Seizure

• escessive and abnormal discharge of electrical activity of all or part of the brain
• - hypersensitive, hyperactive, unstable neuron activity
• - neurons initiate seizure activity from epileptic focus
• - localized or entire focus

affecs motor function, sensation, autonomic function of organs, behavior, consciousness

• a chronic seizure activity vs. isolated incidences
• - idiopathic
• - secondary to birth injury, hypoxia, trauma, infection, metabolic, endobrine, toxins, tumor

onset usually occurs before age 20

begin in one area of cerebral cortex; symptoms depend on area involved

• has no loss of consciousness, usually in one hemisphere
• usually motor portion of cortex-muscle ctx of contralateral part of body confined to one area

ie. hand, face

simple partial that spreads sequentially to adjacent parts

• consciousness impaired
• automatisms = repetitive, nonpurposeful activity

ie. lip smacking, picking, aimless walking; amnesia

involves both hemispheres, deeper brain structures - thalmus, basal ganglia, upper brain stem

consciousness is always impaired

brief cessation of motor activity with blank stare and unresponsiveness; 5-10 secs

begins with loss of consciousness and sharp tonic muscle contractions --> air forced out of lungs -- falls to opisthotonic posture = rigidity, extension, jaw clenched; incontinence; no breathing - cyanosis; pupils fixed and dilated; lasts 15-60secs

clonic phase follows - alternating contractions and relaxation of muscles in all extremities with hyperventilation; eyes roll back; froths at mouth; 60-90sec

lasts 60-90 secs

unconscious, unresponsive to stimuli, relaxes, breathes easily --> slow waking with confusion, disorientation, sleep, amnesia, injuries from fall

continuous, with short breaks between intense, persistent seizures

CALL 911 d/t hypoxia

administer Diazepam q10"

May need surgery; vagal nerve stimulator

• - Developmental history: pregnancy, childbirth events
• - Medical history: illness, infection, fever, head injury
• - Seizure history: alcohol or drug abuse, warning or aura, observational info about seizures

• - changes in pupil size and eye deviations, fluttering
• - LOC, time to return to pre-seizure status
• - presence of apnea, syanosis, salivation
• - invontinence of bowel, bladder
• - movement and progression of motor activity
• - lip smacking or other automatism
• - tongue or lip biting

• Diagnostics:
• - EEG, XR, CT, LP, ECG
• - EEG Video recording
• - No hairspray, oily products in hair. Light meal within 4hrs *Avoid caffeine, no stimulants 24-48hrs prior
• - may restrict sleep night before

• Labs:
• - CBC, electrolytes, BUN, glucose, syphilis

Ongoing Research

• - Risk for Inefffective airway clearance
• - Risk for injury
• - Fear
• - Ineffective coping
• - Knowledge deficit

• - Protect from injury; loosen clothing
• - Maintain ABC's
• - Neurologic checks; VS
• - Keep on side until responsive
• - Allow to rest

• DO NOT
• - force anything into the mouth
• - restrain

• Document
• - date, time, duration
• - description of activity: tonic, clonic, staring, blinking, automatisms
• - sequence of seziure progression, aura

• If status epilepticus
• - oxygen via mask or nasal
• - establish IV access and begin 0.9% saline
• - administer drugs as ordered: Valium IV repeat q10min
• - monitor VS and cardiac rhythm
• - have suction ready

• - correct misconceptions, fears, myths
• - resources: Epilepsy Foundation of America
• - encourage expression of feelings, positive
• - follow up care
• - laws
• - employment, voc counseling; safety issues
• - medic alert band - type of SA and meds
• - Aura alert
• - medication compliance-exactly as prescribed
• - alcohol, caffeine, stress, lack of sleep, upset
• - triggers for SA
• - safety-med SE's *Dilantin- oral hygiene*

• Anticonvulsants
• - Dilantin/Phenytoin (gingival hyperplasia)
• - Depakote/Valproate
• - Tegretol/Carbamazepine
• - Klonopin/Clonazepam
• - Neurontin/Gabapentin
• - Lamictal/Lamotrigine

Valium, Ativan, Phenobarbital

• Nursing responsibilities
• - VS, LFT's, therapeutic drug levels
• - CNS side effects: sedation, drowsiness, dizziness, confusion; vision and speech changes
• - may need diet rich in Vit D if prolonged therapy
• - IV administration