Seizures Flashcards
What is a seizure?
- Sudden abnormal, excessive electrical discharge or neurons in the brain (neurons fire at faster than normal rate)
What do seizures cause?
- Involuntary movements
- Sensory phenomenon
- Emotional expression
- Unusual behavior
What causes a seizure?
- Cause of most is unknown
- Stroke, brain tumors, TBI, cerebral infection
- Hypoxic birth injury, neurodevelopmental disorders, neurodegenerative disease
- Low and very high glucose levels!
- Abnormal serum electrolytes
- Withdrawal
- Dehydration or water intoxication
Extracranial disorders associated with seizures
- HTN
- Heart, lung, liver, kidney disease
- Lupus
- Diabetes
- Septicemia
How are seizures/epilepsy detected?
EEG
- only way to know its a seizure
What is critical for successful surgical intervention?
Locating where the seizure originates/where it is happening in the brain
Two classes of seizures
- Generalized
- Focal
Focal seizures
- Simple
- Complex
Generalized seizures
- Tonic-Clonic
- Absence
- Myoclonic
- Atonic
- Tonic
- Clonic
Seizures may progress through several phases. These phases include:
- Prodromal phase
- Aural phase
- Ictal phase
- Postictal phase
Tonic-Clonic seizures
- Loss of consciousness and falling
- Body stiffens (tonic) with jerking of extremities (Clonic)
- Cyanosis, excess salivation, tongue/cheek biting, incontinence
Postictal phase for tonic-Clonic seizures
- Muscle soreness, fatigue
- May sleep for hours
- No memory of seizure!
- May not feel normal for hours to days
Typical absence seizures
- Usually in children
- Caused by flashing lights and hyperventilation
- Symptom: staring spell “daydreaming”
- Unresponsive when spoken to during seizure
Atypical absence seizures
- Staring spell with eye blinking, jerking lips, repetitive finger movements
- Lasts 30 seconds
- Usually continue into adulthood
Atonic seizure
- Begins suddenly, person falls
- Loss of muscle tone
- Last less than 15 seconds
- Person usually remains conscious
- Risk for head injury!!!
Tonic seizures
- Sudden onset of increased tone in extensor muscles
- Often occur in sleep!
- Affects both sides of body
- Lasts less than 20 seconds
Clonic seizures
- Begin with loss of consciousness and sudden loss of muscle tone
- Followed by rhythmic limb jerking that may or may not be symmetric
- Rare
Focal seizures
- AKA partial or partial focal seizures
- Begin in specific region of cortex in one hemisphere of brain
- Produce manifestations based on function of area of brain involved
- Simple or complex
Simple focal seizures
- Person remains conscious and alert
- Sudden and unexplainable feeling of joy, anger, sadness, or nausea
- May hear, smell, taste, see, or feel things that are not real
Complex focal seizures
- Loss of consciousness or decreased awareness
- Eyes remain open but can’t interact
- Repetitive purposeless actions
- Dont remember activity started before seizure
- Lasts 30 seconds to 20 mins
Psychogenic nonepileptic seizures
- Triggered by emotional events
- EEG doesn’t show seizure
- No vital sign changes
- History of emotional or physical abuse or traumatic event often emerges
Status epilepticus
- Any seizure lasting longer than 5 mins
- Neurologic emergency
- Can occur with any type of seizure
- May result in permanent brain damage or death
What is the most common complication of seizure disorder
- Depression
- Social stigma
- Discrimination
- Driving sanctions
What diagnostic test is used to confirm a seizure?
EEG
Primary drugs for treatment of tonic-clonic and focal onset seizures
- Phenytoin (Dilantin)
- Carbamazepine (Tegretol)
- Valproic acid (Depakote)
How do antiepileptic drugs work?
- Suppression of sodium influx
- Suppression of calcium influx
- Promotion of potassium efflux
- Blockade of receptors for glutamate
-Potentiation of GABA
Phenytoin
- Most widely used traditional AED
- Active against partial and generalized tonic-clonic seizures
- Suppresses seizures without depressing entire CNS
Phenytoin MOA
Causes selective inhibition of sodium channels
Phenytoin A/E
- Effects on CNS (Nystagmus, sedation, ataxia, diplopia, cog. Impairment)
- Gingivial Hyperplasia
- Dermatologic effects (morbilliform measles like rash)
- Effects in pregnancy (teratogen)
- CV effects ( dysrhythmias and hypotension)
What decreases the effects of Phenytoin?
- Oral contraceptives
- Warfarin
- Glucocorticoids
What increases levels of phenytoin?
- Diazepam
- Isoniazid
- Cimetidine
- Alcohol
- Valproic acid
What decreases levels of phenytoin?
- Carbamazepine
- Phenobarbital
- Alcohol
Phenytoin administration
With food
Old AEDs
- Carbamazepine
- Valproic acid
- Phenobarbital
Carbamazepine MOA
- Same as phenytoin but minimal effects on cognitive function
- Used for bipolar disorder and trigeminal neuralgia
Carbamazepine A/E
Bone marrow suppression
Valproic acid
- 1st line drug for all partial & generalized seizures
- Used for bipolar disorder & migraine prevention
Valproic acid A/E
- Hepatotoxicity
-Pancreatitis
Phenobarbital
- One of the oldest AED, effective and inexpensive
- Can cause physical dependence
- Decreases effects of warfarin and birth control
Phenobarbital A/E
Drowsiness, interferes with metabolism of vitamin D & K
Phenobarbital toxicity
- Nystagmus
- Ataxia
Newer AEDs
- Oxcarbazepine
- Lamotrigine
- Gabapentin
- Pregabalin
- Levetiracetam
- Topiramate
Oxcarbazepine mode of action
- Blockade of voltage-sensitive sodium channels
- For management of partial seizures
Oxcarbazepine A/E
- Dizziness
- Drowsiness
- Avoid driving & other hazardous activities
Lamotigine
- Broad spectrum of antiseizure activity
- Bipolar disorder
Lamotrigine MOA
Blocks sodium and calcium channels
Lamotrigine A/E
- Life threatening rash
- Risk for suicide
Gabapentin
- Very well tolerated
- Adjunct therapy for partial seizures
- Common side effects: somnolence, dizzy, ataxia, fatigue, nystagmus, peripheral edema
Pregabalin
- Useful for neuropathic pain, postherpetic neuralgia
- Adjunct therapy for patial seizures
- Can cause life threatening angiodema
Levetiracetam
- Does not interact with other AEDs
- MOA unknown
Topiramate
Broad spectrum antiseizure agent
Lorazepam
- First line management
- Effects last up to 72 hours
- Usual dose 4mg IV at rate of 2 mg/min
Diazepam
- Short duration
- Must be administered repeatedly
- 5-10 mg IV every 5 to 10 mins @ 5 mg/min (don’t exceed 30 mg)
Fosphenytoin
Less irritating
Should you discontinue antiseizure drugs abruptly? Why or why not?
No, this may cause seizures
Epilepsy surgical treatment
- Neurosurgery (best success rate)
- Vagal nerve stimulation
- Laser ablation
- Radiosurgery
- Hemispherectomy for severe cases
How long should patient stay on antiseizure meds after surgery?
2 years or longer
Nursing management
“SEIZURE”
- S : turn patient to SIDE
- E : Ensure safety (rails/pads)
- I : Initiate oxygen therapy
- Z : Zero restraints
- U : Undo tight clothing
- R : Record the seizure
- E : Evaluate post seizure
Prodromal phase
Different for each patient
Intuition/gut feeling
Aural phase
When you actually experience s/s
Ictal phase
Seizure is actively happening
Ictal phase
Seizure is actively happening
