Seizures

Question 1

What is a seizure?

Answer 1

An episode of abnormal motor, sensory, autonomic or psychic activity that results from sudden excessive discharge from cerebral neurons

Question 2

Seizure patho

Answer 2

• caused by abnormal synchronized discharge of many neurons

- every individual has a seizure thereshold

Question 3

Three types of seizures

Answer 3

• generalized onset
• focal onset
• unknown onset

Question 4

Generalized onset seizures

Answer 4

• affect both sides of the brain or groups of cells on both sides of the brain at the same time
• includes tonic-clonic, absence
• always results in a loss of consciousness

Question 5

Focal onset seizures

Answer 5

• start is one area or groups of cells on one side of the brain
• focal onset aware seizure: when a person is awake and aware during a seizure
• focal onset impaired awareness: when a person is confused or their awareness is affected in some way during a focal seizure

Question 6

Etiology if seizures

Answer 6

• cerebrovascular disease
• hypoxemia
• head injury
• HTN
• CNS infection
• metabolic conditions
• brain tumors
• drug or alcohol w/d
• allergies

Question 7

Generalized onset seizures: motor symptoms

Answer 7

• sustained rhythmical jerking (clonic)
• muscles becoming weak or limp (atonic)
• muscles becoming tense or rigid (tonic)
• brief muscle twitching (myoclonus)
• epileptic spasms

Question 8

Generalized onset seizures: non-motor symptoms

Answer 8

• brief twitches (myoclonus)

Question 9

Focal onset seizures: motor symptoms

Answer 9

• jerking (clonic)
• muscles becoming limp or weak (atonic)
• tense or rigid muscles (tonic)
• brief muscle twitching (myoclonus)
• epileptic spasms
• repeating automatic movements

Question 10

Focal onset seizures: non-motor symptoms

Answer 10

• changes in sensation, emotions, thinking or cognition, autonomic functions
• lack of movement

Question 11

Epilepsy

Answer 11

At least two unprovoked seizures occurring more than 24 hours apart

Question 12

Classification of epilepsies

Answer 12

• primary (idiopathic)

- secondary (known cause)

Question 13

Etiology of epilepsy: generalized and focal

Answer 13

• birth trauma
• head injuries
• CVA
• brain tumor
• infectious diseases
• toxicity
• circulatory problems
• fever
• metabolic disorders
• nutritional disorders

Question 14

Common causes of focal epilepsy

Answer 14

• cerebrovascular disease
• primary and metastatic brain tumors
• vascular malformations
• hx of CNS infection
• head injury/TBI
• neurodegenerative dementia

Question 15

Epilepsy in women

Answer 15

• increased seizure activity during menses
• contraceptives and AED
• bone loss
• meds can affect pregnancy

Question 16

Epilepsy in the older adult

Answer 16

• higher incidence
• cerebrovascular disease leading cause
• treatment depends on cause
• AEDs can interact with many different meds
• need education on risk, prevention

Question 17

Initial presentation

Answer 17

• gives a clue as to where the seizure starts
• may be a movement, dizziness, any unpleasant sight, sound, odor or taste
• generally will remain conscious in this early stage but will quickly lose it

Question 18

Generalized seizure manifestations

Answer 18

• epileptic cry
• may become incontinent of urine or feces
• will lose consciousness
• typically will preside in 1-2 mins

Question 19

Focal seizure manifestations

Answer 19

• depends on where seizure is located
• may have alterations in consciousness (black outs, confusion, dejavu, spacing out, feeling of spinning, teeth clenching, etc.)

Question 20

Postictal state

Answer 20

• confusion
• hard to arouse
• drowsy
• headache
• muscle soreness/fatigue
• depression
• embarrassment
• difficulty speaking
• psychosis
• agitation
• thirst

Question 21

Things that can mimic seizures

Answer 21

• syncope
• migraine
• TIA
• psychogenic non-epileptic seizures
• migraines
• panic attack/anxiety
• transient global amnesia
• narcolepsy

Question 22

Meds associated with seizures

Answer 22

• NSAIDs
• opioids
• local anesthetic s
• chemo drugs
• abx
• antiarrhythmics
• beta-blockers
• antipsychotics
• muscle relaxants
• caffeine

Question 23

Electroencephalography

Answer 23

• gold standard for diagnosing seizure
• will help classify type
• abnormalities may continue between seizures
• video recording

Question 24

Other diagnostic tests

Answer 24

• MRI
• CT
• micro-electrodes inserted into brain tissue
• labs

Question 25

Nursing care during seizure

Answer 25

• privacy
• protect head
• loosen restrictive clothing
• remove pillows, raise side rails
• do not put anything in mouth
• suction
• pt on side with head tilted forward
• meds as ordered

Question 26

Nursing assessment during seizure

Answer 26

• aura/precipitating events
• initial movements
• types of movements
• areas of body involved
• size of pupils/if eyes are open
• eyes or head turned to one side?
• incontinence
• duration
• consciousness
• ability to speak
• paralysis?
• sleep after seizure
• cognitive status

Question 27

Care after a seizure

Answer 27

• keep on side to prevent aspiration
• reorient to environment
• pt may be agitated, consider own safety

Question 28

Seizure precautions

Answer 28

• suction set up and working
• bed in low position
• 2-3 side rails
• oral airway at bedside

Question 29

Pt history needed

Answer 29

• prior events
• meds and substance abuse
• past med hx
• family hx
• epilepsy? Known triggers?
• menstruation and pregnancy hx

Question 30

Status epilepticus

Answer 30

• uncontrollable continuous seizure activity for 5 or more minutes
  OR
• 2 or more seizures with little recovery time

Question 31

Treatment of status epilepticus

Answer 31

• neuro exam
• eval of airway and oxygenation
• cardiac monitoring
• IV access
• bloodwork (electrolytes)
• consider using glucome and IV thiamine
• EEG once pt stable

Question 32

Pharmacologic treatment of status epilepticus

Answer 32

• Ativan
• midazolam
• propfol

Question 33

Anti-epileptic drugs (AEDs)

Answer 33

• gabapentin (neurontin)

- clonazepam (klonopin)