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Flashcards in Seizures Deck (33):
1

What is a seizure?

An episode of abnormal motor, sensory, autonomic or psychic activity that results from sudden excessive discharge from cerebral neurons

2

Seizure patho

- caused by abnormal synchronized discharge of many neurons
- every individual has a seizure thereshold

3

Three types of seizures

- generalized onset
- focal onset
- unknown onset

4

Generalized onset seizures

- affect both sides of the brain or groups of cells on both sides of the brain at the same time
- includes tonic-clonic, absence
- always results in a loss of consciousness

5

Focal onset seizures

- start is one area or groups of cells on one side of the brain
- focal onset aware seizure: when a person is awake and aware during a seizure
- focal onset impaired awareness: when a person is confused or their awareness is affected in some way during a focal seizure

6

Etiology if seizures

- cerebrovascular disease
- hypoxemia
- head injury
- HTN
- CNS infection
- metabolic conditions
- brain tumors
- drug or alcohol w/d
- allergies

7

Generalized onset seizures: motor symptoms

- sustained rhythmical jerking (clonic)
- muscles becoming weak or limp (atonic)
- muscles becoming tense or rigid (tonic)
- brief muscle twitching (myoclonus)
- epileptic spasms

8

Generalized onset seizures: non-motor symptoms

- brief twitches (myoclonus)

9

Focal onset seizures: motor symptoms

- jerking (clonic)
- muscles becoming limp or weak (atonic)
- tense or rigid muscles (tonic)
- brief muscle twitching (myoclonus)
- epileptic spasms
- repeating automatic movements

10

Focal onset seizures: non-motor symptoms

- changes in sensation, emotions, thinking or cognition, autonomic functions
- lack of movement

11

Epilepsy

At least two unprovoked seizures occurring more than 24 hours apart

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Classification of epilepsies

- primary (idiopathic)
- secondary (known cause)

13

Etiology of epilepsy: generalized and focal

- birth trauma
- head injuries
- CVA
- brain tumor
- infectious diseases
- toxicity
- circulatory problems
- fever
- metabolic disorders
- nutritional disorders

14

Common causes of focal epilepsy

- cerebrovascular disease
- primary and metastatic brain tumors
- vascular malformations
- hx of CNS infection
- head injury/TBI
- neurodegenerative dementia

15

Epilepsy in women

- increased seizure activity during menses
- contraceptives and AED
- bone loss
- meds can affect pregnancy

16

Epilepsy in the older adult

- higher incidence
- cerebrovascular disease leading cause
- treatment depends on cause
- AEDs can interact with many different meds
- need education on risk, prevention

17

Initial presentation

- gives a clue as to where the seizure starts
- may be a movement, dizziness, any unpleasant sight, sound, odor or taste
- generally will remain conscious in this early stage but will quickly lose it

18

Generalized seizure manifestations

- epileptic cry
- may become incontinent of urine or feces
- will lose consciousness
- typically will preside in 1-2 mins

19

Focal seizure manifestations

- depends on where seizure is located
- may have alterations in consciousness (black outs, confusion, dejavu, spacing out, feeling of spinning, teeth clenching, etc.)

20

Postictal state

- confusion
- hard to arouse
- drowsy
- headache
- muscle soreness/fatigue
- depression
- embarrassment
- difficulty speaking
- psychosis
- agitation
- thirst

21

Things that can mimic seizures

- syncope
- migraine
- TIA
- psychogenic non-epileptic seizures
- migraines
- panic attack/anxiety
- transient global amnesia
- narcolepsy

22

Meds associated with seizures

- NSAIDs
- opioids
- local anesthetic s
- chemo drugs
- abx
- antiarrhythmics
- beta-blockers
- antipsychotics
- muscle relaxants
- caffeine

23

Electroencephalography

- gold standard for diagnosing seizure
- will help classify type
- abnormalities may continue between seizures
- video recording

24

Other diagnostic tests

- MRI
- CT
- micro-electrodes inserted into brain tissue
- labs

25

Nursing care during seizure

- privacy
- protect head
- loosen restrictive clothing
- remove pillows, raise side rails
- do not put anything in mouth
- suction
- pt on side with head tilted forward
- meds as ordered

26

Nursing assessment during seizure

- aura/precipitating events
- initial movements
- types of movements
- areas of body involved
- size of pupils/if eyes are open
- eyes or head turned to one side?
- incontinence
- duration
- consciousness
- ability to speak
- paralysis?
- sleep after seizure
- cognitive status

27

Care after a seizure

- keep on side to prevent aspiration
- reorient to environment
- pt may be agitated, consider own safety

28

Seizure precautions

- suction set up and working
- bed in low position
- 2-3 side rails
- oral airway at bedside

29

Pt history needed

- prior events
- meds and substance abuse
- past med hx
- family hx
- epilepsy? Known triggers?
- menstruation and pregnancy hx

30

Status epilepticus

- uncontrollable continuous seizure activity for 5 or more minutes
OR
- 2 or more seizures with little recovery time

31

Treatment of status epilepticus

- neuro exam
- eval of airway and oxygenation
- cardiac monitoring
- IV access
- bloodwork (electrolytes)
- consider using glucome and IV thiamine
- EEG once pt stable

32

Pharmacologic treatment of status epilepticus

- Ativan
- midazolam
- propfol

33

Anti-epileptic drugs (AEDs)

- gabapentin (neurontin)
- clonazepam (klonopin)