Seizure Disorders Flashcards
Seizures include what types of abnormal activity? (4)
- Motor
- Sensory
- Autonomic
- Psychic
Describe the physiological process that provokes seizures
Sudden, uncontrolled electrical discharge from cerebral neurons
What acute problems are associated with provoking seizures? (3)
- Hypoglycemia
- Drug / alcohol withdrawal
- Traumatic brain injury
How are seizures classified?
According to the part of the brain involved
Where do focal (partial) seizures occur?
One hemisphere
Where do generalized seizures occur?
Both hemispheres
An unknown classified seizure is due to ______
Epilepsy spasm
A provoked seizure is due to ______
Acute reversible condition
What is the requirement for a seizure to be considered epileptic?
Must be more than one unprovoked seizure - an isolated single seizure does NOT constitute epilepsy
What factors are manifestations of seizures dependent on? (3)
- The area of the brain affected
- The number of neurons excited
- The extent to which activity spreads
Sensory seizure symptoms arise from the ______
Parietal lobe
Motor seizure symptoms arise from the ______
Frontal lobe
Psychomotor seizure symptoms arise from the ______
Temporal lobe
Which gene is responsible for myoclonic epilepsy?
Chromosome 21
1/3 of seizures are ______
Secondary
2/3 of seizures are ______
Idiopathic
What are the causes of seizures? (8)
- Allergies
- Brain tumor
- CNS infections
- CVD
- Fever (childhood)
- Hypertension
- Hypoxemia
- Metabolic conditions
Seizures result in increased ______
Oxygen demand
What pathological factor is most likely responsible for seizures?
Insufficient amounts of GABA (inhibitory neurotransmitter)
What occurs if the body regains homeostasis after a seizure?
No residual damage
Everyone has a ______
Seizure threshold - when exceeded, a seizure may result
What is an epileptogenic focus?
Neurons that initiate a seizure
During a seizure, ______ increase dramatically
Metabolic needs of the brain
What metabolic needs of the brain increase during a seizure? (2)
- Cerebral blood flow
- Glucose and oxygen - needed for ATP
The period prior to a seizure that warns the patient of an impending seizure is called ______
Aura
What is an aura?
An intense taste / odor / sensory hallucination (ex. feeling of spiders crawling on the skin)
The seizure itself is called ______
Ictus
The period following a seizure is called ______
Postictal
What are the types of focal seizures? (2)
- Simple partial seizures
- Complex partial seizures
Partial seizures are ______, meaning they arise from a localized area of the brain
Jacksonian
Describe the characteristics of simple partial seizures (4)
- Consciousness is not affected
- No aura present
- Jacksonian March may occur
- Tremor-like movements start on one side of the body
What is Jacksonian March?
Muscle contraction that spreads centrally involving an entire limb
How long do simple partial seizures last?
30 - 60 seconds
A simple partial seizure may progress to a ______
Tonic-clonic seizure
What are the manifestations of simple partial seizures? (7)
- Tachycardia / tachypnea
- Numbness / tingling
- Visual distortions
- ‘Deja Vu’
- Pallor
- Sweating
- Flushing
Where do complex partial seizures usually originate?
Temporal lobe
Describe the characteristics of complex partial seizures (5)
- Consciousness affected
- Aura present
- Automatisms may occur
- May remain motionless
- Unawareness of what is happening
Describe some examples of automatisms (3)
- Aimless walking
- Picking at clothes
- Lip smacking
Automatisms are ______
Involuntary
What are the manifestations of complex partial seizures? (3)
- Epigastric pain
- Tongue fasciculations
- Excessive emotions - fear, anger, irritability
What are the types of generalized seizures? (6)
- Absence (petit mal)
- Myoclonic
- Clonic
- Tonic
- Tonic-clonic (grand mal)
- Atonic
Describe the characteristics of generalized seizures (3)
- Causes reaction in both sides of the body
- Consciousness always impaired
- The patient may be hard to arouse for hours after
Describe the characteristics of absence seizures (4)
- Sudden cessation of all motor activity
- Blank, unresponsive stare
- Eyelid fluttering
- Automatisms
How long do absence seizures last?
5 - 10 seconds
Absence seizures primarily occur in _______
Children
Describe myoclonic seizures (2)
- Sudden muscle jerking
- Confusion
Myoclonic seizures may be triggered by ______
Fatigue
In what populations are myoclonic seizures most common? (2)
- Children
- Elderly
When do myoclonic seizures usually occur?
In the morning
What is a common concern associated with myoclonic seizures?
Falls
Describe tonic seizures (2)
- Abrupt increase in muscle tone
- Autonomic signs
Describe clonic seizures
Rhythmic muscle contraction / relaxation
______ seizures are most closely associated with epilepsy
Tonic-clonic
_______ seizures account for only 10% of seizures
Tonic-clonic
Describe the pattern of tonic-clonic seizure occurrence (5)
- Aura may / may not be present
- Loss of consciousness
- Tonic phase - 30 - 60 seconds
- Clonic phase - 60 - 90 seconds
- Postictal phase - 30 minutes
How long do tonic-clonic seizures last?
2 - 5 minutes
Describe the tonic phase of a tonic-clonic seizure (6)
- Loud cry / moan
- Entire body becomes rigid
- Pupils fixed / dilated
- Respirations stop
- Cyanosis
- Incontinence
Describe the clonic phase of a tonic-clonic seizure (4)
- Rhythmic muscle contraction / relaxation
- Hyperventilation with excessive salivation - frothing
- Tachycardia
- Eyes roll back
Describe the postictal phase of a tonic-clonic seizure (5)
- Unresponsiveness / sleeping for several hours
- Fatigue
- Headache
- Confusion
- Amnesia
What injuries can be expected after the postictal phase of a tonic-clonic seizure? (2)
- Muscle aches
- Bruising from falls
Describe atonic seizures (3)
- Loss of muscle tone
- Body becomes limp
- Mild head nodding
How long do atonic seizures last?
< 15 seconds
Status epilepticus is often a result of …
Noncompliance with prescribed anticonvulsant medications
Describe status epilepticus
30 minutes of continuous seizure activity without full recovery between attacks
Describe the primary concern associated with status epilepticus / continuous clinical seizures
Vigorous muscle contractions produce a heavy metabolic demand - may interfere with respirations
What are the risks associated with status epilepticus? (5)
- Acidosis
- Hypoxia
- Hypoglycemia
- Hyperthermia
- Exhaustion
Why is status epilepticus considered a life-threatening medical emergency?
Repeated episodes of cerebral edema / hypoxia can lead to irreversible brain death
What are the goals in the medical management of status epilepticus? (2)
- Stop seizure activity
- Ensure cerebral oxygenation
What nursing intervention should occur if a patient with status epilepticus remains unconscious?
Insert an endotracheal tube
What medications may be administered DURING a status epilepticus episode? (3)
- IV D50
- IV diazepam (Valium)
- IV lorazepam (Ativan)
What medication may be administered AFTER a status epilepticus episode to maintain a seizure-free state?
IV phenytoin (Dilantin)
Describe the monitoring associated with status epilepticus (3)
- CBCs
- Electrolytes
- Serum anticonvulsant levels
Describe the nursing interventions associated with status epilepticus (2)
- Establish IV access
- Assist patient to side lying position with suction available - prevent aspiration
What are the goals of diagnostic testing for seizures? (3)
- Determine type of seizure
- Determine frequency / severity
- Determine pre-existing injuries
What diagnostic tests are used in the diagnosis of seizures? (4)
- EEG
- SPECT
- CT / MRI
- Lumbar puncture
What is the function of EEG testing?
Determine the type of seizure
What is the function of SPECT testing?
Identification of epileptogenic zone
What is the function of CT / MRI testing?
Rule out tumor, lesions, infarction, and hemorrhage
What is the function of lumbar puncture testing?
Determine presence of infection (meningitis)
In head to head trials there is …
NO anti-seizure drug more effective than any other
What is the safest / most effective surgery used for complex partial seizures?
Cortical resection of the anterior temporal lobe
What type of alternative therapy is used for seizures?
Vagal nerve stimulation
What are the indications for vagal nerve stimulation? (2)
- Patients who are not surgical candidates
- Patients who do not respond to medication
Describe vagal nerve stimulation
Uses a stimulus to desynchronize uncontrolled electrical brain activity
Describe injury prevention associated with seizures (4)
- ABCs
- Protect head
- Clear the area
- Loosen constrictive clothing
Describe the nursing interventions that are contraindicated for a patient having a seizure (3)
- DO NOT restrain the client
- DO NOT force jaws open
- DO NOT to force objects into mouth - can obstruct airway
Describe nursing assessments after seizures (3)
- Assess for confusion - indication of tonic-clonic seizure
- Assess glucose and oxygen saturation
- Assess for injuries
Describe the risks associated with ineffective airway clearance from a seizure (2)
- Decreased gag reflex
- Pooling of secretions in the throat
In most states, a patient cannot drive for ______ after a seizure episode
6 months - 2 years
Describe home care associated with seizures (3)
- Wear a medic-alert bracelet
- Take showers instead of tub baths
- Do not lock bedroom / bathroom doors
Describe the nursing interventions associated with phenytoin (Dilantin) (3)
- Give IV slowly
- Use a filter
- DO NOT give with D5W
Describe the education associated with phenytoin (Dilantin)
Oral hygiene / dental care - avoid gingival hyperplasia
What are the side effects of phenytoin (Dilantin)? (3)
- Rash
- Gingival hyperplasia
- Urine discoloration
What are the manifestations of phenytoin (Dilantin) toxicity? (4)
- Ataxia
- Nystagmus
- Sedation
- Diplopia
Describe the monitoring associated with carbamazepine (Tegretol)
CBC - agranulocytosis / anemia
What is the primary indication of valium (Diazepam)?
Status epilepticus
What is the therapeutic dosage of valium (Diazepam)?
5 - 10 mg Q 10 - 15 minutes
Administration of valium (Diazepam) can be repeated up to ______
30 mg
Describe the nursing interventions associated with valium (Diazepam) (2)
- Give IV slowly
- DO NOT mix with other drugs
What is the primary concern associated with valium (Diazepam)?
Can cause respiratory depression
What alternative form is valium (Diazepam) available in?
Rectal gel (Diastat)
______ is effective for all generalized seizures
valproic acid (Depakote)
What is the primary side effect associated with valproic acid (Depakote)?
Weight gain
What is the other indication of clonazepam (Klonopin) other than seizures?
Depression
What is the primary indication of lorazepam (Ativan)?
Status epilepticus
What is the other indication of gabapentin (Neurontin) other than seizures?
Neuropathic pain in diabetics
Which medication is used for the treatment of broad-spectrum seizure types?
keppra (Levetiracetam)
What is the primary indication of keppra (Levetiracetam)?
Prevention of seizures after head trauma - short-term use
How long should a patient receive keppra (Levetiracetam)?
7 days - if no seizure activity presents within that time, stop the medication
What is the other indication of topiramate (Topamax) other than seizures?
Prevention of migraines
What are the side effects of topiramate (Topamax)? (2)
- Cognitive impairment
- Kidney stones
pregabalin (Lyrica) is a relative of ______
gabapentin (Neurontin)
