seizures/epilepsy

• 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

• 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

• -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

• -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.

• -a generalized epileptic seizure
• -pt. shaking
• -muscle contraction and relaxation lasting several min.

• -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)

• -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.

• -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

• -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

• -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

• -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)

• -account for 1/2 of all seizure activity!
• -occur for no known reason and do not fit onto the generalized or partial classifications

• -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

• -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

-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

• -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

• -for quality of life when other tx options exhausted
• -most candidates have complex PARTIAL seizures

• -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

-ketosis (super high fat diet at all times) improves seizure control for some children