1. 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
  2. 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
  3. 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
  4. 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.
  5. clonic
    • -a generalized epileptic seizure
    • -pt. shaking
    • -muscle contraction and relaxation lasting several min.
  6. 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)
  7. 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.
  8. 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
  9. 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
  10. 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
  11. 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)
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. Temporal or Frontal Lobe Resection (Conventional surgery)
    • -for quality of life when other tx options exhausted
    • -most candidates have complex PARTIAL seizures
  18. 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
  19. Ketogenic diet for children
    -ketosis (super high fat diet at all times) improves seizure control for some children
Card Set
exam 3 seizures, epilepsy