Seizures Flashcards
Seizures are a
Transient, uncontrolled electrical discharge of neurons in brain, interrupting normal function
- sudden
Causes of seizures
other disorders
febrile = mostly in kids
Metabolic disturbances associated with seizures
acidosis
electrolyte imbalance (NA)
HYPOGLYCEMIA
hypoxia
alcohol or barbiturate withdraw
Dehydration or water intoxication
The chronic version of seizures
epilepsy (NO CURE)
Extracranial disorders associated with seizures
HTN
Heart, lung, liver, and kidney disease
Systemic Lupus Erythematosus
DM
Septicemia (all spetic ptsbc of meds)
Seizure Disorders Causes
Genetic
Idiopathic
structural lesions
brian trauma
tumor in brain
vascular disease
Hx of metastatic brain seizures
Do you hold meals for seizure pts on EEG?
No, causes hypoglycemia
Seizures are not considered epilepsy if they occur bc of
metabolic disturbances
treat underlying cause
Epilepsy
Chronic disease with a continuing predisposition to seizures with consequences
unprovoked and unpredictable
- neuro bio
psychosocial
social (2.2 million Americans
Epilepsy higher in
age
ethnicity
gender
Young children and older adults
AA and socially disadvantaged populations
more in males
Epilepsy is detected by
EEG
brain activity
Epilepsy Patho
abnormal neurons
spontaneous firing
scar tissue (gliosis)
Locating seizure focus is critical for
successful surgical interventions
How do you determine where the seizure originated from?
at least 3 seizures during monitoring in the same spot
to determine the pattern of spread and extent of involvement
If they separate locations, then they will give
medication back and intervention is not surgery
If the seizure is only in one location, then
surgery could work better in the local term
S/S of Epilsepsy
seizures
determined by site of electrical disturbances
2 classes (general and focal)
Focal Seizures are located in
1 area
Generalized seizures are located in
multiple parts of the brain
Focal Seizures types
simple
complex
Generalized Seizures types
Tonic-Clonic
Absence
Myoclonic
Atonic
Tonic
Clonic
Which generalized seizures have probably altered consciousness?
tonic-clonic
absence
Which generalized seizures have brief or possibly altered consciousness?
myoclonic
tonic
clonic
atonic
Prodromal phase
only pt knows about it
behavior changes
Triggers of seizures
anything extreme/excessive (drinking and drug use, bright flashing lights, happiness, enjoyment, anger, staying up all night, stress, extreme exercising (cross-fit, weight-lifting competitions
sepsis
Induce seizures – by stopping meds slowly, sleep deprivation
Aural phase
sensory warning similar each time different between patients
Ictal phase
don’t know when the phase hits unless pt is on an EEG
Postictal phase
already happened and recovery
Tonic-Clonic Phase
LOC and falling
(Tonic)the body stiffens with subsequent jerking of extremities (clonic)
cyanosis, excessive salvation, biting down,a nd incontience
Management of Tonic Clonic seizures
seizure pads,
fall risk,
never leave them alone (regardless of privacy),
SUCTION and to the
SIDE-LAYING(aspiration),
O2,
working IV (not when seizing) check patency
The postictal phase for tonic-clonic is characterized as
muscle soreness
fatigue
sleep for hours
not feel normal for hours to days
no memory of seizures
Tonic and Clonic phases last how long
10-20 sec
30-40 sec
Typical absence seizures
occurs in children
precipitated by flashing lights and hyperventilation
staring spells “daydreaming
- no response or s/s
typical absence seizure can occur how many times a day
100-1000s a day
each less than 10 secs
The longer the seizure =
more brain death
Atypical absence seizures are characterized by
staring spell with eye blinking and chewing
slight responsive
jerking lip mvmt
more than 10 secs
continue into adulthood
Myoclonic seizures
sudden, excessive jerk or twitch of body and extremities
- forceful enough to cause fall
- brief few seconds
-occur in clusters
- altered LOC, CAUSES FALLS
Atonic seizures aka
drop attack
Atonic seizure
involves tonic or paroxysmal loss of muscle tone
Suddenly and person falls
lasts less than 15 secs
remain conscious resume activity immediately
risk for major head injury
Tonic seizure
sudden onset of maintained increased tone in the extensor muscles
- in sleep only few seconds
affect both sides of the body
consciousness is usually preserved
Clonic seizures
begin with LOC and loss of tone suddenly
Rhythmic limb jerking may or may not by symmetric
rare
Focal seizures begin in
a specific region of cortex in one hemisphere and manifests in s/s of brian involved
Simple focal seizures
remains conscious and alert
unusual feelings or sensations
- joy, sad, nausea, anger suddenly
- new senses of things not real
Complex focal seizures
loss of consciousness or alteration in awareness
eyes remain open but no interaction
-strange behaviors
-automatisms: repetitive, purposeless actions
Do not remember an activity started before or continued during seizure
30 secs to 2 mins
tired and confused after
Psychogenic seizures
misdx as epilepsy not false
Hx of abuse or traumatic event
Accurate diagnosis usually requires use of video-EEG monitoring
Psychogenic seizures hx
Hx of abuse or traumatic event
Psychogenic seizures need
counseling
Status epilepticus (SE)
State of continuous seizure activity or condition when seizures recur in rapid succession without return to consciousness between seizures
neurologic emergency
How long does Status epilepticus (SE) last
longer than 2-5 minutes
Status epilepticus (SE) can occur with what type of seizures
any and all types
Status epilepticus (SE) is an emergency. why?
The brain needs more energy due to the prolonged time of the seizure (2-5 mins) and stops functioning = leading to death or permanent brain damage
Why is Status epilepticus (SE) more frequent in infants and the elderly?
comorbidities
Dx assessments for seizures
Hx and Physical (birth to present)
seizure hx
EEG
Drugs for Seizure Disorders
Focal
Carbamazepine
Fosphenytoin
Phenytoin
Valproic acid
Primidone
Phenobarbital
Drugs for Seizure Disorders
Generalized
Carbamazepine
Phenytoin
Phenobarbital
Valproic acid
Levetiracetam
Complications of seizure meds
sedation
mental dull
impaired memory and concentration
reason for fall risk and in beds
Goal of seizure tx
suppress neurons or control with acceptable effects
Reduce seizures to a level that allows the patient to live as normal a life as possible
Balance the desire for complete seizure control with acceptable side effects
How do AED drugs work?
suppress discharge of neurons with a seizure focus
suppress propagation of activity from the focus to the other areas of then brain
AED does what to the body on a chemical level?
suppress of Na, Ca influx
promote K
Block glutamate receptors
Potentiate GABA
What needs to be monitored on Antiepileptic drugs?
plasma drug levels
guide dosage adjustment
adherence
cause loss of seizure control
causes of toxicity
Education of Rx AEDs
importance of adherence (50%)
plasma levels
maintain frequency chart
stop one med at a time if undesired
New AED meds are
less complication
more expensive
Phenytoin (Dilantin)
most widely used traditional
active against partial and generalized tonic-clonic
suppress seizures w/o depressing CNS entirely
selective inhibit of Na channels
Phenytoin (Dilantin) Adverse Effects
Gingival hyperplasia
nystagmus (invol. eye mvmt) sedation, atatxia, diplopia, cog impaired
Measle like rash
Teratogen (need contraceptives)
cardiac dysrhythmias and hypotension
Gingival Hyperplasia
growth of gum tissue
- severe cases of removal of gum tissue
Phenytoin (Dilantin) decreases the effects of
contraceptives (need multiple forms)
warfarin
glucocorticoids
What meds increase Phenytoin (Dilantin) levels?
diazepam
isoniazid
cimetidine
acute alcohols
What meds decrease Phenytoin (Dilantin) levels?
Carbamazepine
phenobarbital
chronic alcohol
Phenytoin needs to be administered with
food
after oral hygiene care
Carbamazepine (Tegretol)
MOA: same as phenytoin but minimal effects on cognitive function
Used for bipolar disorder & trigeminal neuralgia
suppresses sodium influx
Carbamazepine (Tegretol) Adverse effects
bone marrow suppression
attention for infections
Valproic acid (Depakene, Depakote)
1st line drug for all partial & generalized seizures
used for bipolar disorder & migraine prevention
Valproic acid (Depakene, Depakote)
adverse effects
hepatotoxicity
pancreatitis
teratogenic
Phenobarbital
Reduce seizures without causing sedation
Phenobarbital causes
physical dependence
low effect of warfarin and birth control
drowsiness with the metabolism of Vitamin D and K
nystagmus
ataxia
Acute withdraw from Phenobarbital can cause
Status epilepticus
Oxcarbazepine (Trileptal)
newer AED
block voltage-sensitive Na channels
Manage partial seizures
children and adults
Oxcarbazepine (Trileptal)
adverse effects
dizzy
drowsy
avoid driving and other activities
Lamotrigine (lamictal)
blocks Na and Ca channels
-life-threatening rash
-risk for suicide
- risk of seizures
Gabapentin (Neurontin)
usually used for neuropathy, prophylaxis migraine, fibromyalgia, post-men hot flash
very well tolerated
primary or secondary therapy
Gabapentin (Neurontin)
common side effects
somnolence
dizzy
ataxia
faigue
nystagmus
peripheral edema
Pregabalin (Lyrica)
Neuropathic pain and neuralgia
partial seizure combined
Pregabalin (Lyrica)
adverse life-threatening
angioedema
Levetiracetam (Keppra)*****
not interact with other AEDs
unknown MOA
helps with seizures
not bing with neurotransmitters
Topiramate (Topamax)
broad antiseizure
What drugs are given for management of acute and Status Epilepticus
Lorazepam (Ativan)
given during seizure
effects last up to 72 hours
Diazepam (Valium)
short duration
Phenytoin (Dilantin)
Fosphenytoin (Cerebyx) less irritating
Magnesium Sulfate
Epilepsy Therapies
surgical tx (neurosurgery and vagal nerve stimulation)
Nursing Management of Seizures
free from injury
optimal functioning
satisfactory psychosocial functions
educate
rest and not extreme exercise
avoid stress
hx of risk factors
Pt is prescribed phenytoin for epileptic seizures. Which of the following is the priority for pt teaching?
a -Teach pt to adjust the dose according to the presence of s/s
b -Tell pt to take meds with meals
c - Inform the pt about prevention of gingival hyperplasia
d -Teach pt to avoid the abrupt cessation of tx
d -Teach pt to avoid the abrupt cessation of tx
In TX, how long do you need to wait to drive after a seizure?
3 months
