SEIZURES Flashcards
These disorders are characterized by sudden,
uncontrolled electrical disturbances in the brain, leading
to a wide range of symptoms and manifestations
Seizure Disorders
is a sudden, uncontrolled electrical disturbance
in the brain
Seizure
a chronic neurological disorder characterized
by recurrent, unprovoked seizures
Epilepsy
can be brief, lasting only a few
seconds, or prolonged, continuing for several minutes
Seizure
an individual must have experienced at least two
unprovoked seizures occurring more than 24 hours apart,
or one unprovoked seizure with a high risk of recurrence
Epilepsy
Classification of Seizures: Focal Seizures
Simple Focal Seizures
Complex Focal Seizures
also known as partial seizures, originate in one specific area of the brain
Focal seizures
- occur without loss of consciousness
- The person remains aware and can often describe their experience during the seizure
Simple Focal Seizures
- involve impaired awareness or consciousness
- The individual may appear confused, perform repetitive movements, or be unresponsive to their environment
- These seizures can last from 30 seconds to several minutes
Complex Focal Seizures
Classification of Seizures: Generalized Seizures
Tonic-Clonic (Grand Mal) Seizures
Absence (Petit Mal) Seizures
Atonic Seizures
Myoclonic and Clonic Seizures
These seizures involve a loss of consciousness, muscle stiffening (tonic phase), and jerking movements (clonic phase). They are the most recognizable type of generalized seizure and can last several minutes.
Tonic-Clonic (Grand Mal) Seizures
Characterized by brief lapses in awareness, often lasting only a few seconds. The person may appear to be staring into space and be unresponsive during this time.
Absence (Petit Mal) Seizures
Also known as “drop attacks,” these seizures cause a sudden loss of muscle tone, leading to falls. They are typically brief but can result in injury.
Atonic Seizures
involve sudden, brief muscle jerks
Myoclonic seizures
are characterized by repetitive, rhythmic jerking movements
clonic seizures
Pathophysiology of Seizures
Neuronal Hyperexcitability
Synchronization
Propagation
Termination
Seizures begin with abnormal electrical activity in neurons, caused by imbalances in excitatory and inhibitory neurotransmitters or ion channel dysfunction.
Neuronal Hyperexcitability
As the abnormal activity spreads, it recruits neighboring neurons, leading to synchronized firing of large groups of neurons.
Synchronization
The synchronized activity can spread to other brain regions, potentially evolving into a generalized seizure if it crosses both hemispheres.
Propagation
Seizures typically self-terminate due to neuronal exhaustion or activation of inhibitory mechanisms, though some may require intervention.
Termination
Generalized Seizures: Clinical Presentation
Initial Phase
Tonic Phase
Clonic Phase
Postictal State
The onset of a generalized seizure is often sudden and dramatic. The patient may experience an abrupt loss of consciousness, falling to the ground if standing.
Initial Phase
This phase is characterized by muscle rigidity throughout the body. The patient’s arms and legs may extend, and they may arch their back. Breathing may become labored or temporarily cease.
Tonic Phase
Following rigidity, rhythmic jerking movements occur. These convulsions can be violent and may last for several minutes. During this phase, the patient may experience incontinence or bite their tongue.
Clonic Phase
After the seizure subsides, the patient enters a period of confusion, disorientation, and often fatigue. This state can last from minutes to hours.
Postictal State
Advanced Imaging Studies in Seizure Diagnosis
MRI
CT
PET (positron emission tomography)
SPECT (Single-photon emission computed tomography)
Laboratory Tests for Seizure Evaluation
Basic Metabolic Panel
Complete Blood Count
Toxicology Screening
Genetic Testing
Antiepileptic Drugs (AEDs)
Lorazepam
Diazepam
Levetiracetam
Phenytoin
Emergent Medications
Administer IV benzodiazepines like lorazepam or diazepam for immediate seizure control in status epilepticus.
Management of Complications: Hypoxia
Provide supplemental oxygen. Consider intubation for persistent low saturation.
Management of Complications: Hyperthermia
Use cooling blankets or ice packs. Administer antipyretics as needed.
Management of Complications: Metabolic Acidosis
Correct with intravenous bicarbonate. Address underlying causes like hypoperfusion.
Recovery Position
Place patient on left side to maintain clear airway and prevent aspiration.
Head Elevation
Slightly elevate head of bed to reduce intracranial pressure when appropriate.
Comfort Measures
Use pillows to support limbs and maintain comfort during recovery.
Seizure Precautions
- Use padded side rails. Keep bed in low position when occupied.
- Consider helmet for patients with frequent falls. Use as needed.
- Ensure call bell is within reach. Teach patient how to use it.
- Place pillows around patient. Pad hard surfaces in room.
