What are seizures?
abnormal episodes of motor, sensory, autonomic , or psychic activity resulting from a sudden, abnormal, uncontrolled electrical discharge from cerebral neurons.
What are seizures classified based on?
-type of seizure at onset
-awareness during the seizure
-motor or other symptoms present
each seizure lasts a few seconds or few minutes
what are the classifications of seizures?
-Focal: originates in one hemisphere
-Generalized: occur and engage bilaterally
-Unknown: epilepsy spasms
“provoked” related to acute, reversible condition
Epilepsy etiology and pathophysiology
A chronic disturbance of the nervous system characterized by various types of persistent seizures that are the result pf abnormal electrical activity of the brain.
Epilepsy etiology and pathophysiology cont….
Epilepsy is defined as at least 2 unprovoked seizures occurring more than 24 hours apart.
Causes of seizures…
- Cerebrovascular disease
- Fever (childhood)
- Head injury
- Central nervous system infections
- Metabolic and toxic conditions
- Brain tumor
- Drug and alcohol withdrawal
Partial of focal seizures
involves only 1 hemisphere
what are the two types of partial/focal seizure?
automatisms (behaviors, pt is unaware of such as lip smacking) can cause loss of consciousness, amnesia can occur prior to and after seizure
consciousness is maintained
unusual sensations, sense of deja vu, changes in HR, abnormal flushing, unilateral abnormal extremity movement, pain, or offensive smell
involves both hemisphere (the whole brain)
there is no warning or aura (feeling)
the patient usually quickly loses consciousness and is unconscious for a few seconds up to several minutes.
manifestations depend on the area of the brain where the abnormal firing occurs
Generalized seizures cont….
Divided into motor and nonmotor (absence) seizure
Absence seizures may last only a few seconds
Generalized seizure cont…
Absence seizures may last only few seconds
- Sudden onset, with no aura or warning and no postictal symptoms.
- Tend to to affect children between 5 and 12 years age disappear puberty
- twitching around eyes and mouth
- remains standing or sitting and appears to have had no more than a lapse of attention or a moment of absentmindedness
Begins with stiffening of muscles (tonic) and loss of consciousness.
1-2 min episode of rhythmic jerking (clonic) follows
Cyanosis, bitting of cheek or tongue, and incontience may occur.
Postictal phase (period of confusion and sleepiness after seizure
only last <30 secs (only tonic)
clonic phase lasts several mins
brief jerking or stiffening of extremities
loss of muscle tone loss, may result in fall
What is status epilepticus?
prolonged partial or generalized seizure of 5 mins without recovery between attacks. Medical emergency
Treatment of status epilepticus?
rapid assessment and treatment are needed
IV lorazepam, IM midazolam, or rectal diazepam
Iv meds are preferred, but other routes can be used when IV access is not available.
intubation and respiratory support may be required
2 unprovoked seizures occur more than 24 hours apart
Electrolytes imbalances, infection, or other reversible causes are ruled out
Control or eliminate cause Antiepileptic drugs and patient teaching Keto diet Biofeedback Surgery
Medications for seizure control
Carbamazepine Diazepam Felbamate Fosphenytoin Gabapentin Lacosamide Lamotrigine Levetriracetam
Antiepioleptic Drugs (AEDs)
also known as anticonvulsants
to control or prevent seizures while maintaining a reasonable quality of life
To minimize adverse effects and drug induced toxicity
Mechanism of Action and Drug effect for AEDs
not known (mechanism) effects: reduced nerve ability
first line drug, prototypical drug
adverse effects for Phenytoin?
gingival hyperplasia acne hirsutism dilantin faces (short nose, flat nose, large head and osteoporosis Therapeutic drug levels are 10-20 mcg/mL
Second most prescribed antispileptic drug
Autoinduction of hepatic enzymes
stops seizure before it starts
Adverse Effect for Carbamazepine (Tegretol)
Headache Dizziness Unusual eye movements Visual Changes Behavioral changes Rash Abdominal pain Gi upset Nausea abnormal gait
Drug interactions for Carbamazepine
Azoles diltiazem macrolides SSRIs acetaminophen antidepressants MAOIs antidepressants
Adjunct therapy for partial seizure with and without secondary generalization
contraindication: known drug allergy
Antiseizure medication patient education
take as prescribed
causes some degree of sedation, drowsiness and lethargy
should not sop taking abruptly
Observations to make during a seizure?
Time the seizure began and the time it ended
what patient was doing before seizure
where in the body seizure began, what body part is involved?
which way eyes are moving?
what side head turns toward
whether patient cries out or screams as the seizure begins
lip smacking, chewing, grimacing, tapping or pill rolling
whether movement is bilateral and symmetrical
incontinence of urine or stool
changes in skin color or profuse perspiration
Care for a patient experiencing a seizure
place patient on side lying, maintain airway
place bed in low position with side rails up and padded
NEVER try to pry open mouth or insert something
protect head if on hard surface
Do not try to restrain
supplemental oxygen is near, should be administrated, if possible
Care for a patient experiencing seizure
suction if needed
check oxygen saturation with pulse ox
check glucose lelvel
stay with patient until they are completely conscious.
reassure them once fully conscious
should be allowed to rest
thoroughly document the event in medical record
after patent airway is ensured
Transient Ischemic Attack
TIA brief interruption in blood flow
Seizures may occur anytime in the what? and deprived of what?
Brain and oxygen
seizures can be caused by what?
Brain injury brain tumor fever uremia drug toxicity
Generalized seizures are characterized by what?
Bilateral Synchronous electrical discharges in the brain
Behaviors patients are unaware of such as lip smacking
Manifestations of epilepsy depend on what?
the area of the brain affected
Status epilepticus is dangerous because what?
irreversible brain damage
could lead to death
Focal Seizures affect what?
one hemisphere of the brain, leading to localized symptoms on that part of the brain affected
Seizures are classified based on what?
where it came from in the brain?
During tonic clonic seizure what happens?
lose consciousness and may have incontinence
What is the goal of anticonvulsant therapy?
to control the seizures by using the least amount of the drug with the fewest side effects
When a seizure occurs, what should you as the nurse note (observations)
Time what they were doing prior where in body it begins which way eye moves which way head moves if they cry out or scream incontinence (bowel or urinary)
TIA (Transient ischemic attacks) are warnings that
a stroke may occur and patient should be evaluated by medical personnnel
Who are most at risk for a stroke?
individuals who have hypertension ,a.fib, and diabetes
when you suspect a stroke, you tell patient to do what?
smile, hold arms straight up, repeat what you say, and answer a simple question
slowly ( inside brain) build up overtime
quickly (came from somewhere else)
subarachnoid hemorrhage is a risk for developing what?
patient with leaking cerebral aneurysm often presents with?
embolus causing stoke often arises from the what?
heart in patients who has a.fib
structures that can cause intercerebral hemorrhage are what?
aneurysm and arteriovenous malformation (AV malformation) (congenital)
Subarachnoid hemorrhage often causes what?
Rapid onset of neurologic signs and loss of consciousness
Meningitis is what?
inflammation of the membranes covering the brain and spinal cord
Bacterial Meningitis frequently follows?
upper respiratory infection
Classic signs of meningitis?
nuchal rigidity, persistent headache, and fever (all sudden)
Petechial rash on the chest and extremities accompanies whT?
Meningitis is confirmed by what?
Viral meningitis signs and symptoms?
fever, headache, photophobia and nuchal rigidity (stiff neck)
Nonvector transmitted form of encephalitis is what?
herpes simplex virus type 1
Encephalitis is spread by vectors such as?
mosquitos, and ticks
what are vectors?
living agent that carries and transmit an infectious pathogen to another living organism
substances that seem to play a role in the occurrence of parkinson disease
Primidone is metabolized in what?
the liver to phenobrbital
Primidone most common adverse effect
adverse effect of primidone?
cardiovascular, CNS, GI and dermatologic reactions
first introduced in 1903, were the standard drugs for insomnia and sedation
Barbiturates mechanism of action
Site of action: brainstem
By potentiating the action of GABA, nerve impulses traveling in the cerebral cortex are inhibited
Benzodiazepines: Sedative-Hypnotic types
Long acting: Clonazepam, diazepam, flurazepam
Intermediate acting: Alprazolam, Lorazepam, Temazepam
Short acting: Midazolam, triazolam,
Benzodiazepines Mechanism of action
Depress CNS activity by affecting hypothalamic, thalamic, and limbic systems of the brain
exact mechanism is uncertain
Gamma-aminobutyric acid (GABA)- primary inhibitory neurotransmitter in the brain, acts to inhibit overstimulation
Transient Ischemic Attack
neurologic dysfunction cause by focal brain, spinal cord or retinal ischemia, without acute infarction
Symptoms are like those of a stroke
10% to 15% patients who have a TIA what in 90 days?
how long do symptoms last for a TIA?
last more than 1 hour and completely resolves within 24 hours without residual deficits
during a tia what might the patient feel?
a sudden weakness or numbness on one side of the body, slurring of speech or inability to talk,
Treatment for TIA and diagnosis
(Diagnosis) physical assessment NIH scale within 10 minutes of arrival carotid duplex ultrasound blood tests MRI EEG (Treatment) angioplasty procedure with stent implantation or a carotid endarterectomy diet, lifestyle modification aspirin (platelet aggregation)
what substance play a role in the occurrence of parkinson disease?
what type of deficiency does parkinson disease have?
dopamine causing balance and coordination problems
multiple sclerosis is a disease of the central nervous system and its symptoms are caused by what?
demyelination of the nerve fibers
what are the four types of clinical progression of MS?
relapsing remitting (most common)
amyotrophic lateral sclerosis is?
progressive neuromuscular disease characterized of the gray matter
Guillan Barre syndrome usually follows what?
viral infection, but can occur after flu vaccine
pathologic changes that occur with gullain barre?
demyelination, nerve root compression, edema
when the lower brainstem becomes involved in GBS, what is affected?
GBS is characterized by the appearance of what?