizure
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Anticonvulsant meds (antiepileptic drugs)
-act on motor cortex of brain to reduce the spread of elecrical discharges from the rapidly firing epileptic foci on this area
-teach pt. to not stop meds even if seizures have stopped, to avoid hazardous tasks until the drug has been regulated, w/ Dilantin maintain good OH, get regular labs: liver function, kidney function, CBC and drug levels as indicated
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Vagal Nerve Stimulation
- -like a pacemaker around vagal nerve, pt. feels seizure coming on and activates it w/ a magnet
- -observe for hoarseness (common), cough, dyspnea, neck pain, dysphagia
- -teach pt. to avoid MRI, microwaves, shortwave radios and ultrasound diathermy
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Temporal or Frontal Lobe Resection (Conventional surgery)
- -for quality of life when other tx options exhausted
- -most candidates have complex PARTIAL seizures
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Partial Corpus Collostomy ("split-brain surgery")
- -anterior 2/3 of corpus callosum sectioned to prevent passage of neruonal discharges between hemispheres
- -for tonic-clonic or atonic seizures ehn pt is not a candidate for other surgical procedures
- -s/e: HA, scalp numbness, depression
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Ketogenic diet for children
-ketosis (super high fat diet at all times) improves seizure control for some children
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