seizure Flashcards
(32 cards)
seizures definition
Unpredictable event involving abnormal activity of the brain cells that often times disturbs consciousness and motor and sensory function.
Uncontrolled electrical discharge of neurons in the brain that interrupts normal function.
Often is a symptom of an underlying condition. May occur spontaneously without a cause or idiopathically as in epilepsy.
idiopathic seizures
¾ can’t find the cause. May have something to do with heredity, environment, and acquired influences. Generally diagnosed before age of 20 yrs.
causes of seizures
idopathic
Withdrawal or overdose of certain drugs.
Hypoxia, poisoning, metabolic disease.
Over 50 yrs old usually cerebrovascular lesion or brain tumor.
Birth injury, congenital defects, trauma.
Noncompliance with anticonvulsant drugs.
pathophysiology of seizures
Seizures are associated with hyperactive neurons. May remain localized as in partial seizures or spread throughout the entire cerebral cortex causing generalized seizures.
Oxygen and nutritive stores are used up at an incredible rate. Body attempts to compensate with an increase in cerebral blood flow.
With serial seizures as in status epilepticus, low glucose levels and low oxygen levels can occur. This can lead to permanent damage to brain cells.
generalized seizures
initial onset is in both hemispheres of the brain. Usually involves a loss of consciousness and bilateral motor activity.
simple partial seizure
begins in focal area of the brain. Symptoms are appropriate to a dysfunction of that area. No loss of consciousness. May be sensory, motor, or automatic type symptoms.
complex partial seizure
Begins in a focal area of the brain but spreads to both hemispheres of the brain. Impairs consciousness.
phases of major tonic-clonic seizure “grand mall”
preictal/aura phase
tonic phase
clonic phase
postictal phase
preictal/ aura phase of tonic clonic seizure
time of uneasiness. Visual or auditory sensations may be felt by the patient. May occur several hours before actual seizure.
tonic phase of tonic clonic seizure
period of loss of consciousness, excessive muscle contraction with initial crying out as air is forced out of lungs via vocal cords. Jaws clamp shut with possible damage to tongue. Apnea for approximately 15 seconds to 1 minute causes cyanosis. Pupils dilate and do not react. Heart rate decreases and there is incontinence of bowel and bladder.
clonic phase of tonic clonic seizure
period of more violent, jerking movement accompanied by forceful rapid and deep respirations. See powerful rhythmic muscle contractions with facial grimacing. There is profuse sweating and salivation. Eyes roll back and heart rate increases. Respirations are loud and irregular. May last up to 5 minutes with movement slowing until all activity stops.
postictal phase of tonic clonic seizure
period of recovery in which muscles are flaccid . Consciousness and normal pupil size returns. Patient is exhausted and may be confused, lethargic and complain of a headache. May sleep for hours. Pupil reaction normal.
absence seizure “petit mall”
May be non-organic brain damage present.
Must be differentiated from day dreaming. May go blank while speaking then continue where they left off.
Sudden onset. May see twitching or rolling of the eyes with brief loss of consciousness.
Can be precipitated by hyperventilation and flashing lights.
atypical absence spell
staring spell
myoclonic seizure
Sudden brief jerking of a muscle group that lasts a few seconds.
Most common in children & elderly. Can be triggered by fatigue.
atonic seizure
Drop attack seizure that involves either a tonic episode or a paroxysmal loss of muscle tone. Consciousness usually returns by the time the person hits the ground.
simple partial seizures
Symptoms correspond to brain lobe involved and action it controls. There is no loss of consciousness.
Temporal- emotional changes seen. Person has intense feelings like fear or bliss.
Frontal- movement of an extremity or changes in speech. May repeat words continually.
Parietal- tingling and feeling of warmth down one side of the body. Arm & leg movement may occur. May report numbness & tingling for a few minutes that goes away.
Occipital- see flashing lights, fireballs, bright colors shooting across half the visual field.
complex partial seizures
Begins in focal area but spreads to both hemispheres of brain. Impairs consciousness and there may be an aura.
Person can’t respond appropriately to commands and won’t remember event.
May see automatisms as in automatic involuntary behaviors such as chewing, lip smacking, undressing in public, eating dog food, laughing uncontrollably.
May progress to generalized seizure with residual neurological deficit postictally. Called Todd’s paralysis with a focal weakness that resolves over time.
complications of seizures
Status Epilepticus
State of continuous seizure activity or a condition where seizures recur in rapid succession without return to consciousness between seizures.
Brain uses more energy and oxygen than can be supplied. Neurons become exhausted and cease to function. Permanent damage may result.
Can also have ventilatory insufficiency, hypoxia, cardiac arrhthymias, hyperthermia and systemic acidosis which may be fatal.
Psychosocial- may have problem coping with stigma and legal sanctions like driving restrictions.
diagnostic studies
Comprehensive description of seizure and patient’s health history.
EEG may or may not show abnormality. Best done within 24 hours of seizure.
CT/MRI done in new onset seizure to r/o lesion.
Cerebral angiography & PET scans sometimes.
Extensive blood work to r/o metabolic disorders.
medical treatment
Anticonvulsants
Surgery to remove epileptic focus
Vagal Nerve Stimulator
Biofeedback
Dilantin ( Phenytoin sodium), Fosphenytoin (Cerebux)
For all types of seizures except absence, myoclonic & atonic. Used for status epilepticus. Can be given po and IV
Monitor for gastric distress, gingival hyperplasia, anemia, ataxia, drowsiness, and nystagmus.
Check CBC, calcium levels and therapeutic levels ( 10-20mcg/ml).
Phenobarbital (Luminal)
For generalized tonic-clonic seizures and partial seizures. Less desirable because of sedation effects. Overdose can be fatal.
Monitor for drowsiness, sleep disturbances, cognitive impairment, ataxia
and depression.
Carbamazepine (Tegretol)
For partial and generalized tonic-clonic seizures.
Monitor for headache, dizziness, diplopia, blurred vision, nausea, vomiting & leukopenia.
Monitor CBC
